The first-line pharmacologic management for dysmenorrhea is:

Rationale: A. Oral contraceptives can be used for dysmenorrhea, particularly if symptoms are severe or associated with ovulatory cycles, but they are not considered first-line therapy. B. Opioid analgesics are reserved for severe, refractory pain and are generally avoided due to risk of dependence and side effects. C. Acetaminophen may provide some pain relief but is less effective than NSAIDs in reducing the prostaglandin-mediated pain of dysmenorrhea. D. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are the first-line pharmacologic treatment. They inhibit prostaglandin synthesis, directly addressing the uterine cramping and pain associated with dysmenorrhea.