Either Mirena or hysterectomy, which is better for irregular periods?

Hi doctor,

I am 29 years old. I have a tilted bicornuate uterus.

My history includes two cesarean sections, PCOS, adenomyosis, dysmenorrhea and amenorrhea. Now, I am suffering from irregular and very painful periods. I am getting heavy clots for three days and bleeding for the next four days. My cycle varies between 23 and 45 days. The pain has been increasing, and the cycle has become more irregular for the past 12 months.

Other symptoms are irritability, night sweats, sore breasts, and feverish days leading up to the period. My current medications are Pristiq, Lithium and Dothep. The plan of treatment was to insert Mirena. However, the attempt failed due to a closed cervix.

I was booked in for Misoprostol (vagina) and attempt Mirenas again. If this does not work, then an open hysterectomy will be considered, as laparoscopy cannot be done due to scarring. Both my mother and maternal grandmother had a hysterectomy before 40 years of age.

Should I seek a second opinion or further testing?

Thank you.