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Introduction: Dysmenorrhea, or painful menstruation, is one of the most common gynecological complaints among women of reproductive age. Ayurveda describes this condition under the term Kaṣṭārtava, where menstruation (ārtava pravṛtti) occurs with pain. It is primarily considered a disorder of Apāna Vāta. Despite being a physiological process, dysmenorrhea significantly affects quality of life, productivity, and mental well-being. Methods: Classical Ayurvedic texts (Charaka Saṃhitā, Suśruta Saṃhitā, Aṣṭāṅga Hṛdaya, Kāśyapa Saṃhitā) were reviewed to identify references to Kaṣṭārtava. Modern databases (PubMed, Scopus, Google Scholar) were searched (2000–2025) with keywords “Ayurveda,” “Kaṣṭārtava,” “dysmenorrhea,” “herbal management,” and “Vāta disorders.” Clinical studies, case reports, and review articles were included. Results: Ayurvedic management of Kaṣṭārtava involves three key approaches: (1) Śodhana cikitsā (purificatory measures such as basti therapy), (2) Śamana cikitsā (palliative therapy with herbs like Aśvagandhā, Śatāvarī, Hiṅgu, Kumārī, Eranda), and (3) Pathya-Apathya (dietary and lifestyle regulations). Yoga, prāṇāyāma, and stress management are also recommended. Modern studies have shown efficacy of certain Ayurvedic formulations (e.g., Hiṅgvādi cūrṇa, Kumāryāsava, Rājapravartinī vaṭī) and therapies (oil massage, basti) in reducing pain intensity, improving blood flow, and regulating hormonal balance. Discussion: The Ayurvedic concept of Vāta śamana aligns with modern understanding of dysmenorrhea pathophysiology, where prostaglandin-induced uterine contractions cause ischemic pain. Herbal drugs with antispasmodic, anti-inflammatory, and analgesic properties offer promising results. However, large-scale randomized controlled trials are limited. Conclusion: Ayurvedic management of Kaṣṭārtava provides a holistic approach addressing diet, lifestyle, and psychosomatic factors along with herbal and panchakarma interventions. Integrating these modalities with modern evidence may provide safe, effective, and sustainable strategies for dysmenorrhea.KEYWORDS: Ayurveda, Basti, Dysmenorrhea, Kaṣṭārtava, Women’s health