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Aromatase Inhibitors in the Treatment of Severe Endometriosis

From the ¹Institute of Medical Science, Samuel Lunenfeld Research Institute and ²Division of Reproductive Sciences, Fran and Lawrence Bloomberg Department of Obstetrics and Gynecology, Mount Sinai Hospital and the University of Toronto, Toronto, Ontario, Canada; and ³Cleveland Clinic Foundation, Cleveland, Ohio.

BACKGROUND: Endometriosis-associated chronic pelvic pain unresponsive to surgical menopause is a difficult clinical problem.

CASE: A middle-aged woman presented with endometriosis and severe pelvic pain after hysterectomy and bilateral salpingo-oopherectomy. She was first treated with exemestane without improvement of symptoms. However, another aromatase inhibitor, letrozole, relieved her pain, and concomitant treatment with estrogen relieved hot flushes without pain reactivation.

CONCLUSION: Letrozole was superior to exemestane in relieving the endometriosis-associated pain in this postmenopausal woman. This suggests that patients may respond variably to different aromatase inhibitors.