Adenomyosis is a poorly understood condition which has been called 'elusive' or 'enigmatic' because of the difficulty in diagnosis, the lack of agreement on definition, and also because of the vague and ill-defined pattern of symptoms which may accompany it. There is little doubt that some women with adenomyosis may experience troublesome, heavy menstrual bleeding, troublesome dysmenorrhoea, and sometimes a tender uterus. However, the frequency and severity with which these symptoms occur, and the proportion of adenomyosis sufferers who are completely asymptomatic, are quite unclear. The common association of adenomyosis with other pelvic pathologies is an additional factor which confuses the understanding of related symptoms. It is clear that there is no specific combination of symptoms caused by adenomyosis, although many of these women will undoubtedly suffer from very heavy menstrual periods. Now that moderate to severe degrees of adenomyosis can be diagnosed preoperatively with a fair degree of reliability by good-quality ultrasound or magnetic resonance imaging (MRI), there is an urgent need for multicentre collaboration to prospectively define symptomatology in a uniform manner, and then correlate this with specific findings on imaging (and compare with later surgical and pathological findings).