Successful treatment of a symptomatic uterine leiomyoma in a perimenopausal woman with a nonsteroidal aromatase inhibitor Makio Shozu, M.D., Ph.D., Kouichi Murakami, Ph.D., Tomoya Segawa, M.D., Tadayuki Kasai, M.D., and Masaki Inoue, Ph.D. Department of Obstetrics and Gynecology, Kanazawa University School of Medicine, Kanazawa, Japan Objective: To assess the management of symptomatic leiomyomas using a nonsteroidal aromatase inhibitor in perimenopausal women. Design: Case report. Setting: Academic clinical practice. Patient(s): A 53-year-old woman suffering from recurrent urinary retention secondary to a uterine leiomy- oma. Intervention(s): Fadrozole, orally, 2 mg daily for 8 weeks and then 1 mg daily for 4 weeks. Main Outcome Measure(s): Measurements of leiomyoma volume, and levels of serum E 2 , LH, and FSH. Result(s): Urinary retention resolved after 2 weeks of treatment and did not recur. Leiomyoma volume estimated by ultrasonography revealed a 71% reduction after 8 weeks of treatment. Conclusion(s): Fadrozole was useful for the management of a symptomatic leiomyoma without transient deterioration of symptoms. Clinical trials are warranted. (Fertil Steril 2003;79:628 –31. ©2003 by American Society for Reproductive Medicine.) Key Words: Leiomyoma, urinary retention, aromatase inhibitors, fadrozole Leiomyomas of the uterus are sex-steroid hormone dependent tumors, and suppression of estrogen and progesterone is the most promising treatment modality for the condi- tion (1). The most common agents used for sex-steroid suppression of leiomyomas are GnRH agonists, which produce hormonal sup- pression by first increasing the release of go- nadotropins, resulting in desensitization and downregulation of the pituitary. The end result is a hypoestrogenic state. In most cases, GnRH agonists decrease the volume of leiomyomas by 30% to 65% within 3 months of therapy (2–5). In addition to GnRH agonists, a number of agents have been considered for the treat- ment of leiomyomas (1, 4). The use of a GnRH antagonist rather than a GnRH agonist has an added benefit of a rapid onset of action (6, 7). Androgenic steroids, such as danazol, have the additional benefit of reducing leio- myoma-related anemia (8). Another andro- genic steroid, gestrinone, is reported to have a carryover effect in which the uterine size continues to decrease after discontinuation of administration (9). Progesterone antagonists such as mifepristone have also been reported to reduce the leiomyoma size without reduc- ing follicular concentrations of E 2 (10). In animal studies, the use of selective estrogen receptor modulators has been shown to inhibit leiomyoma growth (4, 11, 12). This finding has been confirmed by recent observation in postmenopausal women with leiomyomas (13). We describe the first use of an aromatase inhibitor for the management of a symptomatic leiomyoma. Aromatase inhibitors have been widely adopted as a safe treatment for breast cancer, and the possible advantages of this agent over GnRH agonist therapy for the treat- ment of leiomyomas are discussed. Received March 6, 2002; revised and accepted October 3, 2002. Supported by Grants-in- Aid for Scientific Research B12557136, B13470348, and 14031209 from the Ministry of Education, Culture, Sports, Science, and Technology, Japan. Also supported by the Megumi Medical Foundation, Kanazawa, Japan. Reprint requests: Makio Shozu, M.D., Ph.D., Department of Obstetrics and Gynecology, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-0934, Japan (FAX: 81-76-234-4266; E-mail: shozu@med. kanazawa-u.ac.jp). FERTILITY AND STERILITY VOL. 79, NO. 3, MARCH 2003 Copyright ©2003 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. 0015-0282/03/$30.00 doi:10.1016/S0015-0282(02) 04761-1 628
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