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Sir,

We thank O’Brien, El-Gizawy and Tzakas1 for their interest in our paper.2 Their reflection that there is a dearth of evidence in the literature about aromatase inhibitors and pelvic endometriosis is a conclusion derived directly from our review. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is valuable in conditions such as osteoarthritis where symptomatic control is the mainstay of treatment. Endometriosis is a progressive chronic condition and treatment should aim at disease suppression, not just symptom relief. Therefore, it is reasonable to look beyond NSAIDs in management of endometriosis. Proof of principle that an intervention could be effective is required to launch robust randomised controlled trials and our review provides just that.

We did not conclude that aromatase inhibitors are effective or that they should be recommended for use in practice. We would like to take this opportunity to encourage development of a randomised trial to evaluate their effects in endometriosis.

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