Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis
Abstract
Objective To assess the effects of aromatase inhibitors in women symptomatic of pain with endometriosis. Design A systematic review of published literature. Material and methods We conducted a comprehensive literature search to identify all the published observational and randomised studies evaluating the efficacy of aromatase inhibitors on pain associated with endometriosis. A combination of keywords was used to identify the maximum number of relevant citations in MEDLINE, EMBASE, CINAHL and the Cochrane Database. Outcome Pain relief, lesion size and quality of life. Results There were eight studies (137 women) evaluating outcomes of aromatase inhibitors. In case series/reports (seven studies, 40 women), aromatase inhibitors combined with progestogens or oral contraceptive pill or gonadotrophin‐releasing hormone (GnRH) analogues reduced mean pain scores and lesion size and improved quality of life. An RCT (97 women) demonstrated that aromatase inhibitors in combination with GnRH analogues significantly improved pain (P < 0.0001) compared with GnRH analogues alone together with significant improvement in multidimensional patient scores (P < 0.0001). There was no significant reduction in spine or hip‐bone densities. Conclusion Aromatase inhibitors appear to have a promising effect on pain associated with endometriosis, but the strength of this inference is limited due to a dearth of the evidence available.
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Current treatments for endometriosis have limited long-term success and frequent side effects.
“These treatments have limited long-term success with frequent side effects.[56][57][58][59]”
From Altered genome-wide methylation in endometriosis (2014) · cites this paper as [58]
Cites
Koninckx, P. R., Meuleman, C., Demeyere, S., Lesaffre, E., & Cornillie, F. J. (1991) · Fertility and Sterility · doi:10.1016/s0015-0282(16)54244-7 · Cited by 849 · see citing works
The Epidemiology of Endometriosis
CRAMER, D. W., & MISSMER, S. A. (2002) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2002.tb02761.x · Cited by 539 · see citing works
Epidemiology of endometriosis-associated infertility.
Wheeler, J. M. (1989) · PubMed · Cited by 270 · see citing works
Treatment of severe postmenopausal endometriosis with an aromatase inhibitor
Takayama, K., Zeitoun, K., Gunby, R. T., Sasano, H., Carr, B. R., & Bulun, S. E. (1998) · Fertility and Sterility · doi:10.1016/s0015-0282(98)00022-3 · Cited by 270 · see citing works
Kjerulff, K. H., Erickson, B. A., & LANGENBERG, P. W. (1996) · American Journal of Public Health · doi:10.2105/ajph.86.2.195 · Cited by 258 · see citing works
Ailawadi, R., Jobanputra, S., Kataria, M., Gürateş, B., & Bulun, S. E. (2004) · Fertility and Sterility · doi:10.1016/j.fertnstert.2003.09.029 · Cited by 233 · see citing works
Soysal, S. (2004) · Human Reproduction · doi:10.1093/humrep/deh035 · Cited by 227 · see citing works
Epidemiology of endometriosis in women attending family planning clinics
Vessey, M. P., Villard-Mackintosh, L., & Painter, R. (1993) · BMJ · doi:10.1136/bmj.306.6871.182 · Cited by 217 · see citing works
Anastrazole and oral contraceptives: a novel treatment for endometriosis
Amsterdam, L. L., Gentry, W. L., Jobanputra, S., Wolf, M., Rubin, S. D., & Bulun, S. E. (2005) · Fertility and Sterility · doi:10.1016/j.fertnstert.2005.02.018 · Cited by 217 · see citing works
Health-related quality of life burden of women with endometriosis: a literature review
Gao, X., Yeh, Y.-C., Outley, J., Simon, J., Botteman, M., & Spalding, J. (2006) · Current Medical Research and Opinion · doi:10.1185/030079906x121084 · Cited by 206 · see citing works
Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain
Carter, J. E. (1994) · The Journal of the American Association of Gynecologic Laparoscopists · doi:10.1016/s1074-3804(05)80830-8 · Cited by 175 · see citing works
Bulun, S. E., Fang, Z., İmir, G., Gürateş, B., Tamura, M., Yilmaz, B., Langoi, D., Amin, S. A., Yang, S., & Deb, S. (2004) · Seminars in Reproductive Medicine · doi:10.1055/s-2004-823026 · Cited by 131 · see citing works
Molecular basis for treating endometriosis with aromatase inhibitors
Bulun, S. E. (2000) · Human Reproduction Update · doi:10.1093/humupd/6.5.413 · Cited by 113 · see citing works
Aromatase expression in endometriotic tissues and cell cultures of patients with endometriosis
Velasco, I. (2006) · Molecular Human Reproduction · doi:10.1093/molehr/gal041 · Cited by 108 · see citing works
Hefler, L., Grimm, C., van Trotsenburg, M., & Nagele, F. (2005) · Fertility and Sterility · doi:10.1016/j.fertnstert.2005.04.059 · Cited by 93 · see citing works
Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor
Shippen, E., & West, W. J. (2004) · Fertility and Sterility · doi:10.1016/j.fertnstert.2003.11.027 · Cited by 85 · see citing works
Razzi, S., Fava, A., Sartini, A., Simone, S. D., Cobellis, L., & Petraglia, F. (2004) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1046/j.1471-0528.2003.00038.x · Cited by 69 · see citing works
Fatemi, H. M., Al-Turki, H., Papanikolaou, E. G., Kosmas, L., Sutter, P. D., & Devroey, P. (2005) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)61140-6 · Cited by 66 · see citing works
Dheenadayalu, K., Mak, I., Gordts, S., Campo, R., HIGHAM, J. M., Puttemans, P., WHITE, J. O., Christian, M., Fusi, L., & Brosens, J. J. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03324-1 · Cited by 49 · see citing works
Meresman, G. F., Bilotas, M. A., Abello, V., Buquet, R. A., Tesone, M., & Sueldo, C. E. (2005) · Fertility and Sterility · doi:10.1016/j.fertnstert.2005.01.137 · Cited by 49 · see citing works
Appleyard, T., Mann, C., & Khan, K. (2006) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2006.00937.x · Cited by 34 · see citing works
Self-citationUse of estrogen antagonists and aromatase inhibitors in endometriosis.
