A. Initial therapy consists of a nonsteroidal anti-inflammatory drug.
1. Naproxen (Naprosyn) 500 mg followed by 250 mg PO tid-qid prn [250, 375,500 mg].
2. Naproxen sodium (Aleve) 200 mg PO tid prn.
3. Naproxen sodium (Anaprox) 550 mg, followed by 275 mg PO tid-qid prn.
4. Ibuprofen (Motrin) 800 mg, then 400 mg PO q4-6h prn.
5. Mefenamic acid (Ponstel) 500 mg PO followed by 250 mg q6h prn.
B. Combined estrogen-progestin. Low-dose, combination, monophasic birth control pills often relieve mild to moderate pelvic pain; they are often taken continuously.
C. Progestin-only regimen. Medroxyprogesterone (Provera), 10-30 mg/d, produces significant pain relief; breakthrough bleeding is common. Depo-Provera may be used unless fertility is desired in the near future.
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