Current treatment of
endometriosis is mainly based on surgery and ovarian suppressive agents. In the last 10 years, it has been demonstrated that
aromatase P450, a key
enzyme for
estrogen biosynthesis, may have a pathogenic role in
endometriosis because it is aberrantly expressed in endometriotic implants and in eutopic endometrium of women with
endometriosis. Therefore, inhibition of
aromatase activity may represent a new therapeutic option for
endometriosis. Case reports and observational studies have shown that
pain symptoms caused by
endometriosis quickly improve after administration of
aromatase inhibitors. Limited data are available on the long-term course of
pain symptoms after completion of treatment with
aromatase inhibitors; however, some recent studies suggest that symptoms may recur at short-term follow-up. A range of results are reported on the effects of
aromatase inhibitors on endometriotic lesions, with some authors describing improvements and other authors reporting persistence of pelvic lesions at second-look laparoscopy
after treatment. No severe adverse effect has been reported during treatment with
aromatase inhibitors both in pre- and postmenopausal women. On the basis of the available data, administration of
aromatase inhibitors should now be offered only to the small number of women who have severe
pain despite previous surgical and hormonal
therapies. Further research in the form of randomized controlled trials will be required before recommending the routine use of these agents.