Dysmenorrhoea, or painful menstruation, is categorized as primary (without pelvic pathology) or secondary (due to conditions like endometriosis, fibroids, or PID). Primary dysmenorrhoea usually presents with a normal pelvic exam, while secondary causes may show abnormalities. Management begins with NSAIDs and hormonal therapies; combined oral contraceptives are first-line for endometriosis-related pain. Non-pharmacologic options like heat therapy, exercise, and dietary supplements have limited evidence. Progestin-only methods are alternatives when estrogen is contraindicated. If symptoms persist after 3–6 months, diagnostic laparoscopy should be considered to identify underlying pathology. Treatment is tailored based on response, tolerability, and patient preference.