Aromatase inhibitors in the treatment of bladder endometriosis

BACKGROUND: Aromatase inhibitors have recently been proposed for the treatment of endometriosis; however, no previous study examined the effects of these agents on pain and urinary symptoms of premenopausal women with bladder endometriosis. CASE: Two premenopausal patients with bladder endometriosis were treated with letrozole (2.5 mg/day), norethisterone acetate (2.5 mg/day), elemental calcium and vitamin D3 for 6 months. The double-drug regimen quickly improved pain and urinary symptoms in both patients. One patient had no significant adverse effect and continued the therapy for 14 months. The other patient developed myalgia and severe arthralgia; pain and urinary symptoms recurred few months after the interruption of the 6-month treatment and the patient underwent laparoscopic partial cystectomy. CONCLUSION: Aromatase inhibitors improve pain and urinary symptoms in patients with bladder endometriosis; however, severe side effects of treatment may occur. These agents should be administered only to patients who refuse surgery and fail to respond to other therapies.