Common causes of secondary dysmenorrhea include Endometriosis (the most common cause) Uterine adenomyosis Fibroids Less common causes include congenital malformations (eg, bicornuate uterus, subseptate uterus, transverse vaginal septum), ovarian cysts and tumors, pelvic inflammatory disease, pelvic congestion, intrauterine adhesions, and intrauterine devices (IUDs), particularly copper IUDs.