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Primary dysmenorrhoea, also called period pain (table 1), is quite prevalent, with 71% of females affected worldwide and 60% of female athletes (interscholastic, collegiate, national, international, amateur and professional competitors), specifically.1 2 For some, period pain is mild or non-existent; for others, it is extreme. Severity and experiences of period pain change cycle-to-cycle and across the lifespan. Severe period pain and frequently accompanying symptoms such as nausea, fatigue and low mood can prevent normal daily activities, inhibit quality of life and increase the burden on healthcare resources.3 A reported 50–100% of female athletes perceive that menstrual symptoms negatively affect their sports performance.4 Despite the high prevalence of period pain and possible performance effects, female athletes report a dearth of strategies to manage menstrual-related symptoms,5 possibly due to inadequate menstrual health education provided to female athletes, support staff (e.g., coaches, sport scientists and medical personnel) and the wider society. There are also disparities and uncertainties within the scientific literature regarding evidence-based interventions and the biopsychosocial factors involved in period pain. As a result, it is difficult to confidently recommend effective management strategies to reduce or prevent period pain in athletic populations. This editorial explores evidence gaps and management considerations required to address period pain in athletes.