Aromatase Inhibitors: A Complete Guide for Breast Cancer Patients

What are aromatase inhibitors? How do they work? What are the possible side-effects? How can you manage side-effects? In this video, Dr. Jennifer Griggs provides a comprehensive guide on aromatase inhibitors for breast cancer treatment. #breastcancer #breastcancertreatment #cancertreatment
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[@jjm4341]

Thank you for informing people about all aspects of BC. My question: If Anastrozole has a half-life of 50 hours, why take it every day? It seems like every other day would suffice, and I saw a research article that concluded that it probably would---but, it needed to be studied more. The article was several years old, and I wonder why the issue hasn't been researched more. Women have different BC diagnoses, different ages, and differing weights, etc. The one-size-fits-all Anastrozole dosage seems outdated, inefficient, and frankly, unacceptable, in a time when personalized treatment is becoming a valuable aspect of patient care.

[@yerbba]

Such a good point. The therapeutic index (benefit-to-toxicity ratio) is quite wide with the Ais. On the other hand, the dose ranges have been studied in thousands of patients, and there is not inter-person variation in the way the Ais are metabolized as for many other drugs. We appreciate your asking good questions like this.

[@kathysteiner9468]

I take it every other day. I'm not sick like I was taking it every day

[@LauraMilo-x8u]

I was doing fine on tamoxifen for 2 years then letrozole for 8. Then 2 years ago I was taken off w the explanation that no benefit was shown to continue longer. I beg to differ now. 😢

[@kisslena]

This is a great video resource and thank you for providing it. I think you need to also caution people that their blood glucose can increase leading them to a elevated A1C/diabetes diagnosis. In addition to other concerning bloodwork health markers. Much of that is due to inactivity because the AIs make the joints and muscles ache as you mentioned. No one wants to workout if they are in constant pain.

[@yerbba]

We have seen glucose levels increase in people who were already at risk of having this happen. We agree that movement seems implausible when someone is in pain yet movement is the go-to strategy for so many people. In someone who is experiencing so much pain that even the thought of moving is off-putting, a conversation with the medical team to make sure they know how bad the person feels is an important intervention.

[@alessia_traversa]

I was told by the oncologist that acupuncture usually works well for joint pain. I think it’s worth a try. This way you should be able to do both low and high intensity workouts.

[@jpb1085]

I exercised daily due to constant low grade pain in joints and tendons, and stiffness, and while exercise helped, it didn't help for long if I stopped! My blood sugar went slightly out of range as well, despite a healthy diet and all that daily exercise. Now that I'm finished my endocrine treatment, the pain has gone away and I feel sooooo much better - happier, can think better, sleep better, more energy. That was a miserable 5 years and I tried all 3 of the AIs and they were all tough. The ovarian suppression drug wasn't as bad - I had mild symptoms for the 3 months I was getting the injections prior to starting the AI and those were nothing compared to how bad it got on the AI. @@yerbba

[@HafsaMasood-e6m]

​@@alessia_traversahello i have just finished my chemo than surgery now waiting for radiotherapy i want to know is it painful

[@gabrielasaez9601]

@@kisslena Aches and fatigue, also headaches and etcs!

[@revn9203]

My sister who is in her 70s was diagnosed about 6 months ago with early stage BC and has been taking Letrozole following a simple mastectomy. Soon after taking Letrozole she put on weight with marked accumulation of fat around waist and abdomen as well as significant knee pains. I am worried about the increasing abdominal girth and would like to know if this is related to the Letrozole and what can be done about this. Thank you

[@yerbba]

Your sister is fortunate to have you looking out for her. This amount of weight gain is unusual with an aromatase inhibitor. It is possible that other things are contributing to her weight gain. It would be worth her talking with her medical team about her weight gain.

[@justcomment8516]

Many thanks, Dr. Griggs, for this post. I am currently on AI and have osteopenia. What is very important that hardly any oncologists tell their patients: when recommending a bone supporting medication it is essential to consult with a dentist as these medications have long-term effect on jaw health and dental work.

[@same5952]

Thank you for this. I didn't know it but should've connected the dots.

