Graded Motor Imagery for Primary Dysmenorrhea

Inclusion Criteria: 1. Female sex (aged 18-30 years) 2. Diagnosis of primary dysmenorrhea confirmed by a physician (painful menstruation for ≥6 consecutive cycles, in the absence of identifiable pelvic pathology on clinical and/or ultrasound evaluation) 3. Pain ≥4/10 NRS experienced during the last period. 4. Confirmed altered pressure pain threshold: PPT ≥2 standard deviations below published norms for age-matched healthy women, measured at baseline assessment 5. Regular menstrual cycle (21-35 days) 6. Capable of engaging in virtual video sessions and taking online tests. 7. Consent to withhold new analgesic or hormonal treatments during the study period. Exclusion Criteria: 1. Secondary dysmenorrhea (endometriosis, adenomyosis, fibroids, pelvic inflammatory disease, ovarian cysts ≥3 cm confirmed on imaging) 2. Current use of hormonal contraceptives (which alter prostaglandin levels and pain processing) 3. Pregnancy or lactation 4. Concurrent chronic pain condition (fibromyalgia, CRPS, chronic low back pain, chronic pelvic pain unrelated to menstruation) 5. Neurological or psychiatric disorder that would impair motor imagery ability (stroke, schizophrenia, active psychosis) 6. Cognitive impairment affecting informed consent capacity 7. Participation in another clinical trial within 4 weeks before enrollment 8. Previous exposure to graded motor imagery or mirror therapy 9. Regular use of NSAIDs or opioids for non-menstrual indications