###Human: What can cause heavy menstrual flow with late secretary endometrium? ###Assistant: Hi. Your biopsy report is good. The medicines you are taking are also good. But instead of taking hormones daily I recommend that you put in a hormone-releasing intrauterine device called Mirena. That remains in your uterus without problem. Delivers the hormones where they are actually needed, cutting down the side effects of excessive hormone intake plus you get rid of the daily responsibility of taking your pills. However, as per the ultrasound finding of a bulky uterus, you may have adenomyosis which is causing this abnormal uterine bleeding. Adenomyosis is a condition that affects the wall of your uterus. Unfortunately, it does not respond well to hormonal treatment. Please get an MRI of the pelvis done. If that shows adenomyosis you may still try Mirena but if that is ineffective, you may even need surgery.