[@chamilaschadlou3281]

Thank you. I didn’t know and I had no idea. I m right now treating Ayurvedic since I had aramidex and zoladex for over one year !

[@yerbba]

Such a good point. We do recommend both seeing a dentist regarding any dental work that may need to be done before starting a bisphosphonate and letting the dentist know that a bisphosphone is being started.

[@Satya2btrue]

@@yerbbait’s also important to put patients on a rebound protocol if prolia is stopped without a relay/rebound drug spontaneous fractures can occur.

[@jeanmetcalfe786]

These drugs are horrendous they caused me so much pain and hallucinations they should be banned

[@truthseeker4431]

I had both DCIS and invasive BC with progesterone and estrogen positive nodules. Surgical removal and 20 radiation TXs later I have been scared away from taking postmenopausal aromatase inhibitors. My family have histories of debilitating osteoporosis (including my mother) but I have no DNA on the nodules or blood with cancer markers so... my MD oncologist, surgical oncologist, nor radio oncologist had answers. 1.) What is my risk for recurrence without taking HRT? Can you venture a guess or is it too individual? 2.) How often should I be screened now? 3.) Will regular mammograms be sufficient or will I need an ultrasound each time? 4.) Will I need other tests too and how often? I'm 59, WF, never smoked, drank alcohol, and am post-menopausal. I had 4 healthy pregnancies and breastfed my children for at least 1 year, etc. Can you answer? THX!

[@yerbba]

Thank you for reaching out with your question. It is hard to determine your treatment plan without being part of your medical team. For a more comprehensive understanding of your treatment options and available tests visit yerbba.com to get your personalized Yerbba report if you're based in the U.S. We're dedicated to empowering you with personalized treatment options to help you make informed decisions with confidence. Surveillance imaging also depends on a few factors. For our other viewers, we just want to clarify that aromatase inhibitors are endocrine (hormonal) therapy as opposed to HRT (hormone replacement therapy).

[@monicayanez4481]

Thank you Doctor. You just clarified something I wasn't sure about, it's my cholesterol, it hasn't gone down since I started Anastrozole. My PCP told me based on her info that Anastrozole had no effect on my cholesterol. Do you suggest any supplement we can take to reduce the cholesterol levels? Other than food, cause I do follow a plant based diet with no results

[@yerbba]

Thanks for writing. People who are not put on medications and are following a lipid lowering diet have been shown to benefit from psyllium husk fiber (either capsules or mixed into a beverage). Sounds like you're doing everything right. Also helpful to know is that, if this is from the aromatase inhibitor, the effects are reversible.

[@gabrielasaez9601]

Being in Anastrazole for a year and during the last 3 months, more or less, I have been having a lot of stomach upset problems, almost every day. Is it part of the medication side effects? What my oncologist says is stop taking it for a week, but then it comes back again. 😢

[@yerbba]

Stomach issues can definitely be part of the side effects of anastrozole. It’s tough dealing with that every day. Consider asking your oncologist about other possible solutions or medications to help manage the stomach upset.

[@gabrielasaez9601]

Thank you, doctor. Yes, I was already given nausea medication. It helps, I only try to take it when feeling my worst!!

[@LoveLiveCruise]

Thank you for another very informative video. I will be starting AI next month after radiation is complete. Do you recommend a bone density scan prior to starting AI, I also have slightly elevated cholesterol. My cancer was 1cm with clear margins and no lymph node involvement, and although I’m post menopause, could tamoxifen be an alternative because of the cholesterol effects and bone density effects as I believe I am lower risk of recurrence? I am at a healthy weight range and walk 8-10km most days. I accept I will get the mood changes, decreased libido and joint pains either way.

[@yerbba]

For many people, tamoxifen is an excellent alternative for the reasons you propose, and many people find tamoxifen to be better tolerated. These are great questions to bring up with your doctor.

[@karenkurelis1985]

Extreme weakness, feel like I'm in constant panic , something bad is going to happen. Went off the anastrozole for 6 weeks, Dr. Advised it, all got better, then went back on the pill,4 days later, all symptoms are back.

[@yerbba]

It sounds as if the symptoms are related to anastrozole. Hoping you find an alternative. Thank you for sharing your experience.

