The following is a summary of “Low-dose letrozole – an effective option for women with symptomatic adenomyosis awaiting IVF: a pilot randomized controlled trial,” published in the July 2023 issue of Reproductive BioMedicine Online by Sharma et al.

Can low-dose letrozole reduce dysmenorrhea, menorrhagia, and sonographic characteristics in adenomyosis patients awaiting IVF? This was a longitudinal, randomized, prospective pilot study to compare the efficacy of low-dose letrozole and a GnRH agonist in reducing dysmenorrhoea, menorrhagia, and sonographic features in symptomatic women with adenomyosis awaiting IVF. The women were administered either the GnRH agonist goserelin 3.6 mg/month (n = 77) or the aromatase inhibitor letrozole 2.5 mg three times weekly (n = 79) for three months. At randomization, dysmenorrhea and menorrhagia were assessed using a visual analog scale (VAS) and a pictorial blood loss assessment chart (PBAC). After three months of treatment, the improvement of sonographic features was evaluated using a quantitative scoring procedure. 

After three months of treatment, both groups reported markedly improved symptoms. VAS and PBAC scores decreased significantly in both the letrozole and GnRH agonist groups over 3 months (letrozole: P = 0.0001 and P = 0.0001 for VAS and PBAC, respectively; GnRH agonist: P = 0.0001 and P = 0.0001 for VAS and PBAC, respectively). Participants receiving letrozole had regular menstrual cycles, whereas most women receiving the GnRH agonist were amenorrheic, with only four women reporting light hemorrhage. Both treatments enhanced hemoglobin concentrations (letrozole P = 0.0001, GnRH agonist P = 0.0001). Sonographic features improved significantly following both regimens (diffuse adenomyosis of the myometrium: letrozole P = 0.015; diffuse adenomyosis of the junctional zone: letrozole P = 0.025; GnRH agonist P = 0.001). 

Women with adenomyoma responded favorably to both therapies (letrozole P = 0.049, GnRH agonist P = 0.024). In contrast, the letrozole group responded more favorably in focal adenomyosis when the exterior myometrium was involved (letrozole P<0.001, GnRH agonist P = 0.26). Women receiving letrozole therapy did not exhibit any notable adverse effects. Furthermore, letrozole therapy was discovered to be more cost-effective than GnRH agonist therapy. Low-dose letrozole is a cost-effective alternative to GnRH agonists for alleviating adenomyosis symptoms and sonographic characteristics in women awaiting IVF.

Source: sciencedirect.com/science/article/pii/S1472648323001645