Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor

Objective: To treat severe endometriosis in premenopausal women with an aromatase inhibitor and to document the efficacy and side effects of this new treatment. Design: Case report. Setting: Clinical practice setting. Patient(s): Patients were premenopausal endometriosis cases confirmed by prior laparoscopy. Intervention(s): Oral administration of the aromatase inhibitor anastrozole with the addition of 200-mg oral progesterone (P) capsules once daily, hs, and calcitriol 0.5 mug oral capsules twice daily. All three medications were given daily for 21 days followed by 7 days off, for a 28-day treatment cycle. Additionally, rofecoxib 12.5 mg was administered once a day continuously for the 28-day cycle. The dose could be increased to 25-50 mg daily as needed for increased pain. Six repeat 28-day cycles were planned for the treatment course depending on patient tolerance and response. Main Outcome Measure(s): Reduction of symptoms, elimination of endometrial implants, and improvement in fertility potential in the future. Monitoring for ovarian hyperstimulation as a side effect of aromatase inhibitor therapy. Documentation of potential symptoms or side effects when an aromatase inhibitor is used in menstruating women. Result(s): Treatment resulted in a rapid, progressive reduction in symptoms over 3 months with the maintenance of remission of symptoms for over 24 months after treatment in both cases. There was confirmation of absence of disease in one case by follow-up laparoscopy 15 months after treatment. Pregnancy was achieved in both cases after 24 months. Conclusion(s): This is the first case report of successful treatment of severe endometriosis in premenopausal women with the aromatase inhibitor anastrozole combined with P, rofecoxib, and calcitriol. Treatment resulted in a rapid elimination of symptoms and was well tolerated in both cases.