[@karenkurelis1985]

@yerbba thank you! That's what I think! This pill is a nightmare. Gonna keep trying, Amp up my exercise, hopefully that will help. The last thing I feel like doing!! Lol!

[@dom4638]

can patients use vaginal extrogen cream while on aromatase inhibitors to combat vaginal dryness

[@yerbba]

This is somewhat controversial. Check with your oncologist to see if they work with a specialty gynecologist. You might find our video on the safety of hormone replacement therapy (HRT) helpful: kzbin.info/www/bejne/r2nMqZeqqdOohaM.

[@kimbuktu007]

thank you so much for this informative video. You are the first one to mentioned the changes in taste and eyes. Seven years ago, when I went through menopause, I develop dysgeusia or distortion of taste. It has come and gone throughout the years since, but has increased noticeably while taking letrozole. I have been trying desperately to find a natural alternative to aromatase inhibitors. Are there any studies being done on anything with potential? Thanks again!

[@yerbba]

Thanks for writing. In people who have symptoms like this with one AI, switching to another AI is extremely likely to help. If two AIs are not tolerated, tamoxifen is an excellent alternative. It is also worth asking your medical team about the absolute benefit of taking endocrine therapy. If the benefit is small, discontinuing endocrine therapy is an option. In someone with a higher likelihood of benefit, trying different strategies is worthwhile. We do not have alternatives to the AIs at this point.

[@kimbuktu007]

@@yerbba thank you so much for taking the time to reply. I appreciate your videos and respect your opinions and advice! 💛

[@Veronica-kp1xj]

Dim grape seed extract kelp

[@Veronica-kp1xj]

Dim grape seed extract calcium D glucerate

[@Veronica-kp1xj]

Dim calcium D glucerate and grape seed extract

[@julieanderson238]

Do you know if there is a connection between an adenoma on the adrenal gland and DCIS due to estrogen production?

[@yerbba]

Great question. Adenomas are "non-functional." That is, they do not make estrogen.

[@aditeesingh6123]

My mom is 48 having breast cancet and she had a lumpectomy (bcs )of tumour 26mm and 5 out of 20 axillary lymph nodes are positive.plz guide me which stage is this of breast cancer? And how many chemo cycle is required?.. plz suggest

[@yerbba]

With 5 positive lymph nodes, this is a Stage III (3) cancer. Chemotherapy decisions (in terms of how many treatments) will depend on whether people have other medical conditions and other features of the tumor, including the hormone receptor status and the HER2 status. Wishing you well.

[@melaniepitt4295]

A relative of mine is hesitating to take aromatase inhibitors after surgery and radiation for lobular breast cancer because she is afraid of the side effects. She is hormone receptor positive. What are the actual statistics on risk of recurrence or is that too individual an issue to comment on?

[@yerbba]

Great question. Her doctors will be able to answer the question of her recurrence risk more accurately than we can because we don't have all the necessary data. It may be helpful to try the aromatase inhibitor before deciding whether to stay on the medication long-term. Everyone is different, and she won't know until she tries.

[@HareKrishna3760]

AI stops the formation of estrogen, but what about the estrogen that the body gets through food, for example estrogen is found in Fenugreek seeds, flaxseeds and so many food items that we consume, how is the estrogen in food consumed taken care of? Also some people use lubricants for vaginal dryness, this cream used for lubricating during intercourse and tackling vaginal dryness also contains some amount of estrogen , how is this estrogen taken care of ? Like u had explained in tamoxifen video that tamoxifen blocks the estrogen supply for the cancer cells, does lettozole also does the same function, if no, then how is estrogen in food and in the creams used for vaginal dryness taken care of by AI?

[@yerbba]

We'll start with the question about vaginal lubricants. In general, we do not recommend vaginal preparations that contain estrogen. There are alternatives to estrogen containing products. In terms of estrogen in foods (mostly in plants, called "phytoestrogens," there is no evidence that such dietary sources of estrogen increase the risk of breast cancer or its recurrence. This may be because these estrogens bind to the estrogen receptors in such a way that they do not cause cell proliferation.

