{"paper_id":"8d1479c2-32c6-423c-a9f1-8fe42be38be0","body_text":"22764\nCopyright@ Shawky ZA Badawy | Biomed J Sci & Tech Res | BJSTR. MS.ID.004854.\nMini Review\nISSN: 2574 -1241\nAromatase Inhibitors Use for Endometriosis Patients\nShawky ZA Badawy1,2* and Jonathan D Franceschini1,2\n1Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Upstate Medical University, USA\n2Department of Clinical Pathology, Upstate Medical University, USA \n*Corresponding author: Shawky ZA Badawy, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, \nDepartment of Clinical Pathology, Upstate Medical University, Syracuse, New York, USA\n      DOI: 10.26717/BJSTR.2020.29.004854\nIntroduction\nEndometriosis is a chronic inflammatory disease.  The incidence \nof endometriosis is 10-20 percent of women during reproductive \nyears.  It is a disease that affects many regions of the body including, \npelvic cavity, abdominal cavity, chest, and subcutaneous tissues.  \nThe clinical picture depends on the organs affected by this disease \nprocess. Endometriosis depends on estrogen for its growth and \nsurvival.  The main source of estrogen is the ovary.  Therefore, the \nmain line of treatment of these patients is to suppress the ovarian \nfunction, and thus decrease estrogen production that leads to \ninhibition of endometriosis growth. The other source of estrogen \nthat stimulates the growth of endometriosis, is the endometriotic \ncells due to the presence of aromatase that converts testosterone \nto estradiol and androstenedione to estrone [1,2]. This explains \nthe recurrence of endometriosis following removal of the ovaries, \nand also in menopausal women. Aromatase is present also in \nsubcutaneous fat, skin fibroblasts, placental syncytiotrophoblast, \nosteoblasts and the brain [3,4].  Aromatase is stimulated by \nprostaglandin E2 in endometriotic stromal cells.\nAromatase Inhibitors for Treatment of Endometriosis\nAccording to the pathogenesis of endometriosis and the various \nsources of estrogen for the growth of the disease, treatment must \nbe focused on the suppression of estrogen sources.  Therefore, the \ntreatment of a patient with endometriosis during the reproductive \nyears must include 2 agents: \na. Agent to suppress hypothalamic pituitary axis and this \nincludes oral progestogens or GnRH agonist, and \nb. Aromatase inhibitor as Letrozole or Anastrozole to \nsuppress the aromatase produced by endometriosis cells and \nperipheral tissues as stated.\nA meta-analysis of eight trials included 137 women showed \nthat combination of aromatase inhibitors with progestins, oral \ncontraceptives, or GnRh agonists, relieved the pain, reduced the \nsize of the lesions, and improved the quality of life. The European \nSociety of Reproduction and Embryology recommends the use of \naromatase inhibitor with oral contraceptives or GnRH agonist for \nendometriosis patients with pain from rectovaginal endometriosis, \nrefractory to other medical or surgical treatment [5]. In our \nlaboratory, we have shown that aromatase inhibitor significantly \ninhibited the growth of endometriosis cells in culture [6].\nPostmenopausal Endometriosis\nHistory of endometriosis dates back to 1690 when it \nwas first described by Daniel Cristianus.  The first report of \npostmenopausal endometriosis was 250 years later.  The first case \nreported was by Edgar Haydon in 1942; in a 78-year-old woman.  \nIn 1960, Kempers et al reported a series of 136 women with \npostmenopausal endometriosis.  In 1980, Punnonen et al reported \n11 cases of postmenopausal ovarian endometriosis [7]. The data \nin the literature reports an incidence of 2-5% of endometriosis in \npostmenopausal women between ages of 55-95 years old.  Sources \nof estrogen could be from hormonal therapy.  It also could be due \nto aromatase that is present in various tissues. In postmenopausal \nendometriosis, the treatment will focus on the use of aromatase \nReceived: \n   August 14, 2020\nPublished: \n   August 26, 2020\nARTICLE INFO ABSTRACT\nCitation: Shawky ZA Badawy, Jonathan D Franceschini. Aromatase Inhibitors Use for En-\ndometriosis Patients. Biomed J Sci & Tech Res 29(5)-2020. BJSTR. MS.ID.004854.\n\nCopyright@ Shawky ZA Badawy | Biomed J Sci & Tech Res | BJSTR. MS.ID.004854.\nVolume 29- Issue 5\nDOI: 10.26717/BJSTR.2020.29.004854\n22765\ninhibitor to suppress estrogen from all peripheral sources [8]. All \nthis data from both clinical studies, and laboratory studies, suggest \nthat the use of aromatase inhibitors for endometriosis treatment \nis very effective in alleviating the symptoms and decreasing the \nlesions.  Also, aromatase inhibitors are excellent line of treatment \nfor menopausal endometriosis [9].\nReferences \n1. Velasco I, Rusda J, Acien P (2006) Aromatase expression in endometriotic \ntissues and cell cultures of patients with endometriosis.  Molecular \nHuman Reproduction 12(6): 377-381.\n2. Acien P , Velasco I, Gutierrez M, Martinez Beltran M (2007) Aromatase \nexpression in endometriotic tissues and its relationship to clinical and \nanalytical findings.  Fertil Steril 88(1): 32-38.\n3. Sasson IE, Taylor HS (2009) Aromatase inhibitor for treatment of \nrecurrence after laparoscopic treatment of endometriosis.  Fertil Steril \n92(3): 1170.e1-1170.e4.\n4. Snyder BM, Beets JW, Lessey BA, Horton SRW, Abrams GA (2018) \nPostmenopausal Deep Infiltrating Endometriosis of the Colon: Rare \nLocation and Novel Medical Therapy. Case reports in gastrointestinal \nmedicine.\n5. Dunselman GA, Vermeulon N, Becker C, C Calhaz Jorge, T D’Hooghe, et al.  \n(2014) ESHRE guidelines: management of women with endometriosis. \nHum Reprod 29(3): 400-412.\n6. Badawy SZA, Brown S, Kaufman L, Wojtowyca MA (2015) Aromatase \ninhibitor (Anastrozole) affects growth of endometrioma cells in culture.  \nEuropean J Obstet Gynecol and Reprod Biol 188: 45-50.\n7. Punnonon R, Klemi PJ, Nikkanen V (1980) Postmenopausal \nendometriosis. Eur J Obstet Gynecol Reprod Biol 11(3): 195-200.\n8. Pdyzos NP , Faterni HM, Zavoset, Grigoris Grimbizis, Dimitra Kyrou, et al. \n(2012) Aromatase inhibitors in postmenopausal endometriosis.  Reprod \nBiol and endocrine.\n9. Mousa NA, Bedaiwy MA, Casper RF (2007) Aromatase inhibitors in the \ntreatment of severe endometriosis.  Obstet Gynecol 109(6): 1421-1423.\nSubmission Link: https://biomedres.us/submit-manuscript.php\nAssets of Publishing with us\n• Global archiving of articles\n• Immediate, unrestricted online access\n• Rigorous Peer Review Process\n• Authors Retain Copyrights\n• Unique DOI for all articles\nhttps://biomedres.us/\nThis work is licensed under Creative\nCommons Attribution 4.0 License\nISSN: 2574-1241\nDOI: 10.26717/BJSTR.2020.29.004854\nShawky ZA Badawy. Biomed J Sci & Tech Res","source_license":"CC0","license_restricted":false}