Aromatase Inhibitors. Surgical treatment

Aromatase Inhibitors

Aromatase inhibitors have been successfully used in a limited number of cases of persistent disease after hysterectomy and bilateral oophorectomy as well as in patients with intact pelvic organs. The putative mechanism is by suppression of locally produced estrogens from aromatase activity expressed by the endometriotic cells.

Typically, an aromatase inhibitor such as letrozole 2. 5 mg or anastrozole 1 mg daily is given to prevent ovarian cyst formation and a possible decrease in bone mineral density.

Surgical treatment

Aim of surgery is to relieve symptoms, restore fertility, remove endometriotic implants and delay recurrence of the disease. Danazol or gestogens use during 1-2 months is recommended before surgical treatment.

Conservative surgery done with laparoscopy is a diagnostic as well as therapeutic procedure used to remove endometriotic lesions by laser or diathermy and adhesolysis. This type of treatment reduces the need for open surgery in young women who seek future pregnancies.

Radical surgery This is reserved for cases with severe symptoms and progressive disease or women who completed their families. Such procedure include hysterectomy and bilateral salpingo – oophorectomy. Nearly 12% of all endometriosis patients require radical surgery. Endometriosis surgery is more effective in treating severe cases than mild or minimal disease. Surgery in minimal or mild disease fails to restore normal fertility.

Prevention:

There is no known way to prevent this disease but some believe women having more than one child and having children early in life develop a certain level of protection against the disease and women with long term use of birth control pills are less likely to develop endometriosis.

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