Dysmenorrhea is classified as primary and secondary. A complete and detailed medical history, age of onset, evolution of the disease, nature of pain, and concomitant symptoms can help in the differential diagnosis. The absence of positive signs in gynecological examination is the key to diagnose primary dysmenorrhea, but secondary dysmenorrhea may have no positive signs in the early stage of the lesion. Ultrasound, hysterosalpingography, hysteroscopy can understand the situation of uterus and adnexa; laparoscopy can directly see the lesions in the pelvis, and biopsy can be performed. Primary dysmenorrhea Dysmenorrhea without organic pelvic pathology, also known as functional dysmenorrhea, has three characteristics that are important for diagnosis: ① the menstrual cycle of dysmenorrhea is almost always ovulatory; dysmenorrhea mostly occurs in the beginning hours of the menstrual period, and the pain disappears within 2 to 3 days; ② pain in the lower abdomen above the pubic symphysis, with paroxysmal distension or cramping pain. Schroeder et al. suggested that most of the dysmenorrhea in adolescence is caused by endometriosis when painkillers are ineffective. Therefore, after diagnosing primary dysmenorrhea, we should consider those who may have mild endometriosis. 2, secondary dysmenorrhea refers to pelvic organic lesions leading to dysmenorrhea. The performance varies depending on the type of disease. (1) Pelvic infection: adnexitis, parametritis, etc. can cause dysmenorrhea during menstruation. However, pelvic pain is also present during non-menstrual periods and is aggravated during menstruation. When acute and subacute attacks occur, the pain is not related to the menstrual cycle. (2) Endometriosis and adenomyosis: often occurs in the reproductive age. The dysmenorrhea is characterized by progressive aggravation, and the more severe cases usually have pelvic pain and painful intercourse. Gynecologic examination reveals painful nodules in the uterosacral ligament, and laparoscopy improves the diagnostic accuracy. Adenomyosis with dysmenorrhea is similar to endometriosis, but uterine pain is predominant and the uterus may be enlarged. Ultrasound shows irregularities in the myometrium, which has diagnostic value. It may be accompanied by excessive menstruation. (3) Uterine fibroids Usually no dysmenorrhea, occasionally submucosal fibroids (with a tip) are seen with dysmenorrhea. In case of fibroids with dysmenorrhea, adenomyosis or adenomyoma may be combined. Uterine fibroids are not associated with dysmenorrhea and should be checked for fibroid degeneration when dysmenorrhea develops later. Ultrasonography is useful to assist in the diagnosis. Common secondary dysmenorrhea include: endometriosis, adenomyosis, fibroids, endometrial polyps, uterine cavity adhesions, stumpy uterus, pelvic inflammatory disease (acute and chronic), cervical stenosis, hymenopexy, transverse vaginal septum. Chinese medicine treatment has better efficacy and can be divided into two types of treatment: internal Chinese medicine and external Chinese medicine, such as moxibustion, acupuncture, Chinese medicine navel filling and Chinese medicine paste. In addition, daily health care is also very important.