Dysmenorrhea is a very common problem affecting women and may be primary or secondary. Pain in dysmenorrhea is mediated by hypersecretion of prostaglandins and uterine hypercontractility. Secondary dysmenorrhea is due to some underlying pathology like endometriosis, adenomyosis. The treatment options include NSAIDS as first line drugs, Oral contraceptives alone or in combination with NSAIDS or progestins. Cases refractory to combined therapy need further evaluation to rule out a secondary cause.