Prevalence of menstrual pain, use of medication and school absenteeism due to the pain were studied by means of a mailed questionnaire in a sample representing 12-18-year-old girls in Finland (n = 3370, response rate 87%). Prevalence of menstrual pain was 48% among 12-year-old post-menarcheal girls and 79% among 18-year-olds. Thirty percent of the 16-year-old girls had used medication and 21% had stayed at home due to menstrual pain in the last 6 months; 3% had both been absent and used medication several times. Three types of factors were associated with menstrual pain: (1) physiological (gynaecological age, duration of menstrual flow); (2) indicators of poor self-rated health (not feeling active in the morning, bad physical condition, number of common colds); (3) unhealthy practices (consumption of alcohol, low physical activity, smoking). The prevalence of menstrual pain did not correlate with the variables describing the place of residence or the socio-economic status of the family. The determinants of menstrual pain are supposed to lie more in the biological construct and micro-environment of the girls than in macro-level structures of the society. The experience of pain seems to be related to self-rated health as a whole and to lifestyle rather than to specific disorders and health practices.