Pilot of Letrozole for Uterine Myomas

Inclusion Criteria:

1. ≥21 years old

2. Premenopausal (at least one menses in last 3 months)

3. Symptomatic fibroids (fibroids visualized on ultrasound or MRI and heavy uterinebleeding, pelvic pressure or discomfort, urinary or bowel abnormalities, dyspareunia)

4. Fibroids that are ≤4 in total number or Fibroids that are ≤7 in total number if allfibroids are less than 4cm (40 mm) each

5. Fibroids that are ≤7cm in maximum diameter, on screening imaging, if ≤4 fibroids intotal number(fibroid is defined as any mass with radiographic characteristics offibroid >2cm)

6. Up to date in Pap smear screening and surveillance

7. Endometrial biopsy (required if age>45 years with irregular bleeding) does notindicate premalignant or malignant cells

8. Agree to use non-hormonal barrier method of contraception during study period if atrisk for pregnancy

9. Has primary care provider or gynecologist

10. Agrees not to start new medications/treatments for fibroids during the study

11. Able to give informed consent

Exclusion Criteria:

1. Fibroids treated by surgery, radiologic procedure, or GnRH agonist or antagonist inthe last 3 months

2. Any submucosal fibroid ≥2cm that is >50% in uterine cavity (FIGO Type 0 or Type 1fibroids) amenable to hysteroscopic resection

3. Use of exogenous estrogen and/or progestin in the last month. (for 3 month long-actingdepoprovera injection, no use in last 3 months)

4. Pregnant, lactating, or planning to become pregnant in the next 6 months

5. Hematocrit <27% or visit to emergency room or hospitalization for fibroid symptoms inthe last 3 months (cannot be safely randomized to a placebo)

6. History of osteopenia or osteoporosis

7. History of hyperlipidemia

8. Current liver or kidney disease

9. Unable or unwilling to attend 4 study visits

10. Pelvic imaging concerning for gynecologic cancer or cancer of the genitourinary orgastrointestinal system

11. Does not have primary care provider or gynecologist