The document discusses guidelines for using aromatase inhibitors (AI) in gynecologic practice from the ASRM. It recommends that for women with breast cancer using long-term AI, bone mineral density screening is advised due to increased risk of osteoporosis from estrogen deficiency. AI are associated with reduced risk of thrombosis, endometrial cancer, and vaginal bleeding compared to tamoxifen. For women with PCOS and BMI over 30, letrozole is recommended as first-line therapy for ovulation induction due to increased live birth rates compared to clomiphene citrate. Regular exercise and weight loss are also encouraged.

1. Aromatase
Inhibitors
in Gynecologic Practice
ASRM Guidelines, 2016
Prof. Aboubakr
Elnashar
Benha University Hospital,
Egypt
ABOUBAKR ELNASHAR

2. Aromatase inhibitors (AI)
have been used for the
treatment of breast cancer
ovulation induction,
endometriosis, and
other estrogen-modulated conditions.
ABOUBAKR ELNASHAR

3. RECOMMENDATIONS
For women with breast cancer,
BMD screening is recommended with long-term AI
use
{risk of osteoporosis due to estrogen deficiency}.
Based on long-term adverse effects and safety data,
when compared with tamoxifen, AI are associated
with a reduced incidence of
Thrombosis
endometrial cancer, and
vaginal bleeding.
ABOUBAKR ELNASHAR

4. For women with PCOS and BMI greater than 30
letrozole should be considered as first-line therapy
for ovulation induction
{increased LBR compared with CC}.
Lifestyle changes that result in weight loss should be
strongly encouraged.
ABOUBAKR ELNASHAR

5. For women with unexplained infertility
Regular menstrual cycles, all known male or female
factors excluded
Large multicenter study demonstrated that
ovulation induction with letrozole resulted in lower
LBR and multiple gestation rates compared with
gonadotropins
LBR and multiple gestation rates did not differ
significantly between ovulation induction with
letrozole compared with CC.
ABOUBAKR ELNASHAR

6. For endometriosis associated pain
Aromatase inhibitors are a promising therapeutic
option in combination therapy with progestins.
ABOUBAKR ELNASHAR