Adenomyosis can present with secondary progressive worsening dysmenorrhea, which is stomach pain with menstruation. Most women have pain 2-3 days before and 2-3 days after their period, with about 1 week being the most painful time. There are individual women who have pain 1-2 weeks before their period, and some have pain after their period. This type of dysmenorrhea is most often seen in deep endometriosis, or DIE. there may be endogenous lesions, some of which erode into the intestinal wall or even the peritoneum. The lesions may erode into the nerves of the peritoneum, causing some pain after menstruation as well, but this is less common. Some lesions may even implant in the vaginal wall, as well as the posterior vault, and women may have painful intercourse during sex, but this is less common. Most patients have more pronounced pain about 1 week before and during menstruation, and the pain gets worse, often requiring medication or even injections.