[@HareKrishna3760]

@@yerbba thank so much

[@denisemodica9792]

Excellent information ⭐️⭐️I understand u better then my oncologist 😊

[@Smath01]

Thank you doctor for the information. Can you please tell me what to do after 5 years on anastazole, as you told there is no benefit of taking that beyond 5 years. Does the metastasis decrease after 5 years? Is it safe to stop it after 5 years, for someone post menopausal? Thank you

[@yerbba]

The benefit of more than 5 years of any hormonal therapy will depend on the risk of recurrence. In people at high risk, tamoxifen is an option after an AI. This is something to go over with your medical team. Thanks for watching.

[@Smath01]

Thank you doctor for the reply

[@gretacooper6080]

Started Anastrazole May 1, 2024, about two weeks in started dry itchy scalp, got so bad I finally reported it and stopped it June 28. I’m still breaking out in hives in various places despite extreme skin care, using cortisone cream admittedly to excess. Scalp slightly better. I can’t imagine going through this again so I won’t try taking it again. Will try Tamoxifen next.

[@yerbba]

We're sorry to hear about your experience with anastrozole. It sounds very uncomfortable. Changing to tamoxifen is a good option to explore. In the meantime, you might find relief using gentle, fragrance-free skincare products and taking antihistamines for hives. Wishing you the best.

[@olgamuszynska2524]

I am only 37. Had chemotherapy, mastectomy, radiotherapy and still on targeted therapy . Grade 3, lymph nodes involved, HER2+, ER+, PR+ I have gosereline implant every 4 weeks and have to take AI - exemestan . I think I tolerate it pretty well, it’s just my arms get so achy… I need painkillers sometimes 🙁 I take it from mid August 2023. Do you think it will get better with time or it’s worth to try different AI? I’m just worrying that if I start new tablet I feel worse 🤔 I know everyone is different, but you must know many ladies like myself and have some experience… Thanks Olga

[@yerbba]

Thanks for coming here to share your story. It would be helpful to your team to let them know just how severe your pain has been on the exemestane and the ways the pain is interfering with your quality of life. Sometimes people don't want to give details of their symptoms to their team for a few reasons. It is possible that your doctor will offer you one of the other two aromatase inhibitors, and some people do feel much better on another one.

[@mctaylor8465]

Wonderful video..Thank you Dr. Griggs..after a year of not really tolerating Arimidex due to the side effects you mentioned plus more severe depression, i stopped it for a couple of months and with the encouragement of my oncologist (explaining how affective aromatase inhibitors are) i switched to Aromisin which was much more tolerable for the remaining 5 yrs.. we then discussed extending to 10 yrs, but i decided not to and my oncologist agreed..final analysis had not been completed in 2015..

[@yerbba]

Thank you for your kind words. It’s great that switching to exemestane (brand name) Aromasin made a difference for you after struggling with Arimidex. Thank you for sharing.

[@dianallerahurlburt9010]

Your videos are very informative. I really appreciate them!!! Will the AIs continue to help long term, even after completing the 5 to 7 recommended treatment duration? What happens after treatment is completed? Thanks!!!

[@yerbba]

The effectiveness of any endocrine therapy persists even after the medication has stopped. Longer durations have not been shown to be more effective.

[@gabrielasaez9601]

After reading comments I learned Anastrazole can be also be taken 1 pill every other day. I will ask my oncologist about this and see if my upset stomach can be improved.

[@yerbba]

Talking with your doctor sounds like a good idea. It's the case that not all doctors are confident in every other day dosing, so be patient. And some patients find it difficult to remember what day they took it. Nonetheless, sometimes changing the dosage schedule can make a big difference. Thanks for sharing your experience.

[@HappyLife37600]

I am on aromatese inhibitor fir last six months, I have a very bad shoulder joint pain. Doctor has advised to stop letrozole for 7 days and see, I guess it is called flush out time, if I stop letrozole for 7 days, will it be responsible for recurrence? What are pros and cons of flush out time? Can u plz make video on this topic?

[@yerbba]

Thanks for the question. We have a couple of videos about stopping aromatase inhibitors and either restarting the same one or switching to a different aromatase inhibitor or to tamoxifen. There is no harm in a 1 to 2-week washout period.

