Evaluation of the effect of aromatase inhibitor in reducing the size of endometrioma

Selina Afroz Ansary, Shakeela Ishrat, Jesmine Banu, Parveen Fatima, Faria Nasreen, Israt Jahan, Shajia Afrin, Khaleda Nasreen, Muhammad Mohsin
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2021 · vol. 10(4) , pp. 1295 · doi:10.18203/2320-1770.ijrcog20211103 · W3144496151
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Aromatase inhibitor (letrozole) combined with progestin add-back treatment for 6 months significantly reduced endometrioma size and associated pain, with volume decrease related to baseline volume and inversely related to baseline BMI.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This prospective non-comparative observational study evaluated whether aromatase inhibition affects ovarian endometrioma size in 30 women treated for 6 months with letrozole plus norethisterone as add-back, assessing endometriomas by transvaginal ultrasound at baseline, 3 months, and 6 months. The study found that more than 50% volume reduction occurred in 90% of endometriomas, with complete disappearance in one case, and there was a statistically significant reduction in endometrioma mean diameter and volume along with pain; volume decrease correlated linearly with baseline endometrioma volume and inversely with baseline BMI. Mild, well-tolerated side effects were reported, but the authors note a major limitation inherent to the design: no comparative control group was included. This paper is centrally about endometriosis — it evaluates aromatase inhibitor (letrozole) treatment to reduce ovarian endometrioma size and associated pain.

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Abstract

Background: Endometriosis is a chronic and progressive estrogen-dependent disorder that can result in substantial morbidity, including pelvic pain, multiple operations, and infertility. Endometriosis can be ovarian, peritoneal or deep infiltrative. Blocking estrogen production by inhibiting aromatization, aromatase inhibitor (letrozole) has been shown to reduce the size of endometrioma and endometriosis associated pain. Aim of the study was to evaluate the effect of aromatase inhibitor in reducing the size of endometrioma.Methods: A prospective non comparative observational study was conducted in the Department of Reproductive Endocrinology and Infertility of BSMMU on 30 women with ovarian endometrioma during the period of April 2019 to March 2020. Women were treated with aromatase inhibitor (letrozole) 2.5 mg, norethisterone 5 mg, calcium 1200 mg, and vitamin D 800 IU daily for 6 months. Transvaginal ultrasound was performed at baseline, 3 months and 6 months after treatment to assess the mean diameter and volume of endometriomas. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0.Results: More than 50% reduction in volume occurred in 90% of endometrioma. In one (3.3%) case endometrioma disappeared completely after 6 months. There was statistically significant reduction of size of endometrioma (estimated by mean diameter and volume) and pain. Volume decrease was linearly related to baseline endometrioma volume and inversely related to baseline body mass index (BMI). The side effects were mild and well tolerated by the patients.Conclusions: Treatment of ovarian endometrioma with aromatase inhibitor combined with progestin add-back for 6 months cause substantial reduction in size of endometrioma and associated pain.

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endometriosisendometriomainfertility

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