Background: Primary dysmenorrhea, or painful menstruation, is common in menstruating females. However, in some it can cause intense pain, disrupt activities of daily living, and impact quality of life. The treatment of dysmenorrhea does not traditionally include physical therapy. Objectives: A systematic review was conducted to explore the role of physical therapy in treating dysmenorrhea. Study Design: Systematic review. Methods: A search was performed in August 2020 and January 2022 using EBSCOhost, Academic Search Ultimate, CINAHL Complete, and MEDLINE. Search terms included exercise or physical activity or fitness AND dysmenorrhea or menstrual pain or painful menstruation. Inclusion criteria were articles that were peer-reviewed, published in the last 10 years, and available in full text in English. All articles included in the review were analyzed for quality on a hierarchy of evidence scale. Results: Twenty-two results were included in this systematic review. Nineteen articles were level 2 and 3 articles were level 3 on the hierarchy of evidence scale. The Visual Analog Scale and Menstrual Distress Questionnaire were the widely utilized outcome measures used to determine the effectiveness of the interventions. Interventions including aerobic exercise, stretching, kinesio taping, aquatic therapy, acupressure, yoga, core stability, positional activities, spinal manipulation, and patient education have shown to be effective. Conclusions: Physical therapy can assist in the reduction of pain and other symptoms associated with dysmenorrhea. Overall, articles indicated that aerobic exercise, stretching, and core stability yielded the greatest improvement