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Side Effects of Aromatase Inhibitors

Aromatase inhibitors are hormone therapy drugs used to treat hormone receptor-positive breast cancer. They include:

  • Anastrozole (Arimidex)
  • Exemestane (Aromasin)
  • Letrozole (Femara)

Aromatase inhibitors are used to treat breast cancers in:

  • Postmenopausal women
  • Premenopausal women who also get ovarian suppression

Some common side effects are described below.   

Joint and muscle pain

Joint pain (arthralgia) and muscle pain (myalgia) are common side effects of aromatase inhibitors [99-101]. The pain may be in the hands and wrists, feet and ankles, knees, back or other parts of the body.

Almost half of women taking aromatase inhibitors have joint pain and about 15 percent have muscle pain [99-101]. 

Joint and muscle pain can mimic carpal tunnel syndrome. And, in rare cases, aromatase inhibitors can cause carpal tunnel syndrome [102].

Although aromatase inhibitors can cause joint and muscle pain, they don’t cause permanent joint or muscle damage.

Easing joint or muscle pain

If you have joint or muscle pain while taking an aromatase inhibitor, talk with your health care provider.

Your provider may recommend anti-inflammatory medications (such as aspirin or ibuprofen), special exercises or acupuncture to ease the pain [101,103]. Getting regular exercise (such as walking, stretching or yoga) may reduce joint and muscle pain [104-105].

Your provider may also switch you to another aromatase inhibitor (you may have less pain with a different drug) or recommend tamoxifen [106].

Bone health

Aromatase inhibitors cause a loss of bone density, which leads to higher rates of osteoporosis and bone fractures compared to tamoxifen [6,100].

Monitoring bone health

Your health care provider will take a baseline measure of your bone density. Future measures can be compared to this baseline measure to monitor changes to your bone density.

Bone-strengthening therapy

Some medications may help prevent osteoporosis while you are taking an aromatase inhibitor. 

Your health care provider may prescribe drugs called bisphosphonates or the drug denosumab to help maintain bone density.

Health risks of bisphosphonates and denosumab

Although mostly a concern for people with metastatic breast cancer who take higher doses of bisphosphonates or denosumab, these drugs can cause severe bone, joint and muscle pain [100,107].

If you have any of these symptoms, report them to your provider right away.

In rare cases, a serious jawbone disorder called osteonecrosis may occur [108-109].

It’s recommended you have a dental exam (along with any dental work that needs to be done) before you start treatment with a bisphosphonate or denosumab [6,108]. Also, talk with your oncologist before getting any dental procedure while on bisphosphonates [6,108].

Learn more about bisphosphonates and breast cancer treatment.

Exercise, diet and not smoking

Regular exercise can help strengthen and protect your bones [110].

For example, weight-bearing exercise (exercise that involves standing rather than sitting) helps protect bones and lowers the risk of hip fractures [111].

Getting enough calcium and vitamin D (your provider can tell you if you’re getting enough) and not smoking can also help strengthen your bones [110].

Menopausal symptoms

Hot flashes and night sweats

Hot flashes and night sweats are common in women who take aromatase inhibitors [87].

Although these symptoms may become less frequent and less intense over time, they can still be hard to manage.

If you have hot flashes, talk with your health care provider about ways to treat them.

Learn about treating hot flashes.

Vaginal dryness

Vaginal dryness is common in women who take aromatase inhibitors [87].

Unlike hot flashes, vaginal symptoms tend to become worse over time.

If you have vaginal dryness or other symptoms, talk with your health care provider about ways to treat them.

Learn about treating vaginal symptoms.

Side effects of aromatase inhibitors versus side effects of tamoxifen

Although both aromatase inhibitors and tamoxifen can cause menopausal symptoms such as hot flashes, many of their side effects differ (see Figure 5.11 below).

Your health care provider can treat many of these side effects.    

Figure 5.11: Side effects of aromatase inhibitors versus side effects of tamoxifen

 

Aromatase inhibitors

Tamoxifen

Common side effects

  • Hot flashes and night sweats
  • Joint and muscle pain
  • Loss of bone mineral density (may lead to osteoporosis or bone fractures)
  • Loss of sex drive
  • Vaginal dryness or itching

 

  • Hot flashes and night sweats
  • Loss of sex drive
  • Vaginal discharge
  • Vaginal dryness or itching

 

Less common or rare side effects  (Some of these side effects, including cancer of the uterus and stroke, are very rare.)

  • Carpal tunnel syndrome
  • Hair thinning
  • Heart problems
  • Increased blood pressure
  • Increased cholesterol
  • Mood swings and depression

 

  • Blood clots in the large veins (deep vein thrombosis)
  • Blood clots in the lungs (pulmonary emboli)
  • Bone loss (premenopausal women only)
  • Cancer of the uterus (uterine or endometrial cancer)
  • Cataracts
  • Stroke
  • Vaginal bleeding

 

Adapted from select sources [6,87,90-92].

Learn more about the side effects of tamoxifen.

Long-term side effects of aromatase inhibitors

More time is needed to assess the long-term risks of aromatase inhibitors.

 SUSAN G. KOMEN® SUPPORT RESOURCES 

  • If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org.
  • We offer an online support community through our closed Facebook Group – Komen Breast Cancer group. The Facebook group provides a place where those with a connection to breast cancer can discuss each other’s experiences and build strong relationships to provide support to each other. Visit Facebook and search for “Komen Breast Cancer group” to request to join the closed group.
  • Komen Affiliates offer breast health education and some fund breast cancer programs through local community organizations. Your local Affiliate may also help you find breast cancer resources in your area. Find your local Affiliate.  
  • Our Family and Friends section has detailed information and resources for loved ones.
  • Our fact sheets, booklets and other education materials offer additional information.   

 

 

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