Viganò, P., Mangioni, S., Odorizzi, M. P., et al. (2003) · PubMed · Cited by 24 · see citing works
The LUNA Trial Collaboration (2003) · BMC Women s Health · doi:10.1186/1472-6874-3-6 · Cited by 16 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
ESHRE guideline: management of women with endometriosis
Dunselman, G. A. J., Vermeulen, N., Becker, C., Calhaz-Jorge, C., D'Hooghe, T., De Bie, B., Heikinheimo, O., Horne, A. W., Kiesel, L., Nap, A., et al. (2014) · Human Reproduction · doi:10.1093/humrep/det457 · Cited by 2,211 · see citing works
Giudice, L. C. (2010) · New England Journal of Medicine · doi:10.1056/nejmcp1000274 · Cited by 1,924 · see citing works
The link between immunity, autoimmunity and endometriosis: a literature update
Zhang, T., De Carolis, C., Man, G. C. W., & Wang, C. C. (2018) · Autoimmunity Reviews · doi:10.1016/j.autrev.2018.03.017 · Cited by 196 · see citing works
“Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis
Vercellini, P., Crosignani, P., Somigliana, E., Vigano, P., Frattaruolo, M. P., & Fedele, L. (2011) · Human Reproduction · doi:10.1093/humrep/deq302 · Cited by 180 · see citing works
“This finding has prompted performance of several pilot studies in women with endometriosis using one of the two available reversible aromatase inhibitors (i.e. anastrozole and letrozole), which compete with androgens for aromatase-binding sites (Patwardhan et al., 2008; Ferrero et al., 2009a).”
BackgroundNew developments in the medical treatment of endometriosis
Bedaiwy, M. A., Alfaraj, S., Yong, P., & Casper, R. (2017) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.12.025 · Cited by 176 · see citing works
Medical Management of Endometriosis
RAFIQUE, S., & DECHERNEY, A. H. (2017) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000292 · Cited by 173 · see citing works
Medical treatment for rectovaginal endometriosis: what is the evidence?
Vercellini, P., Crosignani, P. G., Somigliana, E., Berlanda, N., Barbara, G., & Fedele, L. (2009) · Human Reproduction · doi:10.1093/humrep/dep231 · Cited by 144 · see citing works
Kulak, J., Fischer, C., Komm, B., & Taylor, H. S. (2011) · Endocrinology · doi:10.1210/en.2010-1010 · Cited by 112 · see citing works
Disturbed estrogen and progesterone action in ovarian endometriosis
Šmuc, T., Hevir, N., Ribič-Pucelj, M., Husen, B., Thole, H., & Rižner, T. L. (2009) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2008.07.020 · Cited by 101 · see citing works
Sakr, S., Naqvi, H., Komm, B., & Taylor, H. S. (2014) · Endocrinology · doi:10.1210/en.2013-1977 · Cited by 91 · see citing works
Altered genome-wide methylation in endometriosis
Naqvi, H., Ilagan, Y., Krikun, G., & Taylor, H. S. (2014) · Reproductive Sciences · doi:10.1177/1933719114532841 · Cited by 82 · see citing works
From pathogenesis to clinical practice: Emerging medical treatments for endometriosis
Clemenza, S., Sorbi, F., Noci, I., Capezzuoli, T., Turrini, I., Carriero, C., Buffi, N., Fambrini, M., & Petraglia, F. (2018) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2018.01.021 · Cited by 63 · see citing works
Naqvi, H., Sakr, S., Presti, T., Krikun, G., Komm, B., & Taylor, H. S. (2014) · Biology of Reproduction · doi:10.1095/biolreprod.113.114165 · Cited by 54 · see citing works
Androgens, Endometriosis and Pain
Evans, S. F., Hull, M. L., Hutchinson, M. R., & Rolan, P. E. (2021) · Frontiers in Reproductive Health · doi:10.3389/frph.2021.792920 · Cited by 14 · see citing works
- Authors
- Patwardhan, S., Nawathe, A., Yates, D., Harrison, G., & Khan, K.
- Affiliations
- Birmingham Women's Hospital (GB)
- Corresponding author
- Patwardhan, S
- ORCID
- Patwardhan, S
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2008-06
- Volume
- 115
- Issue
- 7
- Pages
- 818-822
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W1993192106
- Cited by
- 116
- References
- 23
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 4 · 2020: 8 · 2019: 5 · 2018: 8 · 2017: 8 · 2016: 6 · 2015: 9 · 2014: 9 · 2013: 2 · 2012: 5
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Update notices
- erratum (2008-06-28)
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- 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 › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Keywords
- aromatase inhibitors, endometriosis, dysmenorrhea, analgesia, GnRH analogues, progestogens, oral contraceptives, lesion size, quality of life, bone mineral density, combination therapy
- MeSH terms
- Analgesics, Contraceptive Agents, Female, Endometriosis, Estrogen Antagonists, Female, Humans, Immunologic Factors, Quality of Life, Receptors, Progesterone, Levonorgestrel, Pelvic Pain, Angiogenesis Inhibitors, Aromatase Inhibitors
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