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24 , e13567 (2023)

First-line pharmacological management includes: Analgesia : Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or mefenamic acid for pain relief Hormonal contraceptives : Combined oral contraceptive pill (COCP) or progestogen-only pill, often used continuously to suppress menstruation Progestogens : Including norethisterone, desogestrel, or medroxyprogesterone acetate, which suppress endometrial tissue growth Levonorgestrel intrauterine system (LNG-IUS) : The Mirena coil provides local progestogenic effects and may reduce dysmenorrhoea and menstrual bleeding Second-line hormonal treatments (typically initiated by specialists): GnRH analogues (goserelin, leuprorelin): Create a temporary menopausal state, highly effective for pain relief