Letrozole as good as methotrexate for ending ectopic pregnancy: Study

USA: A recent study has suggested that the use of letrozole, an aromatase inhibitor, can end ectopic pregnancy as effectively as the chemotherapeutic agent methotrexate. The study was presented at the American Society for Reproductive Medicine (ASRM) 2019 Scientific Congress by Mohamed Mitwally, Odessa Reproductive Medicine Center in Helotes, Texas.

According to the authors, this could be a huge breakthrough as in contrast to methotrexate, letrozole works hormonally. So, the findings, if confirmed, could do away with the need for chemotherapy regimen for the treatment of ectopic pregnancy.

An ectopic pregnancy occurs when the fertilized egg, instead of growing inside the uterus, grows outside of it, usually in the fallopian tube. Growing pregnancy can cause the tube to burst that can cause major internal bleeding. This can be life-threatening and requires immediate surgery. A pregnancy can't survive outside of the uterus, so all ectopic pregnancies must end.

Till now, early ectopic pregnancy was managed with the injection of a drug called methotrexate (Trexall). This can be given if the patients have low levels of hCG -- a hormone your body makes when you're pregnant and there's no damage to the fallopian tube. Methotrexate stops the cells from growing and allows your body to absorb the pregnancy. But the drug does have some side effects, like nausea, vomiting, dizziness, diarrhoea, and stomatitis (mouth and lip ulcers). And most women have abdominal pain a couple of days after the injection.

• Complete resolution of ectopic pregnancy occurred in the equal number of patients 12 out of 14 (86%) in each of the study groups.


• In the methotrexate group, two women required surgery after they became hemostatically unstable.


• In the letrozole group, one woman required surgery when she became hemostatically unstable and another underwent surgery when her hCG level failed to decrease 4 days after treatment.


• The metabolic and hormonal effects of the two medications are different -- Women in the methotrexate group experienced a significant elevation in liver enzymes and a significant decrease in platelet levels.


• Hormone profiles were more favourable in the letrozole group, and hCG levels declined more rapidly in the letrozole group than in the methotrexate group.


• 3 months after treatment, anti-Mullerian hormone levels were lower in the methotrexate group than in the letrozole or surgery groups.