CoChat
Sign Up
Cited by 138Endometriosis Research and TreatmentEctopic Pregnancy Diagnosis and ManagementGynecological conditions and treatments

Aromatase inhibitors for the treatment of endometriosis

Open access
Pavone, Mary Ellen, Bulun, Serdar E.·2012·Fertility and Sterility
DOI 10.1016/j.fertnstert.2012.08.053PMC PMC3513666
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective To review the use of aromatase inhibitors (AIs) for the treatment of endometriosis. Design Literature review. Conclusion(s) Most studies show that in reproductive-age women, the combination of AI with conventional therapy alleviates endometriosis-related pain. In postmenopausal women, using an AI alone has been shown to be an effective treatment, although more studies are needed in this subgroup. Side effects of using AIs appear to be tolerable in most women, although special consideration should be given to monitoring bone mineral density. More studies need to be done examining pregnancy rates and outcomes after AI treatment for endometriosis. In addition, larger randomized clinical trials using AIs need to be done. In summary, AIs may be effective in treating endometriosis-related chronic pelvic pain in both reproductive-age and postmenopausal women.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.fertnstert.2012.08.053

Cites

6 of 6 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Intracrine oestrogen biosynthesis plays an important role in endometriosis-associated pain in postmenopausal women.

    “The current consensus is that AI should be considered as a treatment for endometriosis-associated pain in women who are postmenopausal but still symptomatic as it will target intracrine oestrogen biosynthesis, which is thought to play an important role in this age group [99].”

    From Endometrial Intracrinology: Oestrogens, Androgens and Endometrial Disorders (2018) · cites this paper as [99]

    The review links local estrogen production in endometriotic lesions to inflammation and pain, and its post-menopausal endometriosis section reports pain improvement with aromatase inhibitors. It does not establish that estrogen production within lesions is especially important in postmenopausal women: that section identifies extra-ovarian sources, particularly adipose tissue, as the main source of estrogen and says treatment should generally be surgical. The evidence for aromatase inhibitors in this group is described as limited, rather than an established treatment consensus. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Aromatase inhibitors may be a treatment option for postmenopausal women with endometriosis-associated pain, especially if surgery is not feasible.

    “For postmenopausal women with endometriosis-associated pain, clinicians may consider aromatase inhibitors as a treatment option especially if surgery is not feasible (Polyzos et al., 2011; Pavone and Bulun, 2012).”

    From ESHRE guideline: endometriosis (2022) · cites this paper as Pavone and Bulun, 2012

