Endometriosis means that endometrial tissue is growing outside of the uterine cavity. Estrogen is the major chemical stimulating the growth of such tissue, and is produced mainly by the ovaries. There is evidence that the endometrial tissue outside the uterus can produce estrogen as well, as most endometrial biopsies show RNA for aromatase enzyme. This review covers the use of aromatase enzyme inhibitors for the management of endometriosis.
Anastrozole (Arimidex) is an aromatase enzyme inhibitor which has been used for breast cancer. It has been used for severe endometriosis in several cases with relief of symptoms. Of 15 premenopausal patients with painful endometriosis, 14 patients had relief of their pain with anastrozole and birth control pills. As a side effect, they had lower estrogen levels during treatment. Relief from pain came within one month. Several further studies show benefit on anastrozole. Patients were followed for bone density changes and hormone changes.
Animal studies have demonstrated that implanted endometrial tissues treated with aromatase inhibitors is reduced in size by aromatase inhibitors.
CONCLUSION: Most of the literature supports the increased production of estrogen in endometriosis. Reduction of aromatase activity by aromatase inhibitors reduces the size of endometriosis tissue and reduces pain.
NOTE: Natural aromatase inhibitors are useful. Kudzu (Pueraria montana) is an aromatase inhibitor, and it should be considered a possible treatment for endometriosis. Damiana (Turnera diffusa) and licorice (Glycyrrhiza glabra) provide anti-aromatase activity also.
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