Background: During menstruation, there is an imbalance in the hormone progesterone which causes pain or is often called dysmenorrhea. A general percentage of 50–60% of women manage dysmenorrhea using analgetic drugs. Pilates exercise is aimed at producing natural, correct, and efficient motion. It is a stretching and strengthening exercise in the core area, namely the area between the pelvic, abdomen, and back which has the aim of increasing muscle strength, flexibility, muscle endurance so that body stability can be maintained through body control, posture and breathing. Objectives: The purpose of this basic research is to strengthen the theory of the relationship between pilates exercise and dysmenorrhea symptoms. Methods: The research design was an experimental pre-test post-test control group. Subjects were 52 students who experienced primary dysmenorrhea, divided into two groups. The first group received pilates exercise twice a week for four weeks. The second group only received information support. The variables measured include pain, anxiety, pulse frequency. Results: The results showed that there were differences in pain and anxiety scale scores with a mean of 4.15 and 27.7  (p> 0.05). Conclusions: The conclusion obtained by Pilates can be alternative complementary care for adolescent girls who experience anxiety.