I declined AIs since I have osteoporosis and my cholesterol tends to be on the high side, and AIs worsen these conditions. I take Tamoxifen, which generally isn’t offered to post menopausal women - AIs are the drug of choice.

I asked my oncologist about the difference in effectiveness between AI & Tam for my specific situation - Oncotype of 0, tumor stage 1, grade 1, no lymph involvement. She said that in my case, while AIs would maybe be a tiny bit more effective to prevent recurrence, but given my other conditions, Tamoxifen makes sense.

I don’t believe she would have offered me Tamoxifen if I hadn’t asked - I think they are trained to only offer the guideline directed therapy, unless the patient asks. I was surprised at the reaction from my other doctors (surgeon, radiologist, primary care) that I’m taking Tamoxifen & not an AI, they seem to assume that AIs are the only option for post menopausal patients.

I think it’s important to discuss concerns with your doctor, try the meds if they make sense, and know that if you develop issues, talk to your doctor so they can stop or change them.