This chapter addresses relief of abdominal cramping and related symptoms (e.g. pelvic pain, backache) associated with the menstrual cycle. It focuses on analgesic control of dysmenorrhea symptoms, rather than hormonal regulation of the ovulatory cycle. Prostaglandin inhibition by NSAIDs is responsible for their decades of successful use as the mainstay of dysmenorrhea treatment. An RCT in patients undergoing fractional curettage demonstrated the potent analgesic effects of NSAIDs on uterine pain. Due to the need for chronic use, the COX-2 selective NSAIDs are sometimes recommended as a treatment for dysmenorrhea. Data show that valdecoxib, administered in a single dose of 40 mg PO, provides dysmenorrhea pain relief within 30 minutes that lasts for up to 24 hours. The novel analgesic flupirtine is suggested by some to have utility in dysmenorrhea, but this centrally acting agent is not recommended owing to limited evidence and frequent side effects.