1. Conditions causing secondary dysmenorrhea include endometriosis, uterine fibroids, and uterine adenomyosis . 2. Parity, age, and previous uterine abrasion increase the risk of adenomyosis . 3. In adenomyosis , " basal " endometrium penetrates into hyperplastic myometrial fibers. 4. Most cases of adenomyosis are non-symptomatic. 5. In particular, MRI is better able to differentiate adenomyosis from multiple small uterine fibroids. 6. Preterm labour and premature rupture of membranes both occur more frequently in women with adenomyosis . 7. Likewise, they are avoided in order to prevent the onset or aggravation of adenomyosis . 8. Other causes of secondary dysmenorrhea include leiomyoma, adenomyosis , ovarian cysts, and pelvic congestion. 9. Adenomyosis , can be detected with magnetic resonance imaging, which is more sensitive than a sonogram.10. Patients with adenomyosis often present with painful and / or profuse menses ( dysmenorrhea & menorrhagia, respectively ).