Article Female reproductive health fertility|Articles in Press

Low dose letrozole–an effective option for women with symptomatic adenomyosis awaiting IVF: a pilot randomized controlled trial

Published:March 17, 2023DOI:


      Research Question

      Can low-dose letrozole reduce dysmenorrhea, menorrhagia, and sonographic features in symptomatic women with adenomyosis waiting for IVF?


      Longitudinal randomized prospective pilot study. To explore the effectiveness of low-dose letrozole and compare it with GnRH-agonist (GnRHa) in reducing dysmenorrhea, menorrhagia, and sonographic features in symptomatic women with adenomyosis awaiting IVF. These women were treated for 3 months, either with the GnRHa goserelin 3.6 mg/month (n=77), or the aromatase inhibitor letrozole, 2.5 mg/thrice weekly (n=79). Dysmenorrhea and menorrhagia were evaluated at randomization and followed up monthly using visual analog score (VAS) and pictorial blood loss assessment chart (PBAC), respectively. A quantitative scoring method was used to assess the improvement of sonographic features after three months of treatment.


      Both groups reported marked improvement in symptoms after three months of treatment. In both the letrozole and GnRHa groups, VAS and PBAC scores decreased significantly (p<0.05) over three months of treatment. Patients on letrozole had regular menstruation cycles, while most of the women who received GnRHa were amenorrhoeic with only 4 women reporting mild bleeding. Hemoglobin levels and quantitative assessment of sonographic features showed significant improvements (p<0.05) in both groups. No noticeable side effects were observed in women receiving letrozole therapy. Additionally, letrozole therapy was found to be more cost-effective in comparison to GnRHa treatment.


      Low-dose letrozole treatment is a low-cost alternative to GnRHa with comparable effects in improving symptoms and sonographic features of adenomyosis in women awaiting IVF.


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      Dr Sunita Sharma MBBS, MD (G&O), FNB is a gynaecologist and an infertility specialist at the Institute of Reproductive Medicine in Kolkata, India. Her research area of interest is female infertility with special focus on endometrial receptivity and adenomyosis and developing novel methods for pain and infertility management in adenomyosis.