Effect of Letrozole on Endometrial Histology in Patients with Disordered Proliferative Endometrium and Simple Hyperplasia

Abstract

Objectives: This is a preliminary study investigating the efficacy of aromatase inhibitor letrozol on endometrial histology in patients with disordered proliferative endometrium or simple hyperplasia. Materials and Methods: In a randomized clinical trial, 92 patients with abnormal uterine bleeding who had disordered proliferative endometrium or simple hyperplasia in endometrial biopsy, were randomized into case and control groups. patients received 2.5 mg of letrozole daily in case group (n=46) and 40 mg of megestrol acetate daily in control group (n=46) for 3 months. Endometrial biopsy was performed 3 to 4 weeks after completion of therapy to assess response. Results: After intervention in letrozole group, response to treatment was seen in 93% cases (including endometrial atrophy in 58.7% cases and weakly proliferative endometrium in 34.78% cases) and in megestrol group response to treatment was seen in 85% cases (including endometrial atrophy in 41.3% cases and weakly proliferative endometrium in 43.47% cases). The difference between two groups was not statistically significant (P=0.31). Conclusion: The results of this study show that pre and post menopausal women with disordered proliferative endometrium or simple hyperplasia can be successfully treated with letrozole alone. However, due to the lack of significant difference between the two groups, further studies with larger sample size is recommended for better clearance of the topic.

Effect of Aromatase Inhibitors in the Treatment of Endometrial Hyperplasia in Post Menopausal Women

“…A recent study in Iran showed that pre and postmenopausal women with disordered proliferative endometrium or simple hyperplasia can be successfully treated with letrozole alone 20 .…”

“…In 63% of patients endometrium was atrophic and the ultrasound endometrial thickness was 5 mm or less. In 31% of patients, the endometrial histology was abnormal and ultrasound endometrium was greater than 5mm and they suggested that an endometrial thickness of 5 mm is an appropriate cutoff level for conservative management of patients with postmenopausal bleeding 20 .…”

Efficacy of Oral Medications or Intrauterine Device-Delivered Progestin in Patients with Endometrial Hyperplasia with or without Atypia: A Network Meta-Analysis

“…Two RCTs involving 142 patients reported regression rates for LET (94.4%, 67/71) and MA (88.7%, 63/71) [31,34]. The rates did not differ significantly between the two groups (RR 1.04, 95% CI 0.95-1.14, p = 0.423; I 2 = 8.2%; Figure 5D).…”

“…The rates did not differ significantly between the two groups (RR 1.04, 95% CI 0.95-1.14, p = 0.423; I 2 = 8.2%; Figure 5D). [32,35,39,41], (C) a comparison of MA and MA + MET [43,47], or (D) a comparison of LET and MA [31,34].…”

“…Figure 5. Forest plot of the meta-analysis of regression rates in (A) a comparison of LNG-IUS and the NET [24,25,32,41], (B) a comparison of MPA and NET[32,35,39,41], (C) a comparison of MA and MA + MET[43,47], or (D) a comparison of LET and MA[31,34].…”