Whenever such a symptoms present we should always rule out pregnancy in the reproductive age group. Once it is confirmed there is no pregnancy, the other cause responsible for this is fibroid uterus, which is benign tumor arising from the musculature of the uterus. More so when it grows towards the cavity of the womb. The next condition is called as adenomyosis, where there is invasion of the lining of the womb into the musculature of the womb. Also the growth from the mouth of the womb are mostly it is benign, Very rarely it could even be cancer, can cause similar symptoms. Vaginal infections responsible for similar symptom can be associated with white discharge per vaginum also. Menstrual cramps are more common in teenagers in 20’s. So unless we take detailed history, and do a thorough physical examination and necessary investigations. It is very difficult to deduce what is the cause for the painful menstruation.

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