Adenomyosis is a difficult disease to diagnose due to overlapping symptoms with other conditions like fibroids. While historically considered a disease of parous women, it is increasingly being identified in nulliparous women as well. MRI is the gold standard for diagnosis but ultrasound, especially 3D ultrasound of the junctional zone, can also provide clues. Treatment depends on patient goals and includes long acting progestins, long protocol IVF to suppress symptoms during fertility treatment, and in some cases focused ultrasound or uterine sparing surgery. More research is still needed on newer minimally invasive treatments.