Comparison Between Levonorgestrel-Releasing Intrauterine System and Injectable Hormonal Therapy for Persistent Abnormal Uterine Bleeding Following Tubal Ligation

INTERVENTION: Injectable Hormonal Therapy Levonorgestrel intrauterine system CONDITION: ; Pregnancy and Childbirth ; Urological and Genital Diseases ; Fertility‐female ; Abnormal uterine blleding , fallopian tubal ligation Abnormal uterine blleding , fallopian tubal ligation Fertility‐female Pregnancy and Childbirth Urological and Genital Diseases PRIMARY OUTCOME: Change in menstrual blood loss after treatment, assessed using the Pictorial Blood Loss Assessment Chart (PBAC) scor SECONDARY OUTCOME: Improvement in hemoglobin concentration (g/dL). INCLUSION CRITERIA: Women aged 18–45 years. Previous tubal ligation performed at least 12 months before enrollment. Persistent abnormal uterine bleeding for at least 3 months after tubal ligation. Failure of initial medical treatment. Normal cervical cytology (if applicable). No structural uterine pathology requiring surgery. Willing and able to provide written informed consent.