Adenomyosis (ADS) is an old and common disease that is a benign infiltration of the endometrium into the myometrium, the incidence of which has been increasing in recent years.The hypertrophied and hyperplastic myometrium of patients with ADS surrounds ectopic, non-malignant endometrioid glands and mesenchyme. Compared with fibroids, the most important feature of ADS is that it is not clearly demarcated from the myometrium, which makes it difficult to remove completely in clinical practice.The main symptoms of ADS are pain, increased menstrual flow, and infertility. The traditional treatment, i.e. total hysterectomy, causes multiple problems for young patients in terms of physiology and psychology, reproductive function, pelvic floor anatomy, sexual reflexes, and quality of life. Therefore, clinicians have been exploring the pathogenesis of ADS, which is still unclear, although it is known that pregnancy, uterine injuries, drugs, genetics, and environmental influences are all associated with the development of ADS. The ancient uterus is composed of endometrium and subendometrial myometrium and originates from the Müllerian duct tissue. Exploring the anatomical basis, the ancient uterus is closely related to ADS, i.e., abnormalities of the incumbent endometrium and dysfunction of the subendometrial myometrium are involved in the development of ADS. The endometrial myometrial junction (EMI), also known as the uterine junction zone (JZ), is primarily responsible for nonpregnant uterine contractions. Non-pregnant uterine contraction can discharge menstrual blood, close blood vessels to prevent excessive blood loss, assist in transporting sperm into the fallopian tube on the side of the dominant follicle during ovulation, which can help conception, and allow the fertilized egg to stay in the upper uterine cavity for a short period of time during the period of secretion, which is beneficial to the local acquisition of nutrients and the location of the implantation and thus is closely related to the physiological functions such as menstruation and conception. In ADS, there are abnormal contractions in the EMI region, which are characterized by disorders in the direction, intensity and frequency of contractions. Morphologically, it is manifested by the interruption and irregularity of the EMI zone, and the entry of the in-situ endothelium into the muscular layer. In clinical manifestations, it is characterized by dysmenorrhea, increased menstrual flow, and infertility. Localized high estrogen levels play an important role in the development of ADS. focal estrogen abnormalities in ADS may contribute to the peristaltic disorders of EMI through the contractile system and other molecules. abnormalities in the EMI zone lead to abnormal uterine contractions and thus lead to intrauterine hypertension, which clinically manifests itself as infertility and menstrual cramps, and the intrauterine hypertension in turn further promotes infiltration of the endothelium into the basal layer, which further induces the abnormalities in the EMI, forming a vicious circle. A vicious circle is formed. ADS treatment Young ADS patients are mainly treated with symptomatic treatment for uterine enlargement, menorrhagia, dysmenorrhea and infertility. There are drug and surgical treatments. GnRHa can improve fertility by improving the pelvic and intrauterine environment. Some studies have shown that spontaneous pregnancies have been reported within 24 months after the application of long-acting GnRHa treatment. Meanwhile, GnRHa is significantly better than EMS in improving the symptoms of chronic pelvic pain in ADS, and studies have shown that postoperative use of the drug is more effective than use of the drug alone. Mannitol can also be used in patients with ADS. Compared with GnRHa, Mannitol is superior to GnRHa in terms of hypoestrogenic effect, and both are similar in terms of thinning endometrial lining thickness, while GnRHa has a prominent role in reducing uterine volume. The combination of Mannitol and GnRHa can significantly improve clinical symptoms. The indications for the use of Mannitol should be strictly controlled. Mannitol is not indicated in patients with a uterus larger than 10 weeks’ gestational uterine volume, excessive menstrual flow combined with anemia, irregular bleeding, and significant dysmenorrhea. Surgery mainly includes “complete” adenomyosis resection and “partial” adenomyosis resection, the former is applied to patients with limited foci and clearer boundaries, with better therapeutic effect; the latter is applied to diffuse adenomyosis, which mainly reduces the load of the foci and provides a good basis for the use of medication in the postoperative period. medication to provide a good basis. Surgery can significantly reduce the pain symptoms of patients and improve the pregnancy rate, and its effect is affected by the patient’s age, and the postoperative pregnancy rate of patients under 39 years old is significantly better than that of patients over 40 years old. Laparoscopic uterine vascular block + adenomyosis resection has not been widely used in the clinic yet, which is effective in relieving clinical symptoms, but because it is a destructive surgery, the indications need to be strictly controlled. Adenomyectomy has some disadvantages: the removal of the normal myometrium causes the loss of myometrium, the myometrium volume decreases during pregnancy, which is easy to miscarry and premature labor, the myometrial incision increases the tension, and it is difficult to close, which leads to uterine deformation, and the weak myometrial wall of the incision site is easy to lead to rupture of the uterus in pregnancy, and pelvic adhesion after the operation, which affects the conception. Therefore, patients with fertility requirements should carefully choose whether or not to undergo surgical treatment. In addition to the traditional lesion excision, endometrial resection is also currently used in clinical application. However, the recurrence rate of this surgical procedure is high, more patients need medication intervention after surgery, and the poor surgical outcome may be due to the oversized uterus, therefore, uterus larger than 8 weeks of gestation is not suitable for this type of treatment. In addition uterine artery embolization (UAE) is effective in relieving dysmenorrhea, reducing menstrual flow, and reducing uterine size, but the remaining effects are controversial. Also permanent embolization agents affect ovarian function, endometrium and thus pregnancy outcome. Focused ultrasound ablation of adenomyosis foci has no effect on the surrounding normal basement tissues and ovarian function, and there have been case reports of postoperative pregnancies, but a large number of clinical studies and evidence-based medicine are needed to support this, and the indications need to be strictly controlled.