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 57

  1. [1]Bulun SE Endometriosis N Engl J Med 2009 360 268 279 19144942
  2. [2]Giudice LC Clinical practice. Endometriosis The New England journal of medicine 2010 362 2389 2398 20573927 PMC3108065
  3. [3]Lucidi RS Witz CA Chrisco M Binkley PA Shain SA Schenken RS A novel in vitro model of the early endometriotic lesion demonstrates that attachment of endometrial cells to mesothelial cells is dependent on the source of endometrial cells Fertility and sterility 2005 84 16 21 16009148
  4. [4]Giudice LC Kao LC Endometriosis Lancet 2004 364 1789 1799 15541453
  5. [6]Smith SF Roberts NJ Partridge MR Comparison of a web-based package with tutor based methods of teaching respiratory medicine: subjective and objective evaluations BMC Med Educ 2007 7 41 17976233 PMC2180172
  6. [7]Wu MH Sun HS Lin CC Hsiao KY Chuang PC Pan HA Distinct mechanisms regulate cyclooxygenase-1 and -2 in peritoneal macrophages of women with and without endometriosis Mol Hum Reprod 2002 8 1103 1110 12468643
  7. [8]Partridge AH Gelber S Peppercorn J Sampson E Knudsen K Laufer M Web-based survey of fertility issues in young women with breast cancer J Clin Oncol 2004 22 4174 4183 15483028
  8. [9]Agarwal VR Ashanullah CI Simpson ER Bulun SE Alternatively spliced transcripts of the aromatase cytochrome P450 (CYP19) gene in adipose tissue of women The Journal of clinical endocrinology and metabolism 1997 82 70 74 8989235
  9. [10]Agarwal VR Bulun SE Leitch M Rohrich R Simpson ER Use of alternative promoters to express the aromatase cytochrome P450 (CYP19) gene in breast adipose tissues of cancer-free and breast cancer patients The Journal of clinical endocrinology and metabolism 1996 81 3843 3849 8923826
  10. [12]Bulun SE Aromatase deficiency and estrogen resistance: from molecular genetics to clinic Seminars in reproductive medicine 2000 18 31 39 11305285
  11. [13]Fang Z Yang S Gurates B Tamura M Simpson E Evans D Genetic or enzymatic disruption of aromatase inhibits the growth of ectopic uterine tissue The Journal of clinical endocrinology and metabolism 2002 87 3460 3466 12107266
  12. [14]Fazleabas AT Brudney A Chai D Langoi D Bulun SE Steroid receptor and aromatase expression in baboon endometriotic lesions Fertility and sterility 2003 80 Suppl 2 820 827 14505759
  13. [15]Simpson ER Mahendroo MS Nichols JE Bulun SE Aromatase gene expression in adipose tissue: relationship to breast cancer Int J Fertil Menopausal Stud 1994 39 Suppl 2 75 83 7874190
  14. [16]Simpson ER Zhao Y Agarwal VR Michael MD Bulun SE Hinshelwood M Aromatase expression in health and disease Recent Prog Horm Res 1997 52 185 213 discussion-4 9238853
  15. [17]Attar E Bulun SE Aromatase and other steroidogenic genes in endometriosis: translational aspects Hum Reprod Update 2006 12 49 56 16123052
  16. [18]Kitawaki J Noguchi T Amatsu T Maeda K Tsukamoto K Yamamoto T Expression of aromatase cytochrome P450 protein and messenger ribonucleic acid in human endometriotic and adenomyotic tissues but not in normal endometrium Biology of reproduction 1997 57 514 519 9282984
  17. [20]Amsterdam LL Gentry W Jobanputra S Wolf M Rubin SD Bulun SE Anastrazole and oral contraceptives: a novel treatment for endometriosis Fertility and sterility 2005 84 300 304 16084868
  18. [21]Attar E Bulun SE Aromatase inhibitors: the next generation of therapeutics for endometriosis? Fertility and sterility 2006 85 1307 1318 16647373
  19. [22]Bulun SE Fang Z Imir G Gurates B Tamura M Yilmaz B Aromatase and endometriosis Seminars in reproductive medicine 2004 22 45 50 15083380
  20. [23]Ferrero S Venturini PL Gillott DJ Remorgida V Letrozole and norethisterone acetate versus letrozole and triptorelin in the treatment of endometriosis related pain symptoms: a randomized controlled trial Reprod Biol Endocrinol 2011 9 88 21693037 PMC3141645
  21. [24]Grodin JM Siiteri PK MacDonald PC Source of estrogen production in postmenopausal women The Journal of clinical endocrinology and metabolism 1973 36 207 214 4688315
  22. [25]Bulun SE Mahendroo MS Simpson ER Aromatase gene expression in adipose tissue: relationship to breast cancer J Steroid Biochem Mol Biol 1994 49 319 326 8043495
  23. [26]MacDonald PC Madden JD Brenner PF Wilson JD Siiteri PK Origin of estrogen in normal men and in women with testicular feminization The Journal of clinical endocrinology and metabolism 1979 49 905 916 511978
  24. [27]Zhao H Pearson EK Brooks DC Coon JSt Chen D Demura M A humanized pattern of aromatase expression is associated with mammary hyperplasia in mice Endocrinology 2012 153 2701 2713 22508516 PMC3359608
  25. [28]Gurates B Sebastian S Yang S Zhou J Tamura M Fang Z WT1 and DAX-1 inhibit aromatase P450 expression in human endometrial and endometriotic stromal cells The Journal of clinical endocrinology and metabolism 2002 87 4369 4377 12213901
  26. [29]Bulun SE Utsunomiya H Lin Z Yin P Cheng YH Pavone ME Steroidogenic factor-1 and endometriosis Molecular and cellular endocrinology 2009 300 104 108 19150483
  27. [31]Cheng YH Imir A Fenkci V Yilmaz MB Bulun SE Stromal cells of endometriosis fail to produce paracrine factors that induce epithelial 17beta-hydroxysteroid dehydrogenase type 2 gene and its transcriptional regulator Sp1: a mechanism for defective estradiol metabolism Am J Obstet Gynecol 2007 196 391 e1 e7 discussion e7-8 17403431
  28. [32]Cheng YH Imir A Suzuki T Fenkci V Yilmaz B Sasano H SP1 and SP3 mediate progesterone-dependent induction of the 17beta hydroxysteroid dehydrogenase type 2 gene in human endometrium Biology of reproduction 2006 75 605 614 16807381
  29. [34]Ferrero S Venturini PL Ragni N Camerini G Remorgida V Pharmacological treatment of endometriosis: experience with aromatase inhibitors Drugs 2009 69 943 952 19496625
  30. [35]Buzdar AU The ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial: an update Clin Breast Cancer 2004 5 Suppl 1 S6 S12 15347433
