Many women experience menstrual cramps during their periods. What exactly is the disease that causes menstrual cramps? And how to deal with it? First of all, it is necessary to know whether the pain is dysmenorrhea or not. Some patients have a feeling of lower abdominal distension before the onset of menstruation, that may be related to the action of progesterone and may not be dysmenorrhea. Dysmenorrhea refers to the pain that occurs after the onset of menstruation. The condition of dysmenorrhea varies from person to person. Most people do not have dysmenorrhea, and some patients have negligible pain, but some patients can have pain that can make them sweat profusely every time they have menstrual cramps, and they may even have to use medication to treat it. In medical terms, one type of dysmenorrhea is called “primary dysmenorrhea”, which refers to painful menstruation at the time of the first period, while the other type is “secondary dysmenorrhea”. To distinguish between the two, recall whether it hurts when you have your first period or not, and you can probably tell the difference. In the case of primary dysmenorrhea, a systematic physical examination often does not reveal the presence of organic lesions that cause dysmenorrhea, and in the absence of organic lesions, symptomatic treatment is often recommended, and pain medication such as Fenbuterol can be used to control the symptoms. In secondary dysmenorrhea, there is often a pathology of the internal organs, so it is necessary to go to the hospital to find out if there is an underlying disease. What diseases can cause dysmenorrhea? The most common disease is called “endometriosis”, which, as the name suggests, is a condition in which the endometrium, which is supposed to grow inside the uterus, goes elsewhere, and when the endometrium peels off during menstruation, there is no pain. However, if the endometrium goes elsewhere, it bleeds in some abnormal locations, and pain will result. The most common locations are the ovaries, the pelvic peritoneum, the tissue between the vagina and the rectum (vagino-rectal septum), and in rare cases, the intestines, ureter, bladder, or even outside the abdominal cavity. When bleeding occurs in these abnormal locations, it can irritate the peritoneum causing dysmenorrhea. On the ovaries it is common that cysts are formed because the fluid inside the cyst of endometriosis removed during surgery is particularly like chocolate, also known as ovarian coeliacs. Endometriosis is a special disease that is sometimes referred to as a “benign disease with malignant manifestations”, mainly because it is very difficult to treat and has a high recurrence rate with medication and surgery, and it also tends to affect fertility, making conception difficult. For now, the treatment depends mainly on the patient’s symptoms, age, and fertility requirements. For menstrual pain due to endometriosis, a detailed examination and evaluation by a doctor is usually required before deciding on the specific treatment. In mild cases, if there are no cysts or if the cysts are small, a simple treatment is to take oral contraceptives, which have a beneficial effect on relieving menstrual pain. For the treatment of endometriosis, there is also the saying that “pregnancy is the best treatment for endometriosis”, because once pregnant, if a full-term pregnancy and delivery is possible, the body produces a large amount of progesterone, which has a strong inhibiting effect on the ectopic endometrium of endometriosis. After pregnancy, menstrual cramps will be greatly relieved and even stop appearing in the short term. Of course, the more full-term pregnancies there are, the less likely endometriosis will worsen. On the contrary, early miscarriages have an aggravating effect on endometriosis, and many people experience dysmenorrhea after a miscarriage. The second disease, which has similarities to endometriosis, is called myometriosis, which was once thought to be a special type of endometriosis. The ectopic endometrium can locally irritate and cause thickening of the uterine wall, and may even form a tumor-like tissue in the area. Patients may experience dysmenorrhea, which is usually more severe than endometriosis, and can also affect fertility. For myometriosis, if the symptoms are severe, surgery is usually required to remove the localized ectopic lining, but recently there are new methods that do not require surgery, such as focused ultrasound to treat myometriosis, which may be a new direction in the future. Whether or not myometriosis causes a problem that needs to be treated is also a matter of first assessing the severity of the disease. Chronic inflammation of the pelvic cavity may also cause dysmenorrhea due to inflammation of the pelvis during menstruation when the entire pelvic cavity becomes engorged with blood and the irritation of the inflammation can lead to painful symptoms. Pelvic inflammatory disease usually has a clear history of pelvic infection. For chronic pelvic inflammatory disease, it is currently susceptible to overdiagnosis due to the lack of a precise objective diagnostic criteria. Chronic pelvic inflammatory disease also lacks a particularly effective treatment plan, and personal advice is that some relief may be obtained with physical therapy in conjunction with herbal treatment. Rarely, malformations of the uterus, such as vaginal diastasis and vaginal strabismus, may cause poor menstrual flow, which require detailed examination before a clear diagnosis can be made. For these conditions, surgery is usually required to correct the deformity. There are some cases of dysmenorrhea that cannot be prevented, but there are others that can be prevented. Miscarriage, which is not only traumatic for the uterus, but also for many people who begin to experience dysmenorrhea after an abortion, can also be considered a form of prevention by preventing abortion whenever possible. From a clinical point of view, there are many patients who start to have dysmenorrhea after getting cold during their periods. This may be preached in folk and Chinese medicine, but in Western medicine, there is little research in this area, and it is not clear what causes it and the specific pathophysiological mechanisms. Avoiding cold stimulation during menstruation may also be a way to prevent dysmenorrhea. Chinese medicine is sometimes effective in the treatment of dysmenorrhea, and if Western medicine does not solve the problem, it is not a bad idea to try Chinese medicine. However, the treatment of gynecological disorders in Chinese medicine is largely based on personal experience, and I hope that more scientific clinical studies will prove its scientific value.