2• Dysmenorrhea Painful menstrual cramps that are usually severe, and regular and could interrupt daily activities in some cases. The pain may also be present in the lower back and on the thighs. It could be primary and secondary. The primary form is a result of uterine contraction, that worsens during heavy flow. It happens without an underlying disease. It can start as early as less than 6 months after the onset of the first period (monarchy) Secondary form is associated with an underlying disease condition like fibroid, or endometriosis. It starts suddenly, after a series of painless periods, and affected women may respond poorly to pain medications (NSAIDs) and even oral contraceptives