Dysmenorrhea, or painful menstruation, is a common cause of acute pelvic pain that affects approximately two-thirds of women who are postmenarchal in the United States. Dysmenorrhea pain is frequently severe enough to disrupt daily activities and often accompanied by other symptoms, such as diarrhea, nausea, vomiting, headache, and dizziness. Primary dysmenorrhea is likely due to an excess of prostaglandins and is traditionally treated with nonsteroidal anti-inflammatory drugs and hormonal therapy. Secondary dysmenorrhea can have multiple origins and requires targeted therapy. Currently, musculoskeletal dysfunction and psychosocial factors are not listed as causes of secondary dysmenorrhea. The authors present a case in which the cause of secondary dysmenorrhea was thought to be related to both musculoskeletal dysfunction and emotional stress. Osteopathic manipulative treatment and lifestyle changes helped resolve secondary dysmenorrhea.