Pharmacological Treatment of Endometriosis

Simone Ferrero, Pier Luigi Venturini, Pier L Venturini, Nicola Ragni, Giovanni Camerini, Valentino Remorgida
Drugs · 2009 · vol. 69(8) , pp. 943–952 · doi:10.2165/00003495-200969080-00001 · PMID:19496625 · W78201951
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-13 ⓘ

Aromatase inhibitors may offer a new endometriosis treatment option, improving pain symptoms with minimal side effects but showing variable effects on lesions and a potential for short-term symptom recurrence.

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This paper reviews pharmacological treatment options for endometriosis, focusing on the rationale and reported clinical evidence for aromatase inhibitors given the aberrant expression of aromatase (P450) in endometriotic implants and eutopic endometrium. The authors summarize case reports and observational studies reporting rapid improvement in endometriosis-associated pain after aromatase inhibitor administration, while noting limited data on longer-term pain outcomes and mixed results regarding lesion improvement or persistence at second-look laparoscopy, with no severe adverse effects reported in pre- and post-menopausal women. A key limitation emphasized is the lack of randomized controlled trials sufficient to support routine use, leading the review to recommend aromatase inhibitors only for a small subset with severe pain despite prior therapies. This paper is centrally about endometriosis — it focuses on the pharmacological use of aromatase inhibitors and summarizes evidence for their effects on pain and lesions in endometriosis.

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Abstract

Current treatment of endometriosis is mainly based on surgery and ovarian suppressive agents. In the last 10 years, it has been demonstrated that aromatase P450, a key enzyme for estrogen biosynthesis, may have a pathogenic role in endometriosis because it is aberrantly expressed in endometriotic implants and in eutopic endometrium of women with endometriosis. Therefore, inhibition of aromatase activity may represent a new therapeutic option for endometriosis. Case reports and observational studies have shown that pain symptoms caused by endometriosis quickly improve after administration of aromatase inhibitors. Limited data are available on the long-term course of pain symptoms after completion of treatment with aromatase inhibitors; however, some recent studies suggest that symptoms may recur at short-term follow-up. A range of results are reported on the effects of aromatase inhibitors on endometriotic lesions, with some authors describing improvements and other authors reporting persistence of pelvic lesions at second-look laparoscopy after treatment. No severe adverse effect has been reported during treatment with aromatase inhibitors both in pre- and post-menopausal women. On the basis of the available data, administration of aromatase inhibitors should now be offered only to the small number of women who have severe pain despite previous surgical and hormonal therapies. Further research in the form of randomized controlled trials will be required before recommending the routine use of these agents. Similar content being viewed by others

References

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Acknowledgements

The authors thank Prof. Ezio Flucheri for providing the histological images used in the study. No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Ferrero, S., Venturini, P.L., Ragni, N. et al. Pharmacological Treatment of Endometriosis. Drugs 69, 943–952 (2009). https://doi.org/10.2165/00003495-200969080-00001 Published: Issue date: DOI: https://doi.org/10.2165/00003495-200969080-00001

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Condition tags

endometriosis

MeSH descriptors

Aromatase Inhibitors Endometriosis Pain Aromatase Aromatase Aromatase Inhibitors Aromatase Inhibitors Aromatase Inhibitors Clinical Trials as Topic Endometriosis Endometriosis Endometriosis Female Humans Pain Pain Postmenopause Premenopause Severity of Illness Index

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