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Adding an aromatase inhibitor to an OC.

When oral contraceptives (OCs) or gonadotropin-releasing hormone (GnRH) agonists fail to relieve pain, 1 prescribe a continuous OC with an aromatase inhibitor--typically letrozole (Femara, Novartis) at a dosage of 2.5 mg/day. This regimen has worked extremely well over the past 4 or 5 years for these patients.

Donald C. Young, DO

Clive, Iowa

* Dr. Barbieri responds

LNG-IUS is a useful tool

I thank Dr. Kleinberg for sharing his expert clinical experience with our readers. I agree that the LNG-IUS is an excellent way to deliver a progestin to the endometrium and pelvic tissues. Data continue to accumulate showing that the LNG-IUS is effective in the treatment of pelvic pain caused by endometriosis. (1)

As Dr. Varasteh recommends, anti-inflammatory agents often are effective in the treatment of pelvic pain. Unlike ibuprofen (a propionic acid anti-inflammatory), mefenamic acid is a fenamate anti-inflammatory agent and may be effective when propionic anti-inflammatory agents are not. However, mefenamic acid is expensive in the United States-between $4 and $18 per 250-mg pill (pricing from www.drugstore.com).

I agree with Dr. Young that, for patients who have endometriosis and pelvic pain and who do not experience sufficient relief with an OC or GnRH agonist, a combination of an OC and an aromatase inhibitor, or NEA plus an aromatase inhibitor, may be effective. (2,3)

References

(1.) Tanmahasamut P, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, Indhavivad hana S, Leerasiri P. Postoperative levonorg estrel-releasing intrauterine system for pelvic endometriosis-related pain. Obstet Gynecol. 2012;119(3):519-526.

(2.) Ferrero S, Venturini P, Gillott DJ, Remorgida V. Letrozole and norethisterone acetate versus letrozole and triptorelin in the treatment of endometriosis related pain symptoms: a ran domized controlled trial. Reprod Biol Endocri nol. 2011;9:88.

(3.) Ferrero S, Gillott DJ, Venmrini PL, Remorgida V. Use of aromatase inhibitors to treat endometriosis-related pain symptoms: a systematic review. Reprod Biol Endocrinol. 2011;9:89.

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Title Annotation:Comment & Controversy; oral contraceptives
Author:Young, Donald C.
Publication:OBG Management
Article Type:Letter to the editor
Geographic Code:1USA
Date:Jun 1, 2012
Words:314
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