الفهرس 
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Abstract
Hysteroscopic surgery is widely considered the gold standard for the minimally invasive treatment of several intrauterine diseases, such as polyps, septate uterus, synechiae and endometrial hyperplasia resistant to medical treatment. In particular, this technique became popular after improvements in endoscopic instruments and after the introduction of fluid distension media. Since then, the development of small-diameter operative hysteroscopes helped many surgeons to provide more individualised, efficacious, and less invasive procedures. Several medical treatments were used to obtain these important intraoperative advantages. Nevertheless, to date no conclusive data allow a final conclusion about the best preoperative treatment that should be used for the endometrial preparation before hysteroscopy surgery. Aromatase inhibitors were originally developed for the treatment of breast cancer. Aromatase is a cytochrome P450 haemoprotein and catalyses the rate-limiting step in the production of oestrogens (i.e. conversion of androstenedione and testosterone to oestrone and oestradiol, respectively, by three hydroxylation steps). Letrozole, a triazole derivative, is a highly potent, selective, competitive, reversible non-steroidal aromatase inhibitor. Letrozole inhibits oestrogen biosynthesis by about 99% at the dose of 2.5 mg/day and suppresses plasma oestrone and oestradiol concentrations by 84–88% in postmenopausal women with metastatic breast cancer. It is now realized that many other potential indications for aromatase inhibitors exist, especially in the field of gynaecology. Aim of the work. The present study aimed to evaluate the effectiveness of short course of letrozole for endometrial preparation before hysteroscopic surgery of intracaviyatry lesions. Patients and methods. The present study included 30 patients and they were classified into 2 groups: • group A: included 15 women who underwent surgical hysteroscopy after Letrozole 2.5mg/day. • group B: included 15 women who underwent surgical hysteroscopy after Placebo twice/day. Inclusion Criteria: • Patients with endouterine pathologies, identified by office diagnostic hysteroscopy during the early endometrial proliferative phase (cycle days 7 to 8) Exclusion Criteria: • Presence of large submucous (type I, type II) or endocavitary (type 0) fibroids (according to the European Society of Hysteroscopy Classification of Submucous Fibroids) with a diameter exceeding 4 cm, for which preoperative treatment with GnRH agonists is indicated. • Hormonal therapies in the previous 8 weeks (including the drug of the study). • Uterine and/or concomitant adnexal pathologies (including malignancy) for which hysteroscopic surgery was not considered either safe or the method to resolve the problem. • Cardiovascular, hepatic, or renal impairment. • Allergy to letrozole.