ABSTRACT
Medical treatment is often first-line management treatment of pelvic pain. Non-steroidal anti-inflammatory drugs do not treat endometriotic lesions but may be effective in the treatment of pelvic pain. Nonsteroidal anti-inflammatory drugs inhibit cyclo-oxygenase and therefore reduce prostaglandin production and reduce pelvic pain. The commonest non-steroidal anti-inflammatory drugs are ibuprofen and naproxen, which can be bought over the counter. The main side-effects are gastrointestinal, particularly gastric irritation. Peptic ulceration may result if treatment is used for a long period of time, although if taken for 5 days each month, it rarely causes a problem. The oral contraceptive pill is often used as first-line treatment of endometriosis-associated pain. The oral contraceptive pill mediates its effect by suppressing ovulation and creating a pseudopregnancy hormonal environment. Progestins are an important treatment option in the management of endometriosis-associated pain. Progestins exert their effect by causing pseudodecidualisation followed by atrophy of both endometrium and endometriosis.
