Do people with adenomyosis always have heavy periods? This is not necessarily the case. Although there are many typical clinical manifestations in patients with adenomyosis, most patients do not have all of its clinical symptoms at the same time, but often present with one, two or some of them first. There are many symptoms of adenomyosis, including dysmenorrhea, heavy menstrual flow, enlarged uterus, infertility, anemia, anal swelling, and painful intercourse. The first degree symptom is dysmenorrhea, progressively worse menstrual pain, which is very common and ranks first, with a very large and painful population of symptoms. But even so, there are still some patients with adenomyosis who are very lucky that the dysmenorrhea is not severe, tolerable, or even non-dysmenorrhea, and do not need to take painkillers at all. The second most common symptom is heavy menstrual flow, which cannot be generalized. Although adenomyosis also has a large population with heavy menstrual flow and prolonged periods, there are still some exceptions, not necessarily all patients with adenomyosis, who have this symptom, and some patients with adenomyosis have normal menstrual flow and even cases with low menstrual flow. The normal menstrual size is usually 20-60 ml, if it is more than 80 ml it is called too much, if it is less than 15 ml it is called too little. Even in the same patient with heavy menstruation, the degree of menstrual size is relative, and may not be noticeable in mild cases, while severe cases may have varying degrees of anemia. Most patients with adenomyosis have heavy periods The uterus of patients with uterine adenomyosis tends to increase gradually with the number of menstrual periods. Influenced by various factors such as an enlarged uterus, poor contraction capacity and thickened endometrium, patients with uterine adenomyosis tend to have heavy periods, prolonged periods and in severe cases may become anemic, requiring hemostatic drugs and blood supplements for relief or even blood transfusion therapy. Last Saturday, I met a patient with anemia who came to me for consultation. Her uterus is relatively large, the maximum menstrual line reaches more than 120mm, and she has heavy menstrual flow, long periods that can last for ten days, and her hematocrit is only 60g/l. She is severely anemic! When she talked to me, she spoke with a bit of breathlessness, giving a feeling of vitality. She had wanted to be relieved by leuprolide injections or other blood supplements and asked me if I was okay. At that time, I felt both sympathetic and angry when I listened to her, and I directly suggested her surgery. Because her condition is quite serious, simply replenishing blood is no longer a reasonable response, and the dangers of long-term severe anemia are well known, and in her case, if she has no one around to take care of her, what should she do if she faints for a while? Women, you have to know how to love yourself! In addition to excessive menstruation, some adenomyosis patients may have irregular menstruation and dripping periods, which is a reflection of the correlation between the type of adenomyosis lesion and the clinical symptoms of the patient. Other patients with adenomyosis consult me: “I have been suffering from adenomyosis for 5 or 6 years, but others have heavy menstrual periods, but I have very few, all the time.” In fact, adenomyosis itself usually does not directly cause low menstrual flow, but is usually related to endocrine disorders, such as abnormal secretion of various hormones or non-ovulation; in addition, it may be due to the endometrium itself, such as endometriosis caused by endometrial tuberculosis, or women of childbearing age due to abortion, scraping and other uterine operations that cause endometrial loss and cavity adhesions, which may cause low menstrual flow. Low menstrual flow. Do adenomyosis patients always have heavy menstruation? Some people believe that menstruation is a detoxification function and that a low menstrual flow will affect the elimination of toxins from the body. The main components of menstruation are blood, endometrial debris, inflammatory cells, cervical mucus and shed vaginal epithelial cells, etc. There is no toxin content, so there is no such thing as detoxification. Usually, a menstrual flow of 15ml or more is not too small and there is no need to worry about it.