Letrozole in Endometriosis: A Observational Study

Background: This prospective observational study aimed to evaluate the clinical efficacy and safety of a multidrug regimen—letrozole, oral contraceptive pills (OCPs) and calcium supplementation—for the treatment of endometriosis-associated pelvic pain. A total of 50 reproductive-age women with laparoscopically confirmed endometriosis and a baseline Visual Analogue Scale (VAS) pain score of ≥ 5 were enrolled. Participants were divided into two groups: Group A (n=25) received the combination therapy, and Group B (n=25) received OCPs only for a duration of four months. Both groups demonstrated a statistically significant reduction in pain. However, the decline in dysmenorrhea, dyspareunia, and chronic pelvic pain was significantly more pronounced in the letrozole combination group. These findings suggest that letrozole in combination with OCPs is a promising and effective adjunct therapy for endometriosis, particularly in cases of severe pain, though larger, randomized controlled trials are essential to establish its long-term role in disease management and recurrence prevention. Objective: This study aimed to evaluate the clinical efficacy and safety of letrozole, a third-generation aromatase inhibitor, when used in combination with oral contraceptive pills (OCPs), and calcium supplementation, compared with OCPs alone, in reducing endometriosis-associated pelvic pain. Methods: A prospective observational study was conducted at Patna Medical College And Hospital on 50 reproductive-age women with laparoscopically confirmed endometriosis and a baseline pain score of ≥5 on the Visual Analogue Scale (VAS). Group A (n = 25) received letrozole + OCP + calcium carbonate, while Group B (n = 25) received OCP only, for 4 months. Pain severity, gastrointestinal symptoms, hormonal profile, and side effects were assessed. Results: Both groups showed significant pain reduction after 4 months (p < 0.05). However, the decline in dysmenorrhea, dyspareunia, and pelvic pain was more pronounced in the letrozole group. Additional improvement in gastrointestinal symptoms, such as bloating and dyschezia, was reported predominantly in the letrozole group. Side effects were minimal, with irregular bleeding being the most common. Conclusion: Letrozole in combination with OCPs significantly improves pain relief compared to OCP alone. It is a promising adjunct therapy in endometriosis management. Further large-scale randomized trials are warranted to establish its role in long-term disease control and recurrence prevention.