Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review

<p>Abstract</p> <p>This systematic review aims to assess the efficacy of aromatase inhibitors (AIs) in treating pain symptoms caused by endometriosis. A comprehensive literature search was conducted to identify all the published studies evaluating the efficacy of type II nonsteroid...

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Main Authors: Venturini Pier L, Gillott David J, Ferrero Simone, Remorgida Valentino
Format: Article
Language:English
Published: BMC 2011-06-01
Series:Reproductive Biology and Endocrinology
Online Access:http://www.rbej.com/content/9/1/89
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spelling doaj-12fbe7194d9d428cbe76e38ff73d11922020-11-25T00:06:17ZengBMCReproductive Biology and Endocrinology1477-78272011-06-01918910.1186/1477-7827-9-89Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic reviewVenturini Pier LGillott David JFerrero SimoneRemorgida Valentino<p>Abstract</p> <p>This systematic review aims to assess the efficacy of aromatase inhibitors (AIs) in treating pain symptoms caused by endometriosis. A comprehensive literature search was conducted to identify all the published studies evaluating the efficacy of type II nonsteroidal aromatase inhibitors (anastrozole and letrozole) in treating endometriosis-related pain symptoms. The MEDLINE, EMBASE, PubMed, and SCOPUS databases and the Cochrane System Reviews were searched up to October 2010. This review comprises of the results of 10 publications fitting the inclusion criteria; these studies included a total of 251 women. Five studies were prospective non-comparative, four were randomized controlled trials (RCTs) and one was a prospective patient preference trial. Seven studies examined the efficacy of AIs in improving endometriosis-related pain symptoms, whilst three RCTs investigated the use of AIs as post-operative therapy in preventing the recurrence of pain symptoms after surgery for endometriosis. All the observational studies demonstrated that AIs combined with either progestogens or oral contraceptive pill reduce the severity of pain symptoms and improve quality of life. One patient preference study demonstrated that letrozole combined with norethisterone acetate is more effective in reducing pain and deep dyspareunia than norethisterone acetate alone. However, letrozole causes a higher incidence of adverse effects and does not improve patients' satisfaction or influence recurrence of symptoms after discontinuation of treatment. A RCT showed that combining letrozole with norethisterone acetate causes a lower incidence of adverse effects and lower discontinuation rate than combining letrozole with triptorelin. Two RCTs demonstrated that, after surgical treatment of endometriosis, the administration of AIs combined with gonadotropin releasing hormone analogue for 6 months reduces the risk of endometriosis recurrence when compared with gonadotropin releasing hormone analogue alone. In conclusion, AIs effectively reduce the severity of endometriosis-related pain symptoms. Since endometriosis is a chronic disease, future investigations should clarify whether the long-term administration of AIs is superior to currently available endocrine therapies in terms of improvement of pain, adverse effects and patient satisfaction.</p> http://www.rbej.com/content/9/1/89
collection DOAJ
language English
format Article
sources DOAJ
author Venturini Pier L
Gillott David J
Ferrero Simone
Remorgida Valentino
spellingShingle Venturini Pier L
Gillott David J
Ferrero Simone
Remorgida Valentino
Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review
Reproductive Biology and Endocrinology
author_facet Venturini Pier L
Gillott David J
Ferrero Simone
Remorgida Valentino
author_sort Venturini Pier L
title Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review
title_short Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review
title_full Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review
title_fullStr Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review
title_full_unstemmed Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review
title_sort use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review
publisher BMC
series Reproductive Biology and Endocrinology
issn 1477-7827
publishDate 2011-06-01
description <p>Abstract</p> <p>This systematic review aims to assess the efficacy of aromatase inhibitors (AIs) in treating pain symptoms caused by endometriosis. A comprehensive literature search was conducted to identify all the published studies evaluating the efficacy of type II nonsteroidal aromatase inhibitors (anastrozole and letrozole) in treating endometriosis-related pain symptoms. The MEDLINE, EMBASE, PubMed, and SCOPUS databases and the Cochrane System Reviews were searched up to October 2010. This review comprises of the results of 10 publications fitting the inclusion criteria; these studies included a total of 251 women. Five studies were prospective non-comparative, four were randomized controlled trials (RCTs) and one was a prospective patient preference trial. Seven studies examined the efficacy of AIs in improving endometriosis-related pain symptoms, whilst three RCTs investigated the use of AIs as post-operative therapy in preventing the recurrence of pain symptoms after surgery for endometriosis. All the observational studies demonstrated that AIs combined with either progestogens or oral contraceptive pill reduce the severity of pain symptoms and improve quality of life. One patient preference study demonstrated that letrozole combined with norethisterone acetate is more effective in reducing pain and deep dyspareunia than norethisterone acetate alone. However, letrozole causes a higher incidence of adverse effects and does not improve patients' satisfaction or influence recurrence of symptoms after discontinuation of treatment. A RCT showed that combining letrozole with norethisterone acetate causes a lower incidence of adverse effects and lower discontinuation rate than combining letrozole with triptorelin. Two RCTs demonstrated that, after surgical treatment of endometriosis, the administration of AIs combined with gonadotropin releasing hormone analogue for 6 months reduces the risk of endometriosis recurrence when compared with gonadotropin releasing hormone analogue alone. In conclusion, AIs effectively reduce the severity of endometriosis-related pain symptoms. Since endometriosis is a chronic disease, future investigations should clarify whether the long-term administration of AIs is superior to currently available endocrine therapies in terms of improvement of pain, adverse effects and patient satisfaction.</p>
url http://www.rbej.com/content/9/1/89
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