Aims: The purpose of the present study was to predict pain intensity based on pain metaphorical perception with the mediating role of cognitive emotion regulation in women with dysmenorrhea. Method and Materials: This cross sectional study was applied in terms of correlation using structural equation modeling. The statistical population of the present study was all girls in Tehran in the last six months of 2024 who suffered from menstrual pain. According to the inclusion criteria, 250 women with menstrual pain were selected from Tehran through available and voluntary sampling. The participants completed the questionnaires on Pain Intensity, Pain Metaphorical Perception, and Cognitive-emotional Regulation. Data analysis was conducted using SPSS version 26 and Amos version 24 software. Findings: Women's negative and positive cognitive emotion regulation strategies mediate the relationship between pain metaphorical perception and women's pain intensity, with the difference that positive cognitive emotion regulation strategies, as a mediator, reduce the effect of pain metaphorical perception on women's pain intensity. However, negative cognitive emotion regulation strategies as mediators increase the impact of pain metaphorical perception on women's pain intensity (P=0.005). Conclusion: Results indicated that pain intensity is predictable based on pain metaphorical perception, with the mediating role of cognitive emotion regulation in women with dysmenorrhea.