Adenomyosis uteri is a very common clinical entity encountered daily, accounting for visits to gynaecology OPD all over the world. It is classically defined as presence of endometrial tissue (including glands) within the myometrium (endometriosis interna). In asymptomatic woman its exact prevalence is unaccounted for , but a significant proportion of the patients may have associated pathologies eg. Uterine leiomyomatosis , endometriosis (externa) , endometrial hyperplasia and polyposis etc. Usually the diagnosis is made retrogradely on histopathological examination of the specimen of hysterectomy. This review aims at evaluating the role of the various imaging modalities eg. Pelvic ultrasonography and MRI in improving the accuracy of pre–operative diagnosis along with the various medical and surgical therapeutic options available.