Invasion of the endometrium into the myometrium by more than one high-powered view is called adenomyosis. It was previously considered to be an intrinsic endometriosis, but is now considered to be a separate disease. Adenomyosis has become a common gynecologic condition with a high incidence and is therefore receiving a lot of attention. The pathology of adenomyosis is characterized by the invasion of the endometrium and glands into the myometrium. Compared with normal endometrium, the endometrium in the myometrium resembles the basal endometrium, which lacks response to progesterone and is often in proliferative phase. About 20% to 50% of the disease is combined with endometriosis, about 30% is combined with fibroids, and combined pelvic adhesions are also very common. The main symptoms of adenomyosis are dysmenorrhea and menorrhagia, and infertility in a few patients. On examination, the uterus is enlarged, mostly homogeneous and hard, usually not more than 12 weeks in size, otherwise, it may be combined with uterine fibroids. If the uterus is adenomyoma, it can also show asymmetric enlargement. MRI is recognized as the most reliable non-invasive method to diagnose adenomyosis at home and abroad, but because it is expensive, it is only done when other non-invasive diagnostic methods are still not diagnostic and affect the decision of surgical treatment. The gold standard for the diagnosis of adenomyosis remains the pathological diagnosis. Ultrasound is the most commonly used method to assist in the diagnosis of adenomyosis. Vaginal ultrasound is more accurate than abdominal ultrasound, with small cystic echoes within the myometrium being the most specific diagnostic indicator, and the accuracy of vaginal ultrasound in the diagnosis of adenomyosis is even comparable to MRI if not combined with fibroids. On transvaginal color Doppler ultrasound, the ectopic lesion between the uterine walls shows a stellate colored blood flow signal with low flow velocity and very little regular blood flow around the lesion. Transvaginal three-dimensional energy mapping showed thickened and disorganized vessels with smooth, clear walls and a high-velocity, high-resistance arterial spectrum in the uterine lesions, whereas the perfusion of uterine fibroids showed a spherical meshwork structure and a high-velocity, low-resistance arterial spectrum. Although ultrasound diagnosis is easy and non-invasive, it cannot confirm the diagnosis. The sensitivity and specificity of vaginal ultrasonography are 82.7% and 67.1% respectively, while the sensitivity and specificity of puncture biopsy are 44.8% and 95.9% respectively, and the positive prediction rate of both methods are 50% and 81.2% respectively. The specificity of MRI is better than vaginal ultrasound in the diagnosis of adenomyosis, but the diagnostic efficacy is also poor in large uteruses >400 cm3. Hysteroscopy reveals an enlarged uterine cavity, sometimes with abnormal glandular openings, and can exclude endometrial lesions. Laparoscopy reveals a uniformly enlarged uterus with a more pronounced anterior and posterior diameter, a harder uterus, a grayish or dark purple appearance, and sometimes purple nodules protruding from the plasma membrane. When available, multi-point coarse needle aspiration biopsy is performed to confirm the diagnosis. The CA125 level in patients with adenomyosis is significantly higher, with a positivity rate of 80%, while the CA125 positivity rate for uterine fibroids is only 20%, and the CA125 level in patients with adenomyosis is positively correlated with the size of the uterus. 2. Treatment (1) Surgical treatment ① Hysterectomy: It is the main treatment method and the only method proven effective by evidence-based medicine, which can cure dysmenorrhea or/and excessive menstruation, and is suitable for those who are older and have no fertility requirements.? In recent years, the use of negative hysterectomy has been increasing. In simple adenomyosis, the uterus is mostly less than 12 gestational weeks and there is no difficulty in performing negative hysterectomy. Although some studies have shown that slightly more than 10% of the uterus with adenomyosis can involve the cervix, some studies have also shown that adenomyosis is mainly seen in the body of the uterus and rarely in the cervix, and secondary hysterectomy can still be considered as long as all the lower part of the uterus is removed. ② Conservative surgery: the main procedures are excision of adenomyosis lesions, endometrial removal and intervention. There are also laparoscopic uterine artery block and lesion ablation. The number of reports has increased in recent years, but the effectiveness of all these procedures has yet to be confirmed by evidence-based medical studies. 3. Excision of adenomyosis lesions: It is suitable for young patients who require preservation of reproductive function. Uterine adenomyoma can usually be removed, which can significantly improve the symptoms and increase the chance of pregnancy. In limited adenomyosis, most of the lesions can be removed to relieve symptoms. Although the pregnancy rate is lower in diffuse adenomyosis, it still has some therapeutic value. GnRH-a treatment can be used for 3 months before surgery to reduce the size of the lesion and facilitate surgery. Injection of dilute posterior pituitary saline at the surgical site before excision can significantly reduce bleeding and decrease the difficulty of surgery. We generally use a monopolar electric hook and make a transverse pike incision at the most prominent part of the lesion, taking care to preserve the peripheral muscle tissue, followed by suturing the wound in two