Abstract
The third-generation aromatase inhibitor group includes letrozole, and anastrozole and exemestane have both been approved for suppression of estrogen in postmenopausal women with breast cancer. It seems scientifically plausible that various gynecological disorders that are estrogen dependent would benefit from estrogen suppression by aromatase inhibitors. When an aromatase inhibitor is used in premenopausal women, blocking an endogenous rise of gonadotropins by gonadotropin-releasing hormone analogs or sex steroids is mandatory to achieve adequate estrogen suppression. The two most frequently investigated gynecological conditions for the use of aromatase inhibitors include infertility and endometriosis. Available evidence strongly supports the success of aromatase inhibitors for the induction of ovulation, and reducing the pain associated with endometriosis. Preliminary evidence of success in managing other gynecological disorders, such as uterine leiomyomas, exists. Bone loss and dyslipidemia are potential risks caused by hypoestrogenism associated with aromatase inhibitor use. However, those risks seem to be more theoretical than real. The short-term use of aromatase inhibitors and the judicial use of the add-back concept of hormone replacement by estrogen and/or progesterone may minimize those risks.
Financial & competing interests disclosure
Mohamed F Mitwally has patents on the use of aromatase inhibitors for infertility treatment and other applications. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.