Approach to combined treatment of endometriosis with aromatase inhibitors and progestogens
Maria Yarmolinskaya (RU), Arseny Molotkov (RU)
[Yarmolinskaya] Ott‘s Scientific Research Institute of Obstetrics, Gynecology and Reproduction, [Molotkov] Ott‘s Scientific Research Institute of Obstetrics, Gynecology and Reproduction
Context: Endometriosis is a chronic disease that requires hormonal therapy. Aromatase inhibitors block aromatase, decrease estrogen levels and can be used for treatment of endometriosis. Objective: to evaluate effectiveness and safety of aromatase inhibitors in combined treatment of genital endometriosis. Methods: Patients were prescribed letrozole 2.5 mg once a day and lynestrenol 5 mg twice a day for 6 months. Indication for this treatment was endometriosis in combination with history of ineffective treatment with aGnRH and/or reduced ovarian reserve. Patients: 172 patients of reproductive age with endometriosis that was stated during laparoscopy: I stage of the disease was verified in 2 patients, II stage - in 9 patients, III stage in 39 patients and IV stage - in 122 patients. Before treatment 69.2% women had chronic pelvic pain, 44.2% patients had dyspareunia and 60.9% women had infertility. In 41 cases endometriosis was revealed for the first time and in 131 patients it was a recurrence of the disease. Results: During the treatment, pelvic pain disappeared in 98.7% of patients. At the end of the treatment none of the patients had symptoms and findings of recurrence of the disease. In 11 cases regression of endometriotic lesions was confirmed during second-look laparoscopies. The most common side-effects were spotting from genital tract (in 28.9% of patients), body weight gain (in 21.8%), and acne (in 14, 1%). After treatment, 32.6% of patients with infertility became pregnant. In 22.6% of patients pregnancy occurred spontaneously, in other cases - after ovulation induction or after IVF procedure. By now 67.7% of women delivered healthy babies on time. Conclusions: The treatment of endometriosis with aromatase inhibitors is effective and safe.