What is adenomyosis? When the endometrial glands and mesenchyme invade the myometrium, it is called adenomyosis. It is most common in menstruating women aged 30 to 50 years, and about 15% are combined with endometriosis and about half with fibroids. A small number of adenomyosis lesions grow in a restricted manner to form nodules or masses, called adenomyoma. The following diagram shows the normal endometrial structure: Etiology The etiology is unclear. It is generally believed that adenomyosis is caused by the invasion of the basal endometrium into the myometrium, so multiple pregnancies and births, abortions, chronic endometritis and other damage to the basal layer may be the main reason for the development of adenomyosis. Clinical manifestations 1. More than half of the patients have secondary dysmenorrhea, which is progressively aggravated; 2. excessive menstruation, prolonged menstruation, or irregular bleeding; 3. infertility; 4. enlargement of the uterus, which is mostly homogeneous and spherical in shape, but can also be raised and uneven and hard. Diagnosis Ultrasound and MRI can be used as imaging evidence. Serum CA125 can be elevated in most patients, and combined with symptoms and pelvic examination, a preliminary diagnosis can be made. Of course, pathological examination is still the gold standard for diagnosis! Treatment strategy for those with fertility requirements For diffuse adenomyosis, pharmacological therapy (application of GnRH-a for 3-6 months) is preferred to reduce the size of the uterus followed by spontaneous pregnancy or assisted reproductive techniques; for those who fail to respond to pharmacological treatment, wedge hysterectomy with postoperative GnRH-a pretreatment for 3-6 months is feasible, followed by assisted reproductive techniques for pregnancy. For limited adenomyoma, conservative surgical treatment (lesion excision, laparoscopy is preferred) is feasible. Post-surgery pretreatment with GnRH-a for 3-6 months is followed by assisted reproduction techniques for pregnancy. It is important to note that surgery does not completely excise the lesion, has a high recurrence rate after surgery, and carries the risk of uterine rupture in postoperative pregnancies.