Background: The most common cause of pelvic discomfort is primary dysmenorrhea, which causes lower-abdominal cramping pain during menstruation or just before it. Purpose: The aim of this study was to determine the effect of a pulsed high-intensity laser (HILT) combined with a protocol of exercise on pain and quality of life in patients with primary dysmenorrhea. Methods: This randomized control trial was conducted between February and September, 2022 in the Department of Physical Therapy, College of applied Medical Sciences, Umm AL-Qura University, and included 59 female students from Umm AL-Qura University with primary dysmenorrhea who were randomly assigned into four groups. Group 1 (HILT) received two sessions of HILT every menstrual cycle for two cycles, Group 2 (Ex) did an exercise protocol (aerobics, yoga, pelvic floor exercise, and pelvic rocking), Group 3 (HILT+Ex) received HILT combined with the exercise protocol, and group 4 served as a control. All participants were evaluated at the beginning (“pre”) and after one month (post-1) and two months (post-2) with a visual analogue scale (VAS), quality of life scale (QoL), and pain relief scale (PR). Data were analyzed using a repeated-measure ANOVA and t-test. Results: Participants in group 3 showed a significant reduction in pain assessed by VAS and highly significant improvement in their quality of life compared with other groups. Conclusion: The combination of HILT and an exercise protocol showed effectiveness in decreasing pain and improved quality of life after two months of intervention in patients with dysmenorrhea.