Effect of letrozole in adolescent DUB

Sneh Panda,Nalco hospital ,Angul,Orissa

Excessive/dysfunctional uterine bleeding is one of the worrisome common complains in
adolescent gynecologic practice. Treating with progesterone alone causes temporary cessation
with reappearance after stopping progesterone. OCP are not a good choice as it is socially
embarrassing as well as many serious side effects .Hence aromatase inhibitors could be one
theoretical option to reduce estrogen load both from ovary as well as peripheral synthesis making
the proliferative stage of cycle short which will reduce bleeding.
No literature till date available on this aspect of management of DUB with letrozole and
nonsteroidal aromatase inhibitor. Hence this open label study was carried out in few 20
adolescent ranging from- 13-18 years that were reluctant to OCP and not compliant on progestin.
These patients are followed up to 3 consecutive cycles. Prior to letrozole therapy their menstrual
history, drug history any associated systemic/gynec disease was ascertained by a predesigned
proforma. Thereafter s they were examined clinically. Their hormonal profile (TSH, LH, FSH,
and PROLACTIN) was checked along with one pelvic and abdominal ultrasound. After that with
consent and discussion with parent, letrozole was started at a dose of 5mg twice daily. Again
they were assessed on 3​rd​ day, 7​th​ day, after one month for next three cycles and results were
analysed.

Mean age was 15.4 years, mean duration of period irregularity 1.8 years, 70% had excessive
bleeding, 20% had mid cycle bleeding. 10% patient are obese, No patient had vaginal/systemic
problems. Pelvic USG was normal in all cases. Hormonal profile revealed normal FSH,LH and
prolactin. Serum oestradiol was high in all adolescents. Hb% was low (<10gm %) in 60%.all
patients had normal coagulation profile.
After starting letrozole bleeding stopped by 72 hrs. Only on (5%0 did not respond to letrozole
and put on OCP again. Letrozole was given for--------- days/cycles
All patients had normal cycles with normal flow volume and days for next three cycles
No side effects were observed in these 20 patients.
Conclusion- the result of this small study shows letrozole could be one of alternative safe drug to
treat DUB in adolescent.

---------------------*****----------------------------------