This chapter examines the epidemiology, causes and management of dysmenorrhoea and the epidemiology and causes of chronic cyclical and non-cyclical pelvic pain. It discusses the principles of management of patients with chronic cyclical and non-cyclical pelvic pain, including alternative and non-hormonal therapies. The chapter is mainly concerned with gynaecological causes of cyclical pelvic pain but some reference is made to the multifactorial nature of the problem and to management of symptoms of chronic pelvic pain. The reported prevalence of dysmenorrhoea varies widely depending on the population studied and the method of reporting. Uterine myometrial hyperactivity has been demonstrated in women with primary dysmenorrhoea. The most common cause of secondary dysmenorrhoea and chronic cyclical pelvic pain is endometriosis, which occurs in around one third of laparoscopies carried out for pelvic pain. The diagnosis of primary dysmenorrhoea is based on the history of typical spasmodic, cramping, suprapubic pain, confined to menstruation and with no features suggestive of other gynaecological conditions.