Dysmenorrhea is a common gynecological condition characterized by painful menstruation severe enough to interfere with daily activities. It is classified into primary dysmenorrhea (without pelvic pathology) and secondary dysmenorrhea, which occurs due to underlying pelvic pathology, most commonly endometriosis.

Endometriosis is defined as the presence of functioning endometrial glands and stroma outside the uterine cavity. It affects approximately 10–15% of reproductive-age women and up to 70% of women with chronic pelvic pain. Its prevalence is higher among infertile women (30–40%). The rising prevalence is attributed both to lifestyle factors (delayed marriage, postponed conception, small family norms) and improved diagnostic techniques like laparoscopy.

Pain severity in endometriosis does not always correlate with disease stage, indicating complex pain mechanisms. Despite hormonal therapy and surgical management, many women continue to suffer from persistent pain, reduced quality of life, anxiety, and infertility, highlighting the need for alternative therapeutic approaches.

In Ayurveda, secondary dysmenorrhea can be correlated with Kashtartava, Vatiki Yonivyapada, and Udavartini Yonivyapada. Pain (Shoola) is primarily due to Vata vitiation, particularly Apana Vayu dushti. The principle of management focuses on Vatanulomana to maintain normal Artava Pravruti . Classical references from Acharya Charaka, Sushruta, and Vagbhata emphasize Vata as the key etiological factor in Yoni Roga.

The present study aims to evaluate the efficacy of Shoolahara Kashaya (oral) and Yavadi Utkarika (local application) in managing endometriosis-related secondary dysmenorrhea, addressing the current gap in Ayurveda-based, non-hormonal, non-invasive pain management strategies.