  31. [36]Jakesz R Jonat W Gnant M Mittlboeck M Greil R Tausch C Switching of postmenopausal women with endocrine-responsive early breast cancer to anastrozole after 2 years' adjuvant tamoxifen: combined results of ABCSG trial 8 and ARNO 95 trial Lancet 2005 366 455 462 16084253
  32. [37]Ligibel JA O'Malley AJ Fisher M Daniel GW Winer EP Keating NL Patterns of bone density evaluation in a community population treated with aromatase inhibitors Breast Cancer Res Treat 2012 PMC3449001 22791365
  33. [38]Llombart A Frassoldati A Paija O Sleeboom HP Jerusalem G Mebis J Immediate Administration of Zoledronic Acid Reduces Aromatase Inhibitor-Associated Bone Loss in Postmenopausal Women With Early Breast Cancer-12-month analysis of the E-ZO-FAST trial Clin Breast Cancer 2012 12 40 48 22014381
  34. [39]Eidtmann H de Boer R Bundred N Llombart-Cussac A Davidson N Neven P Efficacy of zoledronic acid in postmenopausal women with early breast cancer receiving adjuvant letrozole-36-month results of the ZO-FAST Study Ann Oncol 2010 21 2188 2194 20444845
  35. [40]Bundred NJ Campbell ID Davidson N DeBoer RH Eidtmann H Monnier A Effective inhibition of aromatase inhibitor-associated bone loss by zoledronic acid in postmenopausal women with early breast cancer receiving adjuvant letrozole: ZO-FAST Study results Cancer 2008 112 1001 1001 18205185
  36. [41]Brufsky AM Harker WG Beck JT Bosserman L Vogel C Seidler C Final 5-year results of Z-FAST trial: adjuvant zoledronic acid maintains bone mass in postmenopausal breast cancer patients receiving letrozole Cancer 2012 118 1192 1201 21987386
  37. [42]Ailawadi RK Jobanputra S Kataria M Gurates B Bulun SE Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study Fertility and sterility 2004 81 290 296 14967362
  38. [44]Remorgida V Abbamonte LH Ragni N Fulcheri E Ferrero S Letrozole and desogestrel-only contraceptive pill for the treatment of stage IV endometriosis Aust N Z J Obstet Gynaecol 2007 47 222 225 17550490
  39. [45]Legro RS Kunselman AR Brzyski RG Casson PR Diamond MP Schlaff W D The Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) trial: rationale and design of a double535 blind randomized trial of clomiphene citrate and letrozole for the treatment of infertility in women with polycystic ovary syndrome Contemp Clin Trials 2012 33 470 481 22265923 PMC3312939
  40. [46]Hefler LA Grimm C van Trotsenburg M Nagele F Role of the vaginally administered aromatase inhibitor anastrozole in women with rectovaginal endometriosis: a pilot study Fertility and sterility 2005 84 1033 1036 16213868
  41. [47]Shippen ER West WJ Jr Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor Fertility and sterility 2004 81 1395 1398 15136110
  42. [48]Abushahin F Goldman KN Barbieri E Milad M Rademaker A Bulun SE Aromatase inhibition for refractory endometriosis-related chronic pelvic pain Fertility and sterility 2011 96 939 942 21868006 PMC4498457
  43. [49]Remorgida V Abbamonte HL Ragni N Fulcheri E Ferrero S Letrozole and norethisterone acetate in rectovaginal endometriosis Fertility and sterility 2007 88 724 726 17331508
  44. [50]Ferrero S Camerini G Ragni N Venturini PL Biscaldi E Seracchioli R Letrozole and norethisterone acetate in colorectal endometriosis Eur J Obstet Gynecol Reprod Biol 2010 150 199 202 20227163
  45. [51]Ferrero S Camerini G Seracchioli R Ragni N Venturini PL Remorgida V Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis Hum Reprod 2009 24 3033 3041 19726448
  46. [52]Lall Seal S Kamilya G Mukherji J De A Ghosh D Majhi AK Aromatase inhibitors in recurrent ovarian endometriomas: report of five cases with literature review Fertility and sterility 2011 95 291 e15 e18 20579642
  47. [53]Goumenou AG Chow C Taylor A Magos A Endometriosis arising during estrogen and testosterone treatment 17 years after abdominal hysterectomy: a case report Maturitas 2003 46 239 241 14585528
  48. [54]Sesti F Vettraino G Pietropolli A Marziali M Piccione E Vesical and vaginal recurrent endometriosis in postmenopause following estrogen replacement therapy Eur J Obstet Gynecol Reprod Biol 2005 118 265 266 15653219
  49. [55]Takayama K Zeitoun K Gunby RT Sasano H Carr BR Bulun SE Treatment of severe postmenopausal endometriosis with an aromatase inhibitor Fertility and sterility 1998 69 709 713 9548162
  50. [56]Brinton LA Gridley G Persson I Baron J Bergqvist A Cancer risk after a hospital discharge diagnosis of endometriosis American journal of obstetrics and gynecology 1997 176 572 579 9077609
  51. [57]Borgfeldt C Andolf E Cancer risk after hospital discharge diagnosis of benign ovarian cysts and endometriosis Acta Obstet Gynecol Scand 2004 83 395 400 15005789
  52. [58]Fatemi HM Al-Turki HA Papanikolaou EG Kosmas L De Sutter P Devroey P Successful treatment of an aggressive recurrent post-menopausal endometriosis with an aromatase inhibitor Reprod Biomed Online 2005 11 455 457 16274608
  53. [59]Mousa NA Bedaiwy MA Casper RF Aromatase inhibitors in the treatment of severe endometriosis Obstet Gynecol 2007 109 1421 1423 17540816
  54. [60]Bohrer J Chen CC Falcone T Persistent bilateral ureteral obstruction secondary to endometriosis despite treatment with an aromatase inhibitor Fertility and sterility 2008 90 2004 e7 e9 18555228
  55. [61]Sasson IE Taylor HS Aromatase inhibitor for treatment of a recurrent abdominal wall endometrioma in a postmenopausal woman Fertility and sterility 2009 92 1170 e1 e4 19591983 PMC2742473
  56. [62]Razzi S Fava A Sartini A De Simone S Cobellis L Petraglia F Treatment of severe recurrent endometriosis with an aromatase inhibitor in a young ovariectomised woman Bjog 2004 111 182 184 14723761
  57. [63]Alborzi S Hamedi B Omidvar A Dehbashi S Alborzi M A comparison of the effect of short-term aromatase inhibitor (letrozole) and GnRH agonist (triptorelin) versus case control on pregnancy rate and symptom and sign recurrence after laparoscopic treatment of endometriosis Arch Gynecol Obstet 2011 284 105 110 20661580

