Aromatase Inhibitors in the Treatment of Severe Endometriosis

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.