Aromatase inhibitors: the next generation of therapeutics for endometriosis?
OBJECTIVE
To review the role of aromatase inhibitors (AIs) in the treatment of endometriosis.


CONCLUSIONS
Endometriosis is a common estrogen-dependent disorder that can result in substantial morbidity, including pelvic pain, multiple operations, and infertility. Approximately only half of women with endometriosis get pain relief from existing medical or surgical treatments. Medical treatments usually are directed at inhibiting estrogen action or its production from the ovaries and do not address local estrogen biosynthesis by the aromatase enzyme in endometriotic lesions. A single gene encodes aromatase, which is the final enzyme in the estrogen biosynthesis pathway, and its inhibition effectively eliminates estrogen production. The recently introduced highly specific AIs have successfully treated pelvic pain and significantly reduced the lesion size. In premenopausal women, an AI alone may induce ovarian folliculogenesis, and thus AIs are combined with a progestin, a combination oral contraceptive, or a GnRH analogue. The side-effect profile of AIs administered in combination with an oral contraceptive or a progestin is remarkably benign. We review herein the published clinical evidence for the use of AIs in the treatment of endometriosis.
Attar
Erkut
E
Division of Reproductive Biology Research, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Bulun
Serdar E
SE
D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004715:Endometriosis / Q000188:drug therapy*; D004965:Estrogen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005544:Forecasting; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016896:Treatment Outcome
D047072:Aromatase Inhibitors; D004965:Estrogen Antagonists