Skip to Content

Is It Reasonable to Take a Break from Your Aromatase Inhibitor Medication?

I am always on the lookout for information and studies about the dreaded, drugs we love to hate – aromatase inhibitors. I have written about these drugs quite a few times. They definitely do have a dark side, for some of us anyway. Read my most recent post about staying on them beyond five years here.

I get emails frequently from women struggling with the side effects asking for my advice. I always stress I do not give medical advice here on the blog or anywhere else. Mostly, what I offer is validation and a forum for discussion. 

You might want to read and download, Endocrine Therapy – Managing & Making Decisions About Your Aromatase Inhibitor Medication.

What I do suggest is to make sure your doctor knows about your concerns and issues. Everyone deserves validation and when applicable, assistance in managing side effects.

And simply asking you if  your side effects are tolerable or not, is NOT offering assistance.

So don’t settle. Start with being frank – discuss your issues and yes, I know it’s not always easy. Get validation. Then discuss options. Then make decisions that are right for you.

What options?

There aren’t that many good ones, but here are a few:

1. Basically, you can stay the course and put up with the side effects, until you can’t, or until your ten years are up, whichever comes first. (Sounds kinda like a jail sentence, right? And now there’s talk of a “life-time” one.)

2. You can try doing some things that might help such as:

Try increasing exercise to help alleviate joint pain. Movement is good for many reasons. Get a few motivation tips here.

Think about trying to shed a few pounds, if you know you should. It might help you feel better, in general.

Try making diet changes that may or may not help with hot flashes. Don’t ask me what the diet changes are, I’ve just heard there are some things you can try. A bit of Googling might be needed.

Have a frank discussion with your gynecologist or other specialist to address issues such as low (or no) libido, vaginal dryness and/or atrophy or whatever your issues might be.

Try some “how to get a better night’s sleep strategies” (that’s a seperate post).

Bottom line, there are things to try. Don’t suffer in silence. Just do not. Another thing I like to suggest is keeping a journal or log about your issues. Take it along to appointments so you have documentation.

3. You can consider taking a break now and then. Of course, you should discuss this first with your oncologist.

4. And of course, you can say, ENOUGH, I’m done and stop taking them. It’s your call. And no one gets to judge you for it.

Now, I will address #3 – the possibility of taking breaks, which was studied and the results presented in this article, Intermittent Letrozole Similar to Continuous Administration for Extended Breast Cancer Therapy.

A reader (thank you) sent me the link about a recent study that took a look at 5,000 postmenopausal women who had been diagnosed with hormone-positive, early stage breast cancer and who had completed five years on endocrine therapy (aromatase inhibitors).

Half of the group was randomly chosen to receive continuous letrozole (anastrazole), meaning every day. The other half was put on an intermittent cycle, specifically meaning, daily for nine months, followed by a break for three months. That was for years 1-4. During year five, treatment was daily again.

Speaking as someone who has taken a couple short breaks, this idea makes a lot of sense to me. My breaks have been relatively brief, one being about a month and another about six weeks. I admit, I’ve also just skipped a pill here and there sporadically. Just because. I hate them.

Every time I have taken a break, perhaps like you if you have done the same, I wait. I wait to see if I start feeling better. And then I wait a little longer. And then a little longer. And then, I start to worry about staying off too long and head on over to the cupboard where I store the darn pills and start taking them again.

Here’s the thing, my breaks haven’t really been for that long. So, I’m not sure if I truly started feeling better or not.

Taking a break for three months in years 1-4, would certainly seem to give a person a better idea about if she were truly feeling better or not. In 90 days, you could probably feel a big difference. Or not. Either way, it might help you figure out what you want to do.

Does this make sense?

Oncologist #4 (I’ve had five and no, I am not a difficult patient) and I discussed taking breaks a while back. Her thought process was, once I went off and started feeling better, I’d never go back on.

Well, that doctor/patient relationship didn’t last, not because of the above mentioned discussion. There were various other issues that made me decide to find a different oncologist, and I am glad I did.

And yes, she was wrong. I did go back on and I am still on Aromasin (exemestane) – so there!

The results of the study were perhaps not striking as far as QOL improvement. However and most importantly, there wasn’t much difference in disease-free survival at the end of five years for the two groups, so maybe the results are striking, after all. Depends on how you look at things, I guess. As this article states: 

During a median 5 years’ follow-up, the primary endpoint — disease-free survival — was similar between groups (86–88%). Quality-of-life measures like vaginal problems, sleep disturbances, musculoskeletal pain, mood, and physical well-being were slightly better in the intermittent therapy group at 12 months.

For some women, this might be something to try because for some, a slightly improved quality of life might be a huge deal. Knocking off, or knocking down, one or two side effects, might make a difference. Or not.

If you’re having side effect issues on one of these drugs, but aren’t sure you want to stop altogether, this might be another option to mull over and possibly discuss with your oncologist.

So, is it reasonable to take a break from your aromatase inhibitor medication?

Maybe so.

What do you think?

Have you ever taken a break from a prescribed medication?

If so, did you go back on eventually?

Are you on an aromatase inhibitor or tamoxifen?

Sign up for weekly updates from Nancy’s Point. Keeping it real. Support you can use.

