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

Fertil Steril. 2004 May;81(5):1395-8. doi: 10.1016/j.fertnstert.2003.11.027.


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 microg 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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anastrozole
  • Aromatase Inhibitors*
  • Drug Therapy, Combination
  • Endometriosis / drug therapy*
  • Enzyme Inhibitors / administration & dosage*
  • Female
  • Humans
  • Nitriles / administration & dosage*
  • Progesterone / administration & dosage
  • Triazoles / administration & dosage*


  • Aromatase Inhibitors
  • Enzyme Inhibitors
  • Nitriles
  • Triazoles
  • Anastrozole
  • Progesterone