TREATMENT OF SEVERE POSTMENOPAUSAL ENDOMETRIOSIS WITH AN AROMATASE INHIBITOR

Objective: To treat an unusually aggressive case of recurrent postmeno pausal endometriosis. Design: Case report. Setting: University of Texa s Southwestern Medical Center (Dallas, Texas). Patient(s): A 57-year-o ld woman who presented with recurrent severe endometriosis after hyste rectomy and bilateral salpingo-oophorectomy. Intervention(s): Oral adm inistration of anastrozole (an aromatase inhibitor) (1 mg/d) and eleme ntal calcium (1.5 g/d) for 9 months. Alendronate (a nonestrogenic inhi bitor of bone resorption), 10 mg/d, was added to this regimen. Main Ou tcome Measure(s): Reduction in size of endometriotic lesion, pain reli ef, tissue levels of aromatase P450 messenger RNA, bone density. Resul t(s): Circulating levels of estradiol-17 beta were reduced to approxim ately 50% of the baseline value after the onset of treatment with anas trozole. Pain rapidly decreased and completely disappeared after the 2 nd month of treatment. The 30 x 30 x 20-mm bright red polypoid vaginal lesion was reduced to a 3-mm gray tissue by the end of 9 months of tr eatment. Markedly high pretreatment levels of aromatase P450 messenger RNA in the endometriotic tissue became undetectable in a specimen obt ained from a repeated biopsy after 6 months of treatment. Bone density of lumbar spine decreased by 6.2% after 9 months of treatment. Conclu sion(s): This is the first description of the use of an aromatase inhi bitor in the treatment of endometriosis. The short-term results were e xtraordinarily successful in elimination of pain and near-complete era dication of implants associated with severe endometriosis not responsi ve to other therapy. We conclude that the recently developed potent ar omatase inhibitors are candidate drugs in the treatment of endometrios is that is resistant to standard regimens. (C) 1998 by American Societ y for Reproductive Medicine.