title: Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor.
abstract: OBJECTIVE
  To treat severe endometriosis in premenopausal women with an aromatase inhibitor and to document the efficacy and side effects of this new treatment.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Clinical practice setting.
  
  
  METHODS
  Patients were premenopausal endometriosis cases confirmed by prior laparoscopy.
  
  
  METHODS
  Oral administration of the aromatase inhibitor anastrozole with the addition of 200-mg oral progesterone (P) capsules once daily, hs, and calcitriol 0.5 microg oral capsules twice daily. All three medications were given daily for 21 days followed by 7 days off, for a 28-day treatment cycle. Additionally, rofecoxib 12.5 mg was administered once a day continuously for the 28-day cycle. The dose could be increased to 25-50 mg daily as needed for increased pain. Six repeat 28-day cycles were planned for the treatment course depending on patient tolerance and response.
  
  
  METHODS
  Reduction of symptoms, elimination of endometrial implants, and improvement in fertility potential in the future. Monitoring for ovarian hyperstimulation as a side effect of aromatase inhibitor therapy. Documentation of potential symptoms or side effects when an aromatase inhibitor is used in menstruating women.
  
  
  RESULTS
  Treatment resulted in a rapid, progressive reduction in symptoms over 3 months with the maintenance of remission of symptoms for over 24 months after treatment in both cases. There was confirmation of absence of disease in one case by follow-up laparoscopy 15 months after treatment. Pregnancy was achieved in both cases after 24 months.
  
  
  CONCLUSIONS
  This is the first case report of successful treatment of severe endometriosis in premenopausal women with the aromatase inhibitor anastrozole combined with P, rofecoxib, and calcitriol. Treatment resulted in a rapid elimination of symptoms and was well tolerated in both cases.
authors.affiliation: Shillington Diagnostic Center, Shillington, Pennsylvania, USAand the Reading Hospital and Medical Center, West Reading, Pennsylvania 19607, USA. ershippen@comcast.net
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Shippen
authors.forename: William J
authors.initials: WJ
authors.lastname: West
mesh_terms: D000328:Adult; D000077384:Anastrozole; D047072:Aromatase Inhibitors; D004359:Drug Therapy, Combination; D004715:Endometriosis / Q000188:drug therapy*; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D009570:Nitriles / Q000008:administration & dosage*; D011374:Progesterone / Q000008:administration & dosage; D014230:Triazoles / Q000008:administration & dosage*
chemical_list: D047072:Aromatase Inhibitors; D004791:Enzyme Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole; D011374:Progesterone