layers. The lesion excision is done along with uterine nerve removal or uterine artery blockage to try to increase the efficacy. In recent years, there has been experience with 30 cases, mainly patients who had already given birth but required preservation of the uterus, and the resected lesions were weighed between 15-120 g. The postoperative dysmenorrhea was relieved, and the recurrence rate of dysmenorrhea was about 10% at one-year follow-up, but the pain level was still less than before surgery, and the long-term results are still under observation. Recently, Japanese scholars Takeuchi et al. reported the experience of laparoscopic surgery, in which dilute posterior pituitary saline was injected at the surgical site first, and then a transverse H-shaped incision was made at the lesion, which could dig out most of the lesion and not easily penetrate into the uterine cavity, and then the muscle layer encircling the lesion was folded and sutured. 4.Endometrial removal: In recent years, it has been reported that endometrial removal under hysteroscopy is performed to treat adenomyosis, and after the operation, the patient’s menstrual flow is significantly reduced, even amenorrhea, and dysmenorrhea is improved or disappeared, which can be tried for mild adenomyosis with excessive menstruation. The success rate was 92.86%. The patients’ menstruation improved and anemia was cured. 77.8% of the 18 cases with preoperative dysmenorrhea disappeared and 22.2% were relieved after surgery. Similar reports have been made abroad. However, there are reports of emergency hysterectomy for severe adenomyosis with deeper infiltration of the myometrium. Some authors have reported that immediate postoperative placement of an IUD releasing levonorgestrel in the uterine cavity after TCRE significantly increased the rate of amenorrhea at one year after surgery and reduced the rate of reintervention. Decreased menstruation and disappearance of dysmenorrhea have also been reported in patients with adenomyosis who underwent endometrial removal via hot bulb. As this method is simple and safe, it is worthy of further study. 5, interventional therapy: In recent years, a number of authors have reported the treatment of adenomyosis with arterial embolization therapy. After super-selective cannulation of both uterine arteries or both internal iliac arteries with Seldingers technique, embolization with fresh gelatin sponge pellets carrying antibiotics is confirmed by imaging. In patients with adenomyosis treated with TAE using gelatin sponge as an embolic agent, blood flow was sparse in the normal myometrium and sparse or no blood flow in the lesions 7 days after TAE. However, there are still some complications of TAE treatment that have not yet been solved, the long-term efficacy remains to be observed, and the effect on future reproductive function is still unclear, so the clinical application is still not popular, and further experience has to be accumulated. 6.Laparoscopic uterine artery block: Wang CJ et al. in Taiwan reported that 20 patients with symptomatic adenomyosis were treated by laparoscopic uterine artery block, and the uterine volume was reduced by 0.4%-74.0% six months after the operation. The dysmenorrhea was relieved in 12 of the 16 cases, and no further pain medication was needed in 6 cases. However, nine patients developed non-cyclic abdominal pain after surgery, and three of them subsequently underwent hysterectomy. Most of the patients were not satisfied with the surgical results because the pain could not be completely relieved. The efficacy of medication for adenomyosis is only temporary. For young people with fertility requirements, near menopause or those who do not receive surgical treatment, Danazol, endometrium, progesterone or gonadotropin-releasing hormone analogs or agonists can be tried, with the same dosage and precautions as for endometrium. Although dysmenorrhea disappears during pseudo-menopausal drug treatment, it often returns soon after stopping the drug. Treatment with gonadotropin-releasing hormone agonists can also cause the uterus to shrink, the patient to become amenorrheic, and the dysmenorrhea to disappear. In recent years, some authors in China reported that mifepristone was used to treat perimenopausal adenomyosis. Patients took mifepristone orally for 3 months from the 1st to the 3rd day of menstruation, and after treatment, the patient stopped menstruation, the dysmenorrhea disappeared, and the size of the uterus was significantly reduced, with few side effects. We have done animal experiments and found that mifepristone not only significantly blocked the onset of adenomyosis in mice, but also reduced the size of the uterus and adenomyosis lesions and reduced the extent of lesions, which is consistent with the results of pharmacological treatment of adenomyosis in humans. L-18 methandrostenolone hernia can treat perimenopausal adenomyosis, and the rate of relief of dysmenorrhea was 100% after treatment, although the uterus volume was not significantly reduced. It has been reported at home and abroad that the treatment of dysmenorrhea and menorrhagia in perimenopausal adenomyosis with intrauterine device carrying levonorgestrel has some effect. Our individual cases have been observed for more than 3 years after the device. Preliminarily, it seems that the effect of Manuel is better for excessive menstruation and mild to moderate dysmenorrhea, but not effective enough for severe dysmenorrhea, and there are some side effects, and a multicenter prospective study is currently being conducted in Beijing to investigate the exact efficacy of Manuel in the treatment of adenomyosis.