Menstruation is a physiological phenomenon that accompanies every normal woman for a long period of her life, but many women experience endless pain every month, which can be tolerated in mild cases or not even relieved by oral painkillers in severe cases. But is dysmenorrhea really as simple as getting a cold? Medical science divides dysmenorrhea into two categories: primary and secondary. To put it simply, primary dysmenorrhea is not a problem with the uterus itself, and the pain is mostly caused by an increase in “pain hormones” in the body or by psychological factors. Secondary dysmenorrhea is usually caused by a problem with the uterus itself, and one of the most common causes is endometriosis (endometriosis). There are many types of endometriosis, but the most painful type is the deep infiltrative type. If you experience menstrual pain, painful intercourse, painful bowel movements or even periodic blood in the stool, it is time to come to the hospital to rule out the possibility of having deep infiltrative endometriosis. There are few patients with dysmenorrhea, but deep infiltrative endometriosis, as one of the important causes, may not be well known. To prevent you from taking it lightly and delaying treatment, today we will briefly understand this disease. First, we need to understand what endometriosis is. Simply put, when the endometrial tissue grows outside the uterine body, we can call it endometriosis. For the cause of endometriosis, although there are hypotheses such as ectopic implantation theory, body cavity epithelial metaplasia theory and induction theory, there is still no clear conclusion. However, what is clear is that these “bad” endometrium can grow anywhere in the body, and when they grow to a depth of ≥5 mm below the peritoneum, it is called deep infiltrative endometriosis. Deep infiltrative endometriosis usually occurs in the lower or lowest part of the posterior pelvic cavity, where important organs such as the intestines, ureter, and posterior uterine wall are located, and where the endometrium grows will inevitably affect the normal physiological functions of these important organs. The more they grow, the deeper they are, the larger they are and the more numerous they are, the more pain and other related symptoms the patient will experience. What we want to tell you here is that although dysmenorrhea is a typical symptom of endo, there are 25% of patients who do not have significant symptoms. So how do we detect patients who do not have obvious symptoms? Gynecological examination, as a basic tool for gynecologists to understand the condition, plays an indispensable role in our initial diagnosis of the disease. Many patients in outpatient clinics ask why sometimes there is nothing uncomfortable but a routine physical examination, but after the gynecological examination, the doctor still prescribes an ultrasound or even a costly MRI? This is because when doctors do gynecological examination, if they touch the suspected “bad” endometrial tissues and cause pain to the patient, they will usually prescribe ultrasound and MRI to further clarify the diagnosis. It also provides ideas for the next step of treatment plan. In terms of treatment, medication and surgery are the main means of treating endoheterosclerosis, and individualized treatment is emphasized according to the different clinical manifestations of the disease and patient characteristics. Currently, the following conditions are more common: 1. Patients with mild or no symptoms: painkillers are given to relieve menstrual abdominal pain without special treatment. 2. Patients with fertility requirements but with mild symptoms: oral medication. 3.Patients with fertility requirements but with severe symptoms: surgical treatment is required, while preserving the fertility function. 4.Patients with severe symptoms and lesions but no reproductive function: radical surgery is performed. Compared with other types of endografts, deep infiltrative endografts emphasize more on surgical treatment. It is worth noting that oral medication is not curative, although it can relieve pain and symptoms. At the same time, although surgical resection can significantly improve the patient’s symptoms to achieve the treatment purpose, it is also easy to recur after surgery. Therefore, for patients with conservative surgery, incomplete postoperative surgery or postoperative pain relief, a 6-month postoperative medication is also required to prevent recurrence. For patients with fertility requirements, post-operative treatment with assisted reproduction is also required.