NORETHISTERONE ACETATE ALONE VERSUS IN COMBINATION WITH LETROZOLE FOR TREATMENT OF CHRONIC PELVIC PAIN IN PATIENTS WITH ENDOMETRIOSIS

Abstract

Background: Endometriosis is a chronic inflammation which is estrogen-dependent and a major cause of chronic pelvic pain (CPP) and low quality of life among women of reproductive age. The treatment remains largely dependent on hormonal therapy although the optimal guidelines that should be applied in managing pain remain in research. Objective: To compare mean pain scores after six months of treatment with norethisterone alone versus in combination with letrozole in women with endometriosis.

Methodology: It was a randomized controlled trial that was conducted at the Department of Obstetrics and Gynaecology, Services Hospital Lahore from April 2025 to October 2025. Sixty women who had endometriosis-related CPP were recruited and were randomly matched into two groups of equal size. Group A was given letrozole (2.5 mg/day) in combination with norethisterone acetate (2.5 mg/day), whereas Group B was given norethisterone acetate alone. The length of treatment was six months. The Visual Analog Scale (VAS) was used to assess the severity of pain at the baseline and subsequent to the therapy. The statistical analysis was done using SPSS version 25 and the mean difference between the groups was tested with an independent sample t-test with p 0.05 as significant.

Results:  The combination therapy group had a much greater improvement in mean VAS pain scores at six months than the norethisterone-only group (1.8 ± 0.7 vs 4.3 ± 0.6; p < 0.001). The difference in the improvement of the base was in both groups but the level of pain reduction in the combination group was significantly higher.

Conclusion: Letrozole combined with norethisterone acetate is much more effective at treating endometriotic women. This combination therapy may be a potentially superior therapy in the treatment of chronic pelvic pain in this group.