Dysmenorrhea or painful menstruation is defined as a severe, painful, cramping sensation in the lower abdomen that is often accompanied by other symptoms, such as sweating, headache, nausea, vomiting and diarrhoea, that occur just before or during the menses. There are two commonly defined categories of dysmenorrhea: primary and secondary. Primary dysmenorrhea refers to pain during menses in the absence of any specific pathologic state and is characterized by recurrent, crampy, lower abdominal pain. Secondary dysmenorrhea refers to pain during menses that can be due to underlying pelvic pathology and is more common in women older than 20 years.

Primary dysmenorrhea results from excessive production of prostaglandins at the time of ovulatory menses. In the second half of an ovulatory cycle, the withdrawal of progesterone from the normally involuting corpus luteum causes the release of phospholipids, in particular omega-6 fatty acids, which, in turn, are initially converted to arachidonic acid, and then to prostaglandins. This production of prostaglandin results in increased intrauterine pressure and abnormal uterine contractions. In addition, vasoconstriction of uterine vessels results in decreased blood flow, ischemia of the uterine muscles, and increased sensitivity of pain receptors, all of which cause pelvic pain.

In Unani classical text, causes (Asbab) of dysmenorrhea is described as Sū’-i-Mizāj Mukhtalif of Rahim, Riyāḥ al -ghaleez, Ruá¹­Å«bat -i- Ghilẓ, Sudd’a-al-Rahim. Abnormal humour may cause pain either by their abnormal quality, quantity or combination of both factors. Various single drugs like chiraita, Abhal, Asarun, Sonf, Asgand, Amaltas, Annanas, Elva, Babuna, Bakain, Parshioshan, Podina, Khare khask, Hulba, Hilteet, Kalonji, Mushtar Mashi, Neem, Darchini, Qust Zanjabeel etc have been mentioned in classical Unani literature for the management of ‘Usr al- tamth . 

 The visual analogue scale (VAS) is a robust and accurate assessment of the intensity of chronic pain. Because of its simplicity and reliability, VAS is a widely used validated scale with a 10 cm line (0-10 defined as no pain to worst pain).