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Introduction A 30-year-old female with a history of severe dysmenorrhea presented with worsening symptoms and was found to have well defined lesion along lateral uterine wall with adenomyotic changes. Aims & Objectives To evaluate and manage a case of severe dysmenorrhea due to ACUM, confirm diagnosis through laparoscopic removal, and analyze histopathological findings to provide symptomatic relief and improve quality of life. Material & Methods The patient had a history of dysmenorrhea for 7?8 years and was previously operated on for a right adnexal mass in 2019. MRI revealed a 4.8?3.9 cm mass along lateral uterine wall with adenomyosis.Likely DDs are subserosal fibroid, adenomyoma Or ACUM. Laparoscopic removal of the mass was performed, followed by histopathological evaluation. General and systemic examinations were normal, with no other significant history. Due to the patient being unmarried, pelvic examination was not performed. Results A small sized uterus with a 5 ? 7 cm accessory cavitary uterine mass, in continuation with main uterus , noncommunicating with cervical canal was removed laparoscopically. Histopathology confirmed the diagnosis of ACUM with adenomyotic changes. The procedure aimed to resolve dysmenorrhea and improve the patient?s quality of life. Conclusions ACUM with adenomyotic changes is a rare but treatable cause of severe dysmenorrhea. Accurate diagnosis through imaging and histopathology, combined with laparoscopic management, provides effective symptom relief and improves patient outcomes. Early detection is essential for timely intervention.