The American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice has developed an updated Committee Opinion that offers the following recommendations for aromatase inhibitor use in gynecologic practice for the treatment of breast cancer, ovulation inductions, endometriosis, and other estrogen-modulated conditions:
• For women with breast cancer, bone mineral density screening is recommended with long-term aromatase inhibitor use because of risk of osteoporosis due to estrogen deficiency.
• Based on long-term adverse effects and safety data, when compared with tamoxifen, aromatase inhibitors are associated with a reduced incidence of thrombosis, endometrial cancer, and vaginal bleeding.
• For women with polycystic ovary syndrome and a body mass index (BMI) greater than 30, letrozole should be considered as first-line therapy for ovulation induction because of the increased live birth rate compared with clomiphene citrate. Lifestyle changes that result in weight loss should be strongly encouraged.
• For women with unexplained infertility (regular menstrual cycles, all known male or female factors excluded), a large multicenter study demonstrated that ovulation induction with letrozole resulted in lower live birth rates and multiple gestation rates compared with gonadotropins; however, live birth and multiple gestation rates did not differ significantly between ovulation induction with letrozole compared with clomiphene citrate.
• Aromatase inhibitors are a promising therapeutic option that may help manage endometriosis-associated pain in combination therapy with progestins.
Citation: Aromatase inhibitors in gynecologic practice. Committee Opinion No. 663. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127:e170–4.