Side effects of exemestane (Aromasin)

I was put on Anastrazole first, starting about 3 months after finishing chemo/2 weeks after radiation. It took about 5-6 months to get to the point where I was painful all the time - sharp pain that would move around, today the left ankle, then right hip etc. finally at 8 months, he said “you shouldn’t have to live in pain” and took me off. I was classified as pre-diabetic because of an A1c of 5.9. All lipids had been elevated before but had trouble with statins so unsure if Anastrazole contributed to that. About 6 weeks later started exemestane. First 2 months were fine but then I started month 3. Weight gain (no other changes in diet or exercise, just 10 pounds in 1 week - “not a side effect”, mild discomfort in hips and lower back, weakness on standing, extreme fatigue (before the insomnia started), insomnia (currently I get 4-6 hours a night if I’m lucky) and over the last few months, developed a tinnitus in the left ear. While he noted I “looked tired” 4 months ago and we discussed it, the suggestion was that I’m just depressed. He did at next visit test for multiple things that cause fatigue and (good thing) all were normal but that left me with no reason and therefore no treatment. Good things are that I had a mild osteopenia on the Anastrazole and current bone scan was normal (exemestane does have slightly less effect on bone over Anastrazole), A1c now 5.4 and fasting glucose under 100, and only abnormal lipid is mild increase in ldl - all that seems better on the exemestane. Overall, exemestane MAY be better than Anastrazole for me. I may ask about going to the every 2-3 day schedule - still doing research on that. It’s always a tough call because as many others have indicated, this is all “rock vs hard place”. Do the meds with all the inherent side effects but decreased chance of reoccurrences or take the chance off them and hope for the best but maybe better quality of life. Unless this becomes intolerable, I think I’ll stay on because I certainly don’t want to go through all this again if I don’t have to.

I am totally unqualified to suggest a medical treatment, but you might want to ask your doctor about prescribing a drug for vasodilation as migraines are often caused by vasoconstriction and evidently AIs cause this. There may be contraindications why this won’t work. But maybe you want to ask. (See some of the info I found below).
I had been looking at this type of issue, but I’m on tamoxifen - it’s a long story, so I’ll stop here.

Search for info on these topics on the web, if you’re interested:
“In general, vasodilators are drugs that relax and widen blood vessels. This widening of blood vessels, also known as vasodilation, can improve blood flow and potentially help alleviate certain migraine symptoms.”
“One class of vasodilators, called CGRP inhibitors, are prescribed for migraines because they block the effect of CGRP, a molecule involved in migraine pain and inflammation that can also cause vasodilation.”
“Aromatase inhibitors are hormone therapy drugs used to treat hormone receptor-positive breast cancer. These medications work by lowering estrogen levels in the body. Some women taking aromatase inhibitors may experience migraines or worsening of pre-existing migraines as a side effect.
While the exact relationship between aromatase inhibitors, migraines, and the use of vasodilators in women is not fully detailed in search results, it's possible that vasodilators like CGRP inhibitors may be considered in this context to:
Reduce migraine frequency and severity: CGRP inhibitors, by blocking CGRP, which is a key contributor to migraine, can potentially reduce the frequency and severity of migraine attacks.
Manage vascular-based migraine: The vascular hypothesis of migraine suggests that migraine attacks involve the release of vasoactive peptides like CGRP and other vasodilators. Vasodilators like CGRP inhibitors can help counteract the effects of these peptides.”

I too started exemestane last month joint pain, extreme tiredness and now teeth painful and dry mouth (which can be a sign of diabetes). Has anyone had this side effect? Oncologist has me off meds for 2-weeks to make sure this new side-effect is due to medication.