Aim of the work: To evaluate the impact of oral letrozole therapy for 3-months on infertile patients with pathologically confirmed endometrial hyperplasia (EH).

Patients and Methods: The study comprised 17 infertile patients with EH. All patients underwent full clinical examination, transvaginal ultrasonography (TVU) to determine endometrial thickness (ET) and estimation of serum E2 levels. All patients were prescribed letrozole 2.5 mg tablets once daily for 3 months and underwent endometrial biopsy at end of treatment. The study outcome was defined as regression of EH to histologically normal endometrium at end of treatment.

Results: At the end of the 3-months treatment period, all patients showed significant reduction of preliminary endometrial thickness and decrease of serum E2 levels. All cases with simple EH without atypia (n=10) showed good response with a mean regression rate of ET of 70.2%, while was 59.3% in cases of complex EH without atypia (n=5) and 53% in cases of complex EH with atypia (n=2). The overall pathological success rate was 88.2%; 100% in simple EH without atypia, 80% in complex EH without atypia and 50% in EH with atypia.

Conclusion: For EH without Atypia in infertile patients oral letrozole therapy for 3-months resulted in high regression rate of endometrium and high pathological success rate. However, further large scale studies with dosage modification are needed to determine its true efficacy in EH with atypia in infertile patients.