Treatment of severe postmenopausal endometriosis with an aromatase inhibitor.
OBJECTIVE
To treat an unusually aggressive case of recurrent postmenopausal endometriosis.


METHODS
Case report.


METHODS
University of Texas Southwestern Medical Center (Dallas, Texas).


METHODS
A 57-year-old woman who presented with recurrent severe endometriosis after hysterectomy and bilateral salpingo-oophorectomy.


METHODS
Oral administration of anastrozole (an aromatase inhibitor) (1 mg/d) and elemental calcium (1.5 g/d) for 9 months. Alendronate (a nonestrogenic inhibitor of bone resorption), 10 mg/d, was added to this regimen.


METHODS
Reduction in size of endometriotic lesion, pain relief, tissue levels of aromatase P450 messenger RNA, bone density.


RESULTS
Circulating levels of estradiol-17beta were reduced to approximately 50% of the baseline value after the onset of treatment with anastrozole. Pain rapidly decreased and completely disappeared after the 2nd month of treatment. The 30 x 30 x 20-mm bright red polypoid vaginal lesion was reduced to a 3-mm gray tissue by the end of 9 months of treatment. Markedly high pretreatment levels of aromatase P450 messenger RNA in the endometriotic tissue became undetectable in a specimen obtained from a repeated biopsy after 6 months of treatment. Bone density of lumbar spine decreased by 6.2% after 9 months of treatment.


CONCLUSIONS
This is the first description of the use of an aromatase inhibitor in the treatment of endometriosis. The short-term results were extraordinarily successful in elimination of pain and near-complete eradication of implants associated with severe endometriosis not responsive to other therapy. We conclude that the recently developed potent aromatase inhibitors are candidate drugs in the treatment of endometriosis that is resistant to standard regimens.
Takayama
K
K
Cecil H. and Ida Green Center for Reproductive Biology Sciences and Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9051, USA.
Zeitoun
K
K
Gunby
R T
RT
Sasano
H
H
Carr
B R
BR
Bulun
S E
SE
D000284:Administration, Oral; D000077384:Anastrozole; D000818:Animals; D001141:Aromatase / Q000032:analysis / Q000235:genetics; D047072:Aromatase Inhibitors; D001706:Biopsy; D004715:Endometriosis / Q000188:drug therapy* / Q000473:pathology; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009570:Nitriles / Q000008:administration & dosage / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D017698:Postmenopause; D012333:RNA, Messenger / Q000032:analysis / Q000187:drug effects / Q000235:genetics; D051381:Rats; D012008:Recurrence; D013997:Time Factors; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*
D047072:Aromatase Inhibitors; D004791:Enzyme Inhibitors; D009570:Nitriles; D012333:RNA, Messenger; D014230:Triazoles; D000077384:Anastrozole; D001141:Aromatase