No endometriosis pain on Letrozole

Happy new year everyone!

It’s been quite a long time so I thought I will give you an update.

As you know, I am trying to conceive. I live in the UK and am seeing a consultant fertility specialist in hospital on the NHS (national health service). I started asking for a referral from my GP end of january 2015 and finally finished all the tests end of october 2015, so started a 3 months course of fertility treatment end of november 2015.

The tests and results were:

• Day 2-5 LH: 6
• Day 2-5 FSH: 6.9
• Day 3 Estradiol: 2.29
• Day 21 Progesterone: 22, this is low as anything under 30 means that ovulation has not occured that month
• Hycosy: right ovary is big, right tube is blocked, there is visible adenomyosis. This test was very painful.
• AMH: 2.5 (this was done privately for £86 as you cannot get it on the NHS). This is low as the normal range for someone my age is between 0.3 – 14.7.

So, my main problems are: a low ovarian reserve (low AMH), old eggs, I do not ovulate every month, my right tube is blocked and we also have some male issues (low count and low motility). Oh, and let’s not forget that I have severe endometriosis (diagnosed as stage 3 14 years ago but could well be stage 4 by now).

Afert seeing all the results, my consultant said that I should go straight to IVF ICSI with donor eggs as that will give me a 35 to 40% chance of success. That costs about £10.000 in UK, which I do not have at the moment and I do not qualify for a free IVF on the NHS. He said that he does not recommend fertility pills (ovulation inductors such as clomid) as he thinks that it is not going to work for me, however he said that it is better than doing nothing.

So while I wait to be able to pay for IVF, he gave me a 3 months prescription of:

• Clomid 50mg and letrozole 2.5mg, taken on cycle day 2 to 6
• Progesterone pessaries 200mg from cycle day 10 to 22 (progesterone must be taken after ovulation as it may suppress ovulation if taken before ovulation)

I specifically requested some Femara but he said that you cannot get it on the NHS and that if I want it I have to go to a private clinic. After insisting how clomid aggravates my endometriosis pain and how femara is the recommended fertility pill for people who have endometriosis, he finally gave me Letrozole (Letrozole is the generic name for Femara).

I do not like taking clomid as the last time I took it (last march I think), I had horrible endometriosis pain while on it and afterward. But I wanted to give it another try so the 1st month, I dutifully took it as prescribed with the letrozole.

So, 1st cycle:

• Clomid 50mg and letrozole 2.5mg, cycle day 2 to 6 (I take the clomid in the morning and the letrozole at night before going to bed)
• Side effects: hot flashes, lack of cervical mucus so I used a Conceive Plus Fertility Lubricant before baby making time, my next period only lasted for a day which is a sign that the clomid thinned the lining of my uterus (which is bad as a uterus with a thin linning cannot support a pregnancy)
• Result: I did an ovulation urine test every day from day 6 after the last clomid/letrozole pills till my period arrived, and it was negative all the time so I do not think I have ovulated that month. Also, my cycle only lasted 26 days that month.

The most important thing is that I have not had any endometriosis pain since taking the letrozole. No period pain either. No pain during the whole month. 

I stopped taking systemic enzymes (nattokinase, serrapeptase, wobenzym N) just before starting this fertility treatment. I am still debating whether I shall take some (at a reduced dose) in order to help any leftover endometriosis lesions inside my body.

There are several medical studies that show that Letrozole is effective in treating endometriosis pain. This one (for women not trying to conceive) concluded that a dosage of letrozole 2.5 mg in addition to elemental calcium 1000 mg and vitamin D 880 IU daily for a total treatment duration of 6 months, resulted in substantial improvement of pain with no recurrence of pain for 6 months after completion of treatment. If you are trying to conceive, then you take Letrozole for only 5 days a month (dosage varies from 2.5mg to 12.5mg a day).

Letrozole is an aromatase inhibitor.

How it works

• Aromatase is a protein in the body that is responsible for producing oestrogen. Normally, it is found in the ovaries, and to a much lesser extent in the skin and fat.
• Research has shown that aromatase is also found in high levels in the ectopic endometrial tissue of women with endometriosis, which contributes to the growth of their endometriosis.
• Further research, has shown that inhibiting the aromatase by giving women an aromatase inhibitor suppresses the growth of their endometriosis, and reduces the associated inflammation. This, in turn, significantly reduces their pelvic pain.

Next time, I will write about new supplements I am taking to help with the low ovarian reserve.

Have you tried Letrozole as an ovulation inductor or as a treatement for endometriosis? Please share your story.