Aromatase Inhibitors in the Treatment of Severe Endometriosis

Noha A. Mousa, Mohamed A. Bedaiwy, Casper RF, Robert F. Casper
Obstetrics and gynecology · 2007 · vol. 109(6) , pp. 1421–1423 · doi:10.1097/01.aog.0000265807.19397.6d · PMID:17540816 · W2056817373
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

Letrozole relieved endometriosis-associated pain in a postmenopausal woman when exemestane failed, indicating differential patient response to aromatase inhibitors.

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This case report examines the efficacy of aromatase inhibitors for managing severe endometriosis-associated chronic pelvic pain in a postmenopausal woman who remained symptomatic after hysterectomy and bilateral salpingo-oophorectomy. The patient initially failed to respond to exemestane but experienced significant pain relief with letrozole, while concomitant estrogen therapy successfully managed hot flushes without triggering pain recurrence. The authors conclude that letrozole was superior to exemestane in this instance, highlighting that patients may exhibit variable responses to different agents within the same drug class. This paper is centrally about endometriosis — specifically the pharmacological management of persistent pelvic pain following surgical menopause when standard hormonal suppression has failed.

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Abstract

BACKGROUND: Endometriosis-associated chronic pelvic pain unresponsive to surgical menopause is a difficult clinical problem. CASE: A middle-aged woman presented with endometriosis and severe pelvic pain after hysterectomy and bilateral salpingo-oopherectomy. She was first treated with exemestane without improvement of symptoms. However, another aromatase inhibitor, letrozole, relieved her pain, and concomitant treatment with estrogen relieved hot flushes without pain reactivation. CONCLUSION: Letrozole was superior to exemestane in relieving the endometriosis-associated pain in this postmenopausal woman. This suggests that patients may respond variably to different aromatase inhibitors.
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Background

Endometriosis-associated chronic pelvic pain unresponsive to surgical menopause is a difficult clinical problem. CASE: A middle-aged woman presented with endometriosis and severe pelvic pain after hysterectomy and bilateral salpingo-oopherectomy. She was first treated with exemestane without improvement of symptoms. However, another aromatase inhibitor, letrozole, relieved her pain, and concomitant treatment with estrogen relieved hot flushes without pain reactivation.

Conclusion

Letrozole was superior to exemestane in relieving the endometriosis-associated pain in this postmenopausal woman. This suggests that patients may respond variably to different aromatase inhibitors. An aromatase inhibitor relieved persistent endometriosis pain in a posthysterectomy patient. Copyright © 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Aromatase Inhibitors Endometriosis Nitriles Pelvic Pain Triazoles Androstadienes Androstadienes Aromatase Inhibitors Chronic Disease Endometriosis Endometriosis Estrogen Replacement Therapy Female Hot Flashes Hot Flashes Hot Flashes Humans Hysterectomy Letrozole Middle Aged

Citation neighborhood

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