Aromatase Inhibitor (AI)


Ok, so you are now in legit menopause. You can still take tamoxifen if that works for you. But now you have another class of drugs you can take, known as aromatase inhibitors (AIs). There are three that are common: Arimidex (anastrozole), Femara (letrozole), and Aromasin (exemestane). There are a few others, but I have not run across anyone who was not one of the three mentioned above.


Unlike tamoxifen, AIs work by actually halting estrogen production. This is why they want you to be in menopause so that you aren’t producing a ton of estrogen from your ovaries. You do still produce estrogen in other parts of you body, such as from fat cells, which is why it is still necessary to block the estrogen production.


AI side effects are similar to tamoxifen. There are reports of hot flashes, bone pain, joint pain, and muscle pain. In my case, I mostly have joint pain and insomnia. I am not sure the doctor would say the insomnia is related to the drug, but I do know that the insomnia improved when I first started the AI, then got worse about six months in, which is also when the joint pain started.


A major drawback to AIs is loss of bone mass. Estrogen is good for bones, so stopping it causes bone loss. My doctors have me do a dexa scan every two years to check for bone density. I also take calcium and vitamin D3 supplements daily. I have a dexa scan coming up, so I will update once I see how my bones are fairing a year into Arimidex.


As far as the joint pain, I have found a few things that help. I eat a mostly vegan diet and focus on non-inflammatory foods. When it really acts up, I take over the counter anti-inflammatories such as Advil or Aleve (after discussions with my doctor, I try to limit this to once a week at the most). I also use Tylenol Arthritis, which helps. Heating pads or ice can help when the aching really sets in.


And finally, I take a low dose daily turmeric supplement. This is somewhat controversial, as turmeric (curcurmin) is believed to have phytoestrogenic properties. I made this decision in concert with my oncologist. I strongly urge anyone considering using it to bring it up to their doctor and ensure that this is the right decision for you. It has worked for me, and I feel comfortable in my decision based on my research, my chosen treatments, and my doctor’s recommendation. I think this warning is judicious:

Hormone-sensitive condition such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Turmeric contains a chemical called curcumin, which might act like the hormone estrogen. In theory, turmeric might make hormone-sensitive conditions worse. However, some research shows that turmeric reduces the effects of estrogen in some hormone-sensitive cancer cells. Therefore, turmeric might have beneficial effects on hormone-sensitive conditions. Until more is known, use cautiously if you have a condition that might be made worse by exposure to hormones.i



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