# Endometriosis (referral & initial medical management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ESHRE Guideline Endometriosis 2022 · NICE Guideline NG73 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Egyptian National Drug Formulary, endocrine 2024, medroxyprogesterone acetate monograph, mild to moderate endometriosis - Verified date: 2026-08 ## Verified against - Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) - ESHRE Guideline Endometriosis 2022 - Egyptian National Drug Formulary, endocrine 2024, medroxyprogesterone acetate monograph, mild to moderate endometriosis ## Treatment metadata - Ethinyl estradiol + Levonorgestrel — oral.solid - Medroxyprogesterone acetate — 10 mg — oral.solid - Naproxen — 500 mg — oral.solid ## Complete treatment card ```text ENDOMETRIOSIS (REFERRAL & INITIAL MEDICAL MANAGEMENT) Sources: ESHRE Guideline Endometriosis 2022 · NICE Guideline NG73 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Egyptian National Drug Formulary, endocrine 2024, medroxyprogesterone acetate monograph, mild to moderate endometriosis Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Chronic cyclic pelvic pain, painful periods, painful sex, painful defecation, dysuria, and infertility are the hallmark symptoms, and severity does not track with how much disease is present [abdominal pain · burning on passing urine · infertility · painful periods · pelvic pain] - Neuropathic pain or allodynia can occur, especially with deep infiltrating disease near nerve fibers [burning pain · hyperalgesia] - Bowel or rectovaginal involvement can cause gastrointestinal symptoms or bleeding that follows the cycle, while superficial lesions can be silent [bleeding] - Pelvic pain affects most patients, and many also report significant fatigue [abdominal pain · fatigue · pelvic pain] SIGNS - what you find (1) - Findings can include tenderness of the uterus or adnexa, an adnexal mass from an endometrioma, uterosacral nodularity, or limited uterine mobility [pelvic mass] TESTS (6) - Transvaginal ultrasound is the preferred first-line imaging test, especially for identifying endometriomas - Transvaginal ultrasound often misses superficial peritoneal lesions despite performing well for endometriomas - MRI is a secondary imaging test used mainly for surgical planning in deep endometriosis - Negative imaging does not rule out endometriosis, and treatment can proceed despite normal findings - Laparoscopy can confirm the diagnosis but is not required before starting medical treatment - Biopsy confirms suspicious lesions histologically, but a negative biopsy does not exclude endometriosis IF NOT THIS - what else fits (12) - Primary dysmenorrhea - Adenomyosis - Uterine fibroids - Pelvic inflammatory disease - Irritable bowel syndrome - Inflammatory bowel disease - Interstitial cystitis - Recurrent urinary tract infections - Pudendal neuralgia is on the differential - Ovarian cysts - Ectopic pregnancy and other early pregnancy problems need to be ruled out in women of reproductive age - Central sensitization and somatic symptom disorders are psychosocial factors that can mimic or worsen pelvic pain Source StatPearls "Endometriosis" - disease-level clinical article Status traced to the source above 1. ETHINYL ESTRADIOL + LEVONORGESTREL [1st line] Adult 30 mcg Ethinylestradiol + 150 mcg Levonorgestrel tablet taken once daily continuously (or cyclically 21 days on, 7 days off) - long-term Peds Post-menarcheal adolescents: 1 tablet daily Source ESHRE Guideline Endometriosis 2022 Why Single-ingredient ethinylestradiol is not marketed in Egypt. This is the combined pill, and it is what suppresses the disease. Caution Standalone ethinylestradiol single-ingredient tablets are unavailable in Egyptian pharmacies. Contraindicated in women with history of VTE/PE, severe hypertension, focal migraine, or active liver disease. There is an increased venous thromboembolism risk. Egypt MICROCEPT 21 TAB. CID 0.76 EGP (0.04/unit) MICRODETTE 3* 21 TAB. EL NILE. 7.50 EGP (0.36/unit) NORDETTE 5*21 TAB. EL NILE. > PF... 15.00 EGP (0.71/unit) MICROGENEST 30/150 MCG 21 TABS. ACDIMA INTERN... 23.00 EGP (1.10/unit) TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC) CID 120.00 EGP (5.71/unit) 2. MEDROXYPROGESTERONE ACETATE [2nd line] Adult 10 mg 3 times daily orally continuously x 6-12 months Peds Specialist pediatric gynecology referral required Source Egyptian National Drug Formulary, endocrine 2024, medroxyprogesterone acetate monograph, mild to moderate endometriosis Why Progestin monotherapy for patients unable or unwilling to take combined estrogen therapy Caution Weight gain, irregular breakthrough bleeding, and fluid retention are common. Bone mineral density loss with prolonged use (>2 years); ensure adequate calcium/vitamin D intake. The licensed course is 90 days, started on the first day of a period. Suppressing for six to twelve months is common practice but it is beyond what the label covers - know which one you are doing. Egypt's only oral medroxyprogesterone, PROVERA 5 mg, is marked CANCELLED in the national register, so this 10 mg three-times-daily course cannot be dispensed as written. The medroxyprogesterone injections marketed here (DEPO-PROVERA 150 mg/mL, MEGESTRON, OXYPROGEST, SAYANA 104 mg/0.65 mL) are registered for contraception: the Egyptian National Drug Formulary gives the 150 mg every 3 months intramuscular dose under contraception, not under endometriosis. Consider dienogest or a combined oral contraceptive instead, or specialist referral. Egypt PROVERA 5 MG 24 TABS.(CANCELLED) PFIZER 24.00 EGP (1.00/unit) -> ? strength differs, discontinued 3. NAPROXEN [add-on - not a substitute] Adult 500 mg twice daily with food during dysmenorrhea and pelvic pain flares x 3-5 days during menses Peds Adolescents with severe dysmenorrhea: 500 mg initial, then 250-500 mg BID with food Source Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) Why For the pain of a flare. It does not treat the endometriosis - give it alongside hormonal suppression, not instead of it. Caution Does not suppress endometriotic lesion progression; combined hormonal therapy required for disease control. There is a risk of GI distress and ulceration with chronic use. Egypt ORGOPROXEN 500 MG 20 TAB. ORGANOPHARMA ... 16.00 EGP (0.80/unit) NAPROSYN 500 MG 10 TAB. MISR > F.HOFF... 8.05 EGP (0.81/unit) NAPROFEN 500MG 10 TAB. EL NILE. 12.00 EGP (1.20/unit) NAPROFEN 500MG 20 TAB. EL NILE. 24.00 EGP (1.20/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)