Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Italy.
Reprod Biol Endocrinol. 2011 Jun 21;9:89. doi: 10.1186/1477-7827-9-89.
This systematic review aims to assess the efficacy of aromatase inhibitors (AIs) in treating pain symptoms caused by endometriosis. A comprehensive literature search was conducted to identify all the published studies evaluating the efficacy of type II nonsteroidal aromatase inhibitors (anastrozole and letrozole) in treating endometriosis-related pain symptoms. The MEDLINE, EMBASE, PubMed, and SCOPUS databases and the Cochrane System Reviews were searched up to October 2010. This review comprises of the results of 10 publications fitting the inclusion criteria; these studies included a total of 251 women. Five studies were prospective non-comparative, four were randomized controlled trials (RCTs) and one was a prospective patient preference trial. Seven studies examined the efficacy of AIs in improving endometriosis-related pain symptoms, whilst three RCTs investigated the use of AIs as post-operative therapy in preventing the recurrence of pain symptoms after surgery for endometriosis. All the observational studies demonstrated that AIs combined with either progestogens or oral contraceptive pill reduce the severity of pain symptoms and improve quality of life. One patient preference study demonstrated that letrozole combined with norethisterone acetate is more effective in reducing pain and deep dyspareunia than norethisterone acetate alone. However, letrozole causes a higher incidence of adverse effects and does not improve patients' satisfaction or influence recurrence of symptoms after discontinuation of treatment. A RCT showed that combining letrozole with norethisterone acetate causes a lower incidence of adverse effects and lower discontinuation rate than combining letrozole with triptorelin. Two RCTs demonstrated that, after surgical treatment of endometriosis, the administration of AIs combined with gonadotropin releasing hormone analogue for 6 months reduces the risk of endometriosis recurrence when compared with gonadotropin releasing hormone analogue alone. In conclusion, AIs effectively reduce the severity of endometriosis-related pain symptoms. Since endometriosis is a chronic disease, future investigations should clarify whether the long-term administration of AIs is superior to currently available endocrine therapies in terms of improvement of pain, adverse effects and patient satisfaction.
本系统评价旨在评估芳香化酶抑制剂（AIs）治疗子宫内膜异位症相关疼痛症状的疗效。进行了全面的文献检索，以确定所有评估 II 型非甾体芳香化酶抑制剂（阿那曲唑和来曲唑）治疗子宫内膜异位症相关疼痛症状疗效的已发表研究。检索了 MEDLINE、EMBASE、PubMed 和 SCOPUS 数据库以及 Cochrane 系统评价，检索截止日期为 2010 年 10 月。本综述包括符合纳入标准的 10 项研究的结果；这些研究共纳入 251 名女性。5 项研究为前瞻性非对照研究，4 项为随机对照试验（RCT），1 项为前瞻性患者偏好试验。7 项研究评估了 AIs 改善子宫内膜异位症相关疼痛症状的疗效，3 项 RCT 研究了 AIs 作为术后治疗在预防子宫内膜异位症手术后疼痛症状复发中的作用。所有观察性研究均表明，AIs 联合孕激素或口服避孕药可减轻疼痛症状的严重程度，提高生活质量。一项患者偏好研究表明，来曲唑联合醋酸炔诺酮比单独使用醋酸炔诺酮更能有效减轻疼痛和深部性交痛。然而，来曲唑引起的不良反应发生率更高，且不能提高患者的满意度或影响治疗停止后症状的复发。一项 RCT 显示，来曲唑联合醋酸炔诺酮的不良反应发生率和停药率低于来曲唑联合曲普瑞林。两项 RCT 表明，与单独使用促性腺激素释放激素类似物相比，在子宫内膜异位症手术后，联合使用 AIs 和促性腺激素释放激素类似物治疗 6 个月可降低子宫内膜异位症复发的风险。总之，AIs 可有效减轻子宫内膜异位症相关疼痛症状的严重程度。由于子宫内膜异位症是一种慢性疾病，未来的研究应明确在改善疼痛、不良反应和患者满意度方面，长期使用 AIs 是否优于目前可用的内分泌治疗。