[@07734KAT]

Thank you Dr. Griggs. May I ask if taking calcium tablets (600 mg/tablet) twice a day (so total 1200mg /day) is safe? My doc prescribes me this as Im taking AI (stage 1 estrogen positive, right breast mastectomy. I hear some say taking calcium tablets might cause heart problems. Is this true? I have ostopenia. On A1 since Jan 2021, after right breast mastectomy in Nov. 2020, Thank you for your reply.

[@07734KAT]

Also my doc says I need to take AI for 10 yrs OR 5 yrs AI and then 5 yrs Tamoxifen (if I'm worried about my bone and heart health). I'm already menopause by the way, had total hysterectomy due to benigh myomas/fibroids last 2019.

[@yerbba]

Thanks for writing. In general, the amount of calcium you are taking is in line with what we get in our food. The connection between calcium and cardiac disease is not entirely clear. These are worthy concerns to bring up with your doctor.

[@Annie-ZA]

😱I'm on Anastrozole 1 and have the complete opposite to vaginal dryness.

[@yerbba]

Thank you for sharing your experience, which shows that everyone really is different.

[@snowcat4895]

Can you please do a video on switching from tamoxifen to an AI. I’m 46. I finished surgery, chemo and radiation in August. I’m back at work and my life is starting to feel normal again. My doctor wants me to consider switching because the prevention is better with an AI. This will mean putting myself into an early menopause. However, menopause isn’t far off anyway. I’m willing to do whatever it takes to prevent a recurrence. But I feel good & I’m hesitant to age myself so quickly. I also have PCOS. I don’t know if my ovaries are even functioning normally. Also, are the benefits of AIs really that substantially better? The data I read only showed a few percentage points of a difference

[@yerbba]

For people who are premenopausal, the AIs are not appropriate until there is certainty that the ovaries have stopped working. The absolute benefit of switching to an AI is small in many people. Your doctor may be able to give you an estimate of the benefit in your case. Thanks for the video suggestion.

[@FirdoseHussain]

One of friend (married women, aged about 25 years) was in sexual activities with his boyfriend, That man take drugs capsule, injection and viagra tablets to give more sexual pleasures. They were in sexual activities for 1 year. Now, that woman is facing infection in her left breast, swelling has started around 3 places on her left breast. A small surgery was done to remove all swelling, but even after 3 months, swelling has not stopped yet. Can you please explain what is the cause for this. Is this sexually transmitted infection on her breast? Was the infection transmitted during sucking of her breast? Please help, she is now worried a lot.

[@yerbba]

Thank you for writing. It's clear this story is troubling you. We can say with great certainty that breast cancer is not caused by sexual activity. It is also not likely that the infection was caused by intimacy. It is worth pursuing a diagnosis for the swelling as surgery is usually not required for non-cancerous conditions.

[@SofiaAhmad-rp8sm]

What food not allowed when taking letrozole?

[@yerbba]

There are no known interactions between food and letrozole.

[@jenfest7295]

Do AI’s potentially help kill cancer cells by starving them of estrogen or do they simply help them to not grow as quickly?

[@yerbba]

A bit of both. Having seen areas of cancer shrink dramatically in people with advanced disease, it's hard not to be confident that there is tumor death as well as stopping tumors in their tracks.

[@teresa8363]

How about getting secondary cancer like uterine cancer , can this be a side effect ? It happens with tamoxifen .

[@yerbba]

Aromatase inhibitors, because they reduce the level of estrogen in the body, reduce the risk of endometrial (uterine) cancer. People on the aromatase inhibitors can, however, still get uterine cancer just as in the general population. In people with certain inherited mutations, the risk of endometrial cancer can be very high. It is critical to let your medical team know your cancer family history.

[@alleynehowe]

Best content, I’ve listened & learn soo much information, better than my oncologist & medical team

[@johndepner9237]

This is true for me as well!

[@yerbba]

Thank you for your positive feedback! We're pleased to hear that our content has been helpful. Yerbba appreciates you!

[@staceyvaas1210]

Thank you so much Dr. Griggs 😊

[@yerbba]

Thank you for watching. Yerbba appreciates you!

