Every day from all over the country a large number of inquiries are focused on endometriosis and adenomyosis, many patients are most concerned about the problem is not to find our doctors to do surgery, but to ask the temple of higher medicine, such as Concordia, there can be no surgery can also cure the disease of the wonders of the trick. I have been in the medical field for almost twenty years, and I have been in and out of the operating room every day since I started practicing, and I have been a small assistant to the resident doctor on the stage pulling the hooks, and I started to be the main assistant for some medium-sized surgeries after I became a chief resident, and I started to do surgeries independently after I became an attending physician and assisted the professors to do some large-scale and complicated obstetrics and gynecology surgeries, and I felt that I had to bear more burdens after I became an associate professor, and I felt that more and more patients were being admitted to the clinic and the trust given to the clinic was also growing. The trust and hope of the patients are also increasing. Every surgeon’s dream is to become a master on the operating table in the future. However, although our surgical equipment is changing rapidly, our surgical techniques are improving, and our surgical skills are improving, surgery as a traumatic treatment, my experience is that the people are ultimately afraid of surgery, and will never operate unless absolutely necessary. Zhang Yu, Department of Gynecology, Peking Union Medical College Hospital, returns to the subject. Adenomyosis is a common benign gynecological disease, about its pathogenesis, that is, why patients have this disease, is not very clear, Peking Union Medical College Hospital Department of Obstetrics and Gynecology by the National Natural Science Foundation Funding Committee of the National Natural Science Foundation of China, conducted a large number of endometriosis and adenomyosis of the uterus of the basic research, the first to put forward in the international onset of endometriosis determinism 3A pathogenic mechanism, won the National Science and Technology Progress Award. I myself have also successfully applied for a grant from the National Natural Science Foundation of China this year, specializing in the pathogenesis of adenomyosis. I hope that through combined clinical-basic research, my small team and I will be able to make some contribution to the pathogenesis of adenomyosis. In clinical work, we usually explain to patients in this way, the normal uterus is like an inverted duck pear, the endometrium is equivalent to the core of the central part of the pear, and the myometrium is surrounded in the core of the outer layer of the pear meat, under normal circumstances, the two live next door to each other, do not infringe on each other, the monthly menstruation is the thickening of the endometrium to shed blood, the female physiological phenomenon of the vagina to the outside of the body. However, if the neighboring endometrium and myometrium are in disarray, the endometrium invades into the myometrium and grows, and over time, adenomyosis is formed. When menstruation, the normal location of the endometrium occurs shedding bleeding, can be successfully discharged through the cervix and vagina, so women are only slightly uncomfortable, no big deal, however, ectopic growth to the myometrium of the endometrial tissue is not so well-behaved, they are the same to be swollen, bleeding, shedding, but there is no place to be dispatched and unblocked, can only be in the uterine myometrium in the chaos, resulting in patients with menstrual pain. The three main symptoms of adenomyosis: pain, infertility and excessive menstrual flow. Pain, mainly manifested in menstrual cramps, and menstrual cramps more years and months, constantly aggravated, at the beginning may just rest a little, take a painkiller can “muddle through”, but usually after a few years, the pain aggravated, seriously affecting the patient’s work and study, unable to hold on to the work, and even affect the sleep, even if increase the dosage of pain medication and the frequency of the labor force of patients are not helpful, seriously affecting the patient’s ability to labor. Even if the dosage and frequency of painkillers are increased, it will not help, seriously affecting the patient’s ability to work and quality of life. Infertility, young married couples living together for one year without any contraceptive measures, in the case of normal sexual life can not conceive that is, infertility, a large part of the patients because of infertility to come to the examination, only to find out that it is suffering from adenomyosis. Excessive menstrual bleeding, patients with excessive menstrual bleeding, large blood clots, long-term chronic blood loss is likely to cause the patient anemia. Treatment, which usually depends on the patient’s age, symptoms, and fertility requirements, is individualized for each patient. Surgery remains the mainstay of treatment, and total hysterectomy is particularly suitable for patients who have severe symptoms, a long history of the disease, are older, and have completed childbearing. Surgery can be done either by traditional open surgery or minimally invasive surgery (laparoscopy), depending on the size of the uterus, the degree of internal adhesions, the presence of other comorbidities, and the surgeon’s personal technical ability. Surgery can also be used for young patients who have not yet given birth, but it is difficult to remove the lesions completely and thoroughly, and it is easy to recur after the