Not all patients with adenomyosis are actually in pain, have scary heavy periods, or are even anemic. Some special patients may never know they have adenomyosis because she is not in pain, has no symptoms and looks just like a normal person. Do you find it a little unbelievable and even start to envy and hate …… Adenomyosis, also known as intrinsic endometriosis, is an invasion of the endometrial glands and mesenchyme into the myometrium to form a diffuse or confined lesion. Patients with adenomyosis can be classified as diffuse or limited depending on the extent of endometriosis into the myometrium. Restricted means that only a portion of the endometriosis has invaded the uterine muscle, forming a localized lesion. In diffuse cases, a large number of endometriosis invades into the uterine muscles, just like stars covering the sky, scattered everywhere, with many lesions. How can I tell if adenomyosis is diffuse or limited? This can usually be seen by ultrasound. In the case of limited lesions, the ultrasound report shows that the lesions are generally “35mm x 28mm posterior wall echogenicity. The boundary is unclear”, and some masses may even be misdiagnosed as uterine fibroids. The borders of fibroids are relatively clear and distinct, while the borders of adenomyosis lesions are crossed and unclear. If a patient is examined and there is only one circular lesion with unclear borders on the uterus, this is likely to be a limited adenomyosis lesion, which is also called an adenomyoma. Otherwise, most cases are diffuse adenomyosis. In fact, in clinical practice, adenomyosis tends to be diffuse and truly limited adenomyosis is very rare. Which is more serious, diffuse or restrictive adenomyosis? Although we do encounter limited adenomyosis, it is actually very rare and its incidence is very low. In this type of patient, the uterus is often normal in all other parts of the uterus, with only a small area that is abnormal. The patient himself is often not feeling it and has no symptoms. Patients with limited adenomyosis, if they have symptoms at all, do not present as severely as those with diffuse adenomyosis. The surgical management of limited adenomyosis is relatively simple, as the localized area of the lesion is simply excavated. It can even be resolved without open surgery, using laparoscopy. And some of those with insignificant symptoms do not need to be treated, and even medications can be dispensed with. Diffuse lesions have more severe dysmenorrhea and relatively heavy menstrual flow because they are more widely distributed within the myometrium of the patient and have more lesions, making them relatively more troublesome to handle surgically. We basically perform many adenomyosis surgeries every day, and we always encounter a few of the more difficult ones. For example, if the lesion spreads to complex areas such as the cervix, the surgery must be done with great care. In short, diffuse adenomyosis is more complicated and more difficult to manage.