Maybe it’s nerves: Common pathway may explain pain

The discovery that endometriosis implants may contain the aromatase enzyme prompted consideration of aromatase inhibitors as a nonsurgical treatment for endometriosis. These agents, which prevent conversion of androgens to estrogens, are used in the management of breast cancer.

This pilot study evaluated the use of the aromatase inhibitor letrozole in 10 women in whom medical and surgical therapy for endometriosis had failed. Addback therapy with norethindrone acetate was given to prevent the decrease in bone mineral density that might have occurred with letrozole alone. In 9 of the 10 women, pain decreased over the 6 months of the study.

This encouraging result suggests that larger trials with control subjects and longer follow-up will be worthwhile.

Recommendation: Use GnRH agonist

Nasir L, Bope ET. Management of pelvic pain from dysmenorrhea or endometriosis. J Am Board Fam Pract. 2004;17:S43–S47.

Recommendations from the Family Practice Pain Education Project published at the end of 2004 support use of nonsurgical therapies for endometriosis, based in part on the findings of Ling et al,¹ which demonstrated the effectiveness of empirical therapy.

ACOG agrees

That recommendation is similar to the nonsurgical approach to chronic pelvic pain recommended in 1999 in an ACOG Practice Bulletin²:

“Therapy with a GnRH agonist is an appropriate approach to the management of women with chronic pelvic pain, even in the absence of surgical confirmation of endometriosis, provided that a detailed initial evaluation fails to demonstrate some other cause of pelvic pain.”

The author is a speaker and consultant for TAP Pharmaceuticals.