Primary dysmenorrhea remains one of the most prevalent gynaecological disorders affecting adolescents and young women globally. Contemporary cross-sectional and analytical studies from Asia, the Middle East, Europe, and South America consistently report high prevalence rates with significant academic absenteeism, reduced work productivity, impaired quality of life, and economic burden. Pathophysiological advances highlight the central role of prostaglandin-mediated uterine hypercontractility and inflammatory cascades, with emerging insights into immune and stress-related mechanisms. Validated tools such as the Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score demonstrate strong reliability and cross-cultural applicability, facilitating standardized severity assessment. Non-steroidal anti-inflammatory drugs remain first-line pharmacotherapy; however, variations in utilization patterns, self-medication practices, and safety concerns persist. Network meta-analyses confirm NSAID superiority, while evidence for exercise, stretching, and complementary therapies is growing yet heterogeneous. Psychological stress, nutritional status, body mass index, and lifestyle factors consistently emerge as significant modifiers of symptom severity. Despite expanding literature, gaps remain in longitudinal data, comparative effectiveness research, and integration of patient-reported outcomes into routine care. A multidimensional, evidence-based framework that integrates pharmacologic therapy, lifestyle modification, and psychosocial support is essential for optimized real-world management.