[@hildalabricort]

Anyone have access to the UK's Butchers Book? A list of clinics and doctors who perform mastectomies on healthy girls with mental health issues. Always be wary of any doctor who avoids the term "woman" and replaces it with "people".

[@yerbba]

Because men can get breast cancer, it's really important to not restrict our language to women alone.

[@hildalabricort]

@@yerbba you said "people with ovaries" not "women with ovaries" and "people with a uterus" not "women with a uterus", so obviously you think men can have ovaries and a uterus. This, as you well know, has NOTHING to do with saying men can have breast cancer.

[@HL-qv3yd]

Thank dear doctor Griggs ❤

[@yerbba]

Thank you for watching. Yerbba appreciates your support.

[@leewhiting3834]

Rheumatoid arthritis can in rare cases also be a side effect.

[@yerbba]

Although the aromatase inhibitors do not cause rheumatoid arthritis, an autoimmune condition, the joint pains from the aromatase inhibitors can resemble rheumatoid arthritis. It's important to note that while AIs can cause joint pain and arthralgia, a true diagnosis of rheumatoid arthritis requires specific clinical and laboratory criteria. Patients experiencing persistent joint pain or other concerning symptoms while on AI therapy should consult their healthcare provider for proper evaluation and management.

[@metroflagyl1]

Your videos are helping so much ❤

[@yerbba]

Thank you so much for your kind words and being part of the Yerbba community!

[@farmanmed9164]

well done

[@yerbba]

Thank you for the positive feedback!

[@sudharshanampavankumar4992]

Can we combine fenbedazole ivermectin aromatase

[@sudharshanampavankumar4992]

And use all of them

[@yerbba]

Febendazole and ivermectin are used to treat parasites in animals. There are some studies in mice and in collections of cells on a glass dish (Petri dish). There are currently no studies showing that these are effective in treating breast cancer. Without knowing whether there are interactions with the anastrozole, it would not be prudent to take these medications with anastrazole.

[@jennypangalanko]

thnk you

[@yerbba]

Thank you for watching. Yerbba appreciates you!

[@naththomas9946]

Thank you, Dr, Griggs, for your helpful and medical material.

[@yerbba]

We're deeply grateful for your kind words. Thank you for watching!

[@lisamurphy6203]

Im very worried about a fine needle biopsy i had. I was called back after a mammogram and had a biopsy there and then. I nearly hit the roof with the pain it was horrific the person taking the biopsy apologised and said she hit a nerve. Now im worried about the cancer cells running amok through my nervous system or blood stream is that possible. Thank you for all the videos. Lisa

[@yerbba]

This is a common concern. Sounds like you had a rough time of it. It is extremely unlikely that breast cancer cells are going to spread to other parts of the body. Any cells displaced during a procedure like this generally do not have the "ability" to form other areas of cancer in other parts of the body.

[@lisamurphy6203]

Thank you for replying, it's eased my concerns.

[@sueschoormans4124]

Thank you Dr. Griggs for this and your other videos. You mentioned there is no benefit of taking AI's beyond 5 years. I therefore question why some women are prescribed them for more than five years and what about those with metastasized BC? I have BC with mets and have been told I will be on them for the rest of my life. What does the research say about taking AI's for +5 years for metastasized BC? Also is it best to switch from one AI to another after 5 years or is there no benefit in that either? Thank you in advance.

[@iambobbiesgirl]

I second this as I was told gonna be on for 10 years..?

[@yerbba]

Such a great question. The video about the duration of AIs was specifically for people with non-metastatic disease. We can see the confusion. Yes, in someone with metastatic disease, we will continue the medication until it no longer works or unless there are intolerable side effects. There is no need to switch from one to another. Regrets for any confusion, and thank you so much for writing.

[@sueschoormans4124]

@@yerbba Thank you so much Dr Griggs for taking the time to respond. I very much appreciate. Hoping for me and many others that the AI's work for as long as we are meant to be here for. :-) Thank you once again for your videos.

[@sheila7814]

I thought it was determined by your oncotype dx score. The type of tumor/DNA/genes/growth rate/ etc. Certain types determine if you need 5 or 10 years.