Dysmenorrhea is the most common problem in pediatric and adolescent gynaecology and it reaches approximately 20-90% of adolescents and young adult females. Dysmenorrhea in adolescent girls is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Secondary dysmenorrhea, associated with some pelvic pathology, constitutes approximately 10% of the cases and its most frequent reasons are: endometriosis, pelvic inflammatory disease, congenital mullerian anomalies and ovarian cysts. Prostaglandins and leukotriens play a significant role in etiopathogenesis of the primary dysmenorrhea. The therapy of the primary dysmenorrheal in adolescent girls involves: nonsteroidal anti-inflammatory drugs for at least 3 months, combined with oral contraceptives for at least 3-6 menstrual cycles, as well as dietary supplementation, other alternative therapies (vitamins, herbal remedies, acupuncture, TENS) and surgical treatment Secondary causes of dysmenorrhea should be considered in adolescents with dysmenorrhea who do not respond to the treatment. The role of the pediatric and adolescent gynaecologist is to diagnose the reason of symptoms, educate the patient, review effective treatment options as well as to restore normal daily functioning.