Does the fact that the uterus is not large, or even small, mean that adenomyosis is mild and does not need to be treated? We know that a normal uterus is the size of an egg, but with adenomyosis the uterus may be as big as a volleyball! In addition to the common symptoms of adenomyosis, such as dysmenorrhea, heavy menstruation and infertility, the signs are often an enlarged uterus, which is spherically and uniformly enlarged and bulging like a balloon. In our hospital, we have seen patients with adenomyosis, the largest uterus is over 200mm, the belly is like 3 or 4 months pregnant, very striking, and the focal tissue removed after surgery is also very much, so it can be called “full”. In general, adenomyosis patients have a large uterus. For patients with a particularly large uterus, even if they do not have symptoms of pain or are even nearing menopause, we recommend surgery and do not recommend conservative drug treatment because there are some uncertain safety risks for the uterus. So adenomyosis patients with a small uterus are not very lucky? In fact, no, although a large uterus is a common symptom of adenomyosis, the severity of adenomyosis is not directly related to the size of the uterus. The patients with normal uterus and adenomyosis with a small uterus often have the same pain and suffering. One such case happened to be encountered during the last few days of surgery. The patient was 36 years old, from Handan, Hebei Province, and her preoperative uterus was only 44mmx52mmx37mm, a size smaller than many of the patients we see daily for surgery, but the pain she experienced was no less than most, and she had even been advised by her local doctor to have her uterus removed. According to the patient’s self-report, she developed dysmenorrhea with no obvious cause 6 years ago, accompanied by low back pain and anal swelling, and went to the local hospital for ultrasound to find a left ovarian cyst, and then underwent abdominal left ovarian cyst debridement, after which the dysmenorrhea was reduced, but still required intermittent oral diclofenac sodium extended-release tablets for relief. Six months ago, the dysmenorrhea progressively worsened, the pain lasted 2-3 days, the menstrual flow increased 1-fold, there were occasional blood clots, anal cramping and discomfort, she took 3-4 tablets of diclofenac sodium, which was not effective, then she went to the local hospital for examination and found adenomyoma of the uterus and cystic mass in the left adnexal area, then she underwent left ovarian cystectomy, postoperative injection After 3 injections of leuprolide, she had amenorrhea for 3 months. 2 months ago, her menstrual flow increased 2 times with blood clots, and 4-5 oral diclofenac sodium tablets did not relieve the painful menstruation, so the local hospital suggested continuing leuprolide injections and removing the uterus if necessary, which she refused. During the subsequent uterus-preserving surgery, we found after repeated careful exclusion that there was really not much focal tissue either, and the focal tissue that was removed, sparsely, was not strikingly large, but a small uterus and few foci do not indicate that the patient’s condition is mild and painful. To be honest, most patients who can still tolerate the pain of adenomyosis will not consider surgery, and at best choose medication to relieve it. It is a common thought among many people that they can take medication instead of injections, and that they can take injections instead of surgery. However, as a doctor, I still recommend that we do a good job of disease prevention at the same time, early detection, early diagnosis, early treatment, and follow medical advice, do not self-diagnosis, self-medication.