The efficacy of oral contraceptives (OC) in the treatment of primary dysmenorrhea in controlled studies varies from 50 to 80%. The addition of a prostaglandin synthetase inhibitor, naproxen, was found to afford pain relief to a further 70% of women with OC-resistant dysmenorrhea in a double-blind cross-over study comprising 39 patients. This effect was shown to be statistically significant at p = 0.0005. Our recommendation is that low-dose OCs should be the first choice as contraceptive agents for women with dysmenorrhea and that a prostaglandin synthetase inhibitor should be given when OCs are ineffective.