Which statement regarding the use of aromatase inhibitors (letrozole) in endometriosis is correct?
- A They are first-line therapy for endometriosis-associated pain per ESHRE 2022 guidelines
- B They are used off-label, typically combined with a progestin or GnRH analogue, for refractory pain ✓
- C They act by directly suppressing ovarian steroidogenesis as monotherapy
- D They are contraindicated in postmenopausal women with endometriosis
Correct answer: B. They are used off-label, typically combined with a progestin or GnRH analogue, for refractory pain
Explanation
Aromatase inhibitors are off-label for endometriosis and reserved for refractory pain, usually combined with a progestin or GnRH analogue to suppress ovarian stimulation. ESHRE guidelines do not recommend them as first-line. They block peripheral aromatase in endometriotic lesions, not ovarian steroidogenesis directly. They have a role in postmenopausal endometriosis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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