Reviewer’s report
Title: 
Anastrozole and Levonorgrestrel-Releasing Intrauterine Device in the
Treatment of Endometriosis: A Randomized Clinical Trial.
Version: 
1 
Date: 
23 Sep 2020
Reviewer's report:
I read with great interest the manuscript, which falls within the aim of this
Journal. In my honest opinion, the topic is interesting enough to attract the
readers' attention. Nevertheless, authors should clarify some points and improve
the discussion, as suggested below.
Authors should consider the following recommendations:
- Manuscript should be further revised in order to correct some typos and
improve style.
- Accumulating evidence suggests that immune cells, adhesion molecules,
extracellular matrix metalloproteinase and pro-inflammatory cytokines
activate/alter peritoneal microenvironment, creating the conditions for
differentiation, adhesion, proliferation and survival of ectopic endometrial cells. I
would discuss these points in the light of new theories about the pathogenesis of
endometriosis, referring to: PMID: 31717614; PMID: 31663401; PMID:
28571791.
- Although peritoneal superficial lesions and ovarian endometriomas represent
the majority of endometriotic implants within the pelvis, deep infiltrating
endometriosis and extrapelvic endometriosis are the most challenging conditions
to face off. Despite sometimes medical therapy is enough to reduce symptoms
and signs (PMID: 28537213; PMID: 30074068), in a large number of patients a
complete eradication, with nerve-sparing and vascular sparing approach (PMID:
27579309; PMID: 30415128) is needed to restore the normal pelvic anatomy
and its functions. I would add few lines to discuss these points, referring to the
abovementioned works. 
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Is the study design appropriate to answer the research question (including the use
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