Treatment of severe recurrent endometriosis with an aromatase inhibitor in a young ovariectomised woman

Endometriosis is a chronic and progressive disease manifested by chronic pelvic pain and infertility and which may affect 2–10% of women of reproductive age. Because it is an oestrogen-dependent disease, the goal of current medical therapy is to induce hypoestrogenism or to antagonise oestrogen action. Oestrogen biosynthesis in women of reproductive age takes place primarily in the ovary, while after spontaneous or surgical menopause, the adipose tissue and adrenal glands are the main source.1 Aromatase P450 catalyses the conversion of androstenedione of adrenal origin to oestrogens, endometriotic tissues express it2–4 and prostaglandins are the most potent known aromatase stimulator in endometriotic stromal cells.