Is it reasonable to take a break from your aromatase inhibitor medication? #breastcancer #meds #endocrinetherapy

Previous
"A Woman's Guide to Living with Heart Disease" by Carolyn Thomas, a Review & Giveaway
Next
A #MetsMonday Invitation

Stephanie

Wednesday 2nd of June 2021

I am 42, diagnosed with ER+, PR+, HER2- at 37. I had a bilateral mastectomy. I was on Tamoxifen for two years then it started causing painful ovarian cysts and I had a complete hysterectomy. I then started Anastrazole and have been on that for 2 years. I don’t think I can take it anymore. The hot flashes, night sweats, horrible mood swings, insomnia, depression, and ZERO libido are making life almost unbearable. But. I am scared to death of reoccurrence. I just had the scare of my life 2.5 weeks ago. I was doing a breast exam and found a lump! I had an ultrasound and MRI taken and the lump showed enhancement as well as an enlarged lymph node. I had a lumpectomy on the 21st and everything was benign thank God! That scared me so bad. I really don’t know what to do. I took 5 days off of the Anastrazole because the anesthesia made my insomnia worse and I almost snapped from lack of sleep. Any advice? I’d sure give almost anything for a magic wand right about now.

Steph K.

Virginia

Saturday 22nd of May 2021

I am 4 years into Anastrozole and recently took a 1 month break. I have experienced a variety of side effects from this drug, not all at the same time. (Anxiety, depression, joint pain, fatigue, insomnia, hair loss, bladder pain among them.) I was coping physically, so I guess I took the break as a way of mentally powering through. For me, it wasn't the vacation I had hoped for. I was just starting to sleep a little better and feel a bit more myself and the month was over. Once I went back on it, I didn't just pick up where I left off - I regressed a little and had to relive some of the anxiety and depression I pushed past in the first two years. Which I could have done without. But with all that said everyone's experience is different and yes, I believe breaks are absolutely reasonable. I learned something even if it wasn't as refreshing as I might have wanted. Thank you for providing this forum. There need to be BETTER OPTIONS for us than AIs but until there are, this exchange of information is invaluable.

Cheryl

Sunday 2nd of May 2021

Hi ! Thank you for all this info! I am on Aromasin. Femara was unbearable. I’m terrified of all the belly fat that is happening! My clothes around the waist are not fitting. It’s only been 2 months and I haven’t gained weight ! Just belly fat. I was taking MYOMIN a Chinese herbal estrogen blocker, and doing fine. The oncologist said because there are no stats on it it’s ridiculous to be using it. I’m 57 stage 2-3 1 lymph node involvement. Isn’t that weird they call it stage 2-3? Anyway...feeling angry I’m on a steroid that is causing belly fat and I’m told this will help the situation. Going to discuss one month on one month off. By the way I take the pill every other day because the half life is at 24 hrs. Why take it everyday? Made no sense to me. ❤️

Nancy

Thursday 6th of May 2021

Cheryl, You're very welcome. I was on Aromasin (exemestane) for roughly 8 years after being on Arimidex first. Couldn't tolerate that one. Your stage must've been based on size of tumor and grade I'm guessing. I hear you on the belly fat. We all have to decide what we want to do. Feeling angry is the topic of my latest post, so check that out! It'll be interesting to see what your oncologist says about one month on one month off. Good luck with all of it and thank you for sharing.

Leslie

Wednesday 3rd of March 2021

Nancy, Thank you for your kind words of support. My MD has taken me off tamoxifen permanently. There is one more AI I can try and I'm considering it. In the meantime I continue to reinvent my life style, especially around stress management, exercise and 'clean nutrition.' It certainly can't hurt and it could help!

Nancy

Thursday 4th of March 2021

Leslie, I'm glad you have a supportive MD. Good luck with the new med - should you decide to try it. Regardless, that other stuff you mentioned will hopefully make a difference too. Keep on keepin' on, that's what I like to say. Thank you for taking time to share.

Leslie

Wednesday 24th of February 2021

As I read through everyone's comments I decided I would write, just as a personal exercise in venting, believing these posts were from 2018 and no one would see my rant of 2021. Ha! So glad to see this is an ongoing missive. Last Feb-Apr I had BCS for DCIS, followed by 3 weeks of full breast radiation. Then began on anastrozole. I stuck that out for 6 months but the joint/spinal pain just kept getting worse. I often registered it at 8/10. Pain, hot flashes and insomnia left me exhausted. I felt mentally weakened as well. I chose to stop the anastrozole. After a 5 week break, my MD started me on exemestane. After a month on that I experienced the same side effects. I was trying to stay active with all the joint pain and had been taking online yoga classes, slow flow, twice a week. But during the last class I took, I broke a bone in my hand simply by weight-bearing into it in a 4-point position. I decided to stop the exemestane before I broke any more bones. Next I went on tamoxifen, 10 mg every other day. I was very hopeful this would be the solution to limiting side effects. However, after about a month in, the insomnia and hot flashes had me once again worn out. I also had dizziness and a mild 'brain fog.' Then I developed a superficial blood clot in my leg. I was told the blood clot was not caused by the tamoxifen, but it did worry me. My MD told me to stop taking the tamoxifen for now. That was yesterday. Now I'm wondering what to do. I'm 65 and it seems difficult to imagine giving up 5 years of my life to the side effects of these drugs, which truly do feel like poison to me. On the other hand I have a strong family history of cancer, including breast cancer. It feels reckless to abandon adjuvant hormone therapy, yet......... Anyway, thank you Nancy, for letting me 'keep it real' in this blog. And thanks to everyone else for sharing and giving me food for thought.

Nancy

Thursday 25th of February 2021

Leslie, I understand your dilemma. It does sound like your side effects are quite severe. I can't and won't tell you what to do, as that's certainly not my place. You'll have to decide what's best for you. I've said many times, sometimes it feels like we're damned if we do and damned if we don't. No matter what you decide, my best to you. Thank you for sharing.