surgery. In my personal experience, surgery is more suitable for patients with adenomyomas that have more limited lesions. Medications, at present, no drugs have been developed that can cure the disease, so if patients see small advertisements or secret recipes that can cure the disease, do not blindly follow them. Patients with mild symptoms can take non-steroidal anti-inflammatory drugs (NSAIDs), commonly used such as Fenbid, Futajet, if there are no contraindications to the use of drugs (gastrointestinal ulcerative diseases, serious liver and kidney diseases, platelet aggregation disorders), under the guidance of a doctor for long-term use, are safer and more mature drugs. However, these drugs are ultimately treating the symptoms and difficult to remove the root cause. For women who are not seriously ill and also have contraceptive requirements, they can also take short-acting oral contraceptives for a long period of time under the guidance of a doctor, which on the one hand can control the pain, and on the other hand can reduce the amount of menstruation without anemia. It should be noted that both of these drugs are symptomatic treatments that do not improve fertility and do not help infertile patients. The Mannix Ring was first developed for contraceptive use and is a slow-release system of medication placed in the uterine cavity. In recent years, clinicians have been trying to use it in the treatment of a number of diseases, especially in patients with endometriosis and adenomyosis, and have shown initial success. I also want to give those who are not willing to do surgery, or because there are serious comorbidities are not suitable for surgery to provide a new treatment avenue, before writing this popularization of the article, just searched on Baidu, do not know, a search startled, the Internet on the information about Mannuelle can be said to be all over the place, how to remove the false and save the real read and get information, but also on the vast number of patients is a test. The following is my clinical experience: (1) older, do not intend to have another child, the symptoms are not too serious, increased menstrual flow of patients can consider placing the Man Yue Le ring, the normal use of the ring is five years, if the effect is good, five years after the replacement of a new to continue to use. 2004 January to 2008 October in the hospital to place the Man Yue Le treatment of adenomyosis of the uterus in the middle and severe dysmenorrhea of 83 cases. The study was conducted in the hospital from January 2004 to October 2008 for the treatment of adenomyosis. A retrospective study found that the long-term efficacy of Mannuelle in relieving dysmenorrhea symptoms was significant. Preoperative application of GnRH-a, which can be used in combination as an induction drug before the full effect of Mannitol, improves the efficacy. The results of this research, Concord Hospital has already had a professional article published and submitted to the core journals and magazines, should be published soon, so please look forward to it. 2004 initially received the release of a portion of the patients, because of the efficacy of the treatment, many of the old patients returned to the wards, remove the expiry of the expiry of the ring, and then re-placement of a new Mannuelle ring. So, from my personal clinical experience, it seems that the ring has stood the test of time. (2) Not all patients with adenomyosis are suitable for treatment with this ring, the uterus is too large, the effect will be poorer, I have a patient, in the outside of the hospital on the ring, not see the results, come to see my outpatient clinic, I found that her adenomyosis is very serious, the uterus is as large as 12 weeks of gestation, take a look at the ultrasound, the ring is missing, the analysis of the ring has been dislodged, I don’t know where to go, more than a thousand dollars, it’s a pity. Therefore, this part of the patient’s best surgical treatment, do not avoid medical treatment, if the fear of surgery, you can try to use GnRH-a class of drug treatment, first let the uterus to a certain extent shrink smaller, and then the ring may be more appropriate, but the treatment cost increases, more expensive, about a shot need to range from 1700 to 2000 yuan, every 28 days to play a shot, usually need 3-6 shots, health insurance can be partially reimbursed. (3) It should be emphasized that not all patients are suitable for this ring, about 15% to 40% of patients with adenomyosis also combined with endometriosis, about 50% of patients combined with uterine fibroids, and if combined with huge ovarian chocolate cysts, submucosal uterine fibroids, and endometrial polyps, the treatment should also be taken into account. The most common side effect of the IUD is irregular bleeding, which usually occurs during the first few months after the IUD is inserted and may be due to shedding of the uterine lining as it undergoes metaplasia and atrophy. Other side effects include the formation of follicular cysts on the ovaries, facial thrush, and painful breast swelling. These side effects usually resolve naturally after 3 months of IUD placement. No treatment is foolproof, what is suitable for this patient may not be suitable for another patient, therefore, it is most important for doctors to formulate an individualized treatment plan for each case after seeing the patient. Inappropriate selection of cases and inability to correctly recognize and deal with the side effects of the initial period of IUD release are the main reasons why many patients are unable to continue the band and adhere to the treatment.