This is a prospective quasi experimental pre post intervention study conducted in the

Department of Obstetrics and Gynaecology at J R Medical College and Hospital Tindivanam.

After obtaining approval from the Institutional Ethics Committee and written informed consent

from participants eligible women aged 30–45 years with heavy menstrual bleeding will

be recruited from the gynecology outpatient department. Baseline data including detailed

menstrual history PBAC scoring physical and pelvic examination and relevant investigations

 will be collected. A Pap smear and endometrial biopsy will be performed to

rule out malignancy. Transvaginal sonography will be carried out to assess endometrial

thickness and uterine artery Doppler indices the resistance index and pulsatility index

in the arcuate and radial arteries. Color Doppler ultrasound was used to pinpoint the arcuate artery

in the outer myometrial layer and radial arteries extending into the endometrium. A pulsed wave

Doppler, set at a 2 mm sampling size and an insonation angle under 30 degrees. The mean Pulsatility

Index and Resistance Index were automatically calculated from at least three consistent

waveforms. Following the baseline assessment all participants will undergo insertion of a

levonorgestrel releasing  intrauterine system 52 mg releasing 20 mcg per day using asterile no touch technique in the OPD. Participants will be advised to maintain a menstrual diary

to track PBAC scores throughout the study period. Follow-up visits will be conducted at 3

months and 6 months post insertion. At each follow up PBAC scores and hemoglobin levels

will be recorded and  repeat TVS with Doppler will be performed to reassess endometrial

thickness and uterine artery flow indices. Data will be analyzed to assess changes in primary

outcomes the PBAC score and hemoglobin levels and secondary outcomes (endometrial

thickness and Doppler indices  at 3 and 6 months compared to baseline.