OP20.06: Changes in sonographic findings of adenomyosis after treatment with aromatase inhibitor

To investigate the changes in the sonographically detectable alterations of the myometrium caused by adenomyosis after treatment with aromatase inhibitor. This prospective study included symptomatic women with adenomyosis. The diagnosis of adenomyosis was suspected on the basis of transvaginal ultrasonography (TVS) and confirmed by magnetic resonance imaging. Patients received oral letrozole (2.5 mg/day, Femara; Novartis Farma) for 6 months. Patients underwent TVS before starting the treatment, after 3 and 6 months of treatment. During TVS the following parameters were examined: uterine diameters and volume, thickening of the transition zone, regularity of the endometrial-myometrial junction, presence and size of myometrial cystic anechoic areas, thickness of uterine wall, asymmetrical myometrial thickening (not cause by the presence of myomas), presence of subendometrial hyperechoic linear striation, parallel shadowing and characteristics of localized adenomyomas. 34 patients were included in the study; 4 patients (11.8%) discontinued the therapy because of adverse effects. After 3 months of treatment there was a significant decrease in uterine volume (p < 0.05); a further decrease was observed after 6 month of treatment (p < 0.001 compared with baseline; p < 0.05 compared with 3-month treatment; 6-month decrease in uterine volume: 56.2%). The treatment caused a significant decrease in: size of anechoic area (p < 0.01), thickness of uterine wall (p < 0.05), larger diameter of localized adenomyomas (p < 0.01) and total adenomyoma volume (p < 0.001, decrease in total adenomyoma volume: 53.7%). The treatment improved pain symptoms. In patients with adenomyosis, letrozole causes a significant decrease in uterine and adenomyoma volume, which is associated with changes in some ultrasonographic characteristics of adenomyosis.