Non-steroidal-anti-inflammatory drugs (NSAIDs) are the first-line treatment for women with dysmenorrhea without proven endometriosis. A typical regimen consists of ibuprofen, 600 to 800 mg orally, four times per day, or naproxen, 550 mg orally, twice per day. NSAIDs should be initiated with the onset of premenstrual symptoms and continued for at least 3 days.To minimize gastrointestinal upset, women should take the medication with food or after meals. In patients with mild to moderate endometriosis, hormonal suppression is indicated. Progestins, such as medroxyprogesterone acetate