Cited by

Sorted by citations

Authors
Pavone, M. E., & Bulun, S. E.
Affiliations
Northwestern University (US)
Corresponding author
Pavone, Mary Ellen
ORCID
Venue
Fertility and Sterility
Publisher
Elsevier BV
Published
2012-12
Volume
98
Issue
6
Pages
1370-1379
ISSN
0015-0282 (ISSN-L)
DOI
10.1016/j.fertnstert.2012.08.053
PMC
PMC3513666
OpenAlex
W2021118491
Cited by
138
References
6
Citations by year
2026: 6 · 2025: 7 · 2024: 9 · 2023: 9 · 2022: 8 · 2021: 9 · 2020: 15 · 2019: 3 · 2018: 15 · 2017: 8 · 2016: 10 · 2015: 17 · 2014: 11 · 2013: 9 · 2012: 1
FWCI
1.65
Type
journal article
Language
en
Open access
Licence
Locations
  • Fertility and Sterility (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
American Society for Reconstructive Microsurgery (R37HD038691)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
Keywords
aromatase inhibitors, endometriosis, chronic pelvic pain, postmenopausal women, women of reproductive age, bone mineral density, adverse effects, pregnancy outcomes, endometriosis treatment
MeSH terms
Endometriosis, Female, Humans, Infertility, Female, Ovulation Induction, Aromatase Inhibitors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review