Anastrozole and vestibular disease

Thank you, Lynn, please check with your doctor about the swollen fingers and toes, there are many causes for that. How long are you going to take anastrozole? Are they checking your bone density every year? I’m glad that you are doing well, it sounds like aromatase inhibitors were recommended for 10 years for you, for me it was 5 years. It depends on the several factors. Best wishes to you, also! Kathy

Thank you to all who brought this topic up! I’ve been on Anastrozole for five years and have intermittent bone pain, mostly at night. However, last October (2025) I had a severe vertigo experience. Since then I’ve had numerous chiropractic adjustments, the Eply procedure, Mullein ear drops, heating pad, etc. I cannot lay on my right side in bed for long without having vertigo when I turn over. I ended up going to my family doctor this March and he scheduled an MRI for April. I had concerns about the MRI and considered cancelling it! But then I read the heading:

Anastrozole and vestibular disease. I looked up vestibular disease and a MRI is often used by ENT doctors to diagnose it. So I won’t cancel my appointment. Further searching showed a connection between Anastrozole and vertigo, vestibular disease. So, I’m going off of it! My oncologist said I could opt not to take Anastrozole anymore since I’ve been on it for five years and my yearly mammograms have been good. (However, I had a tiny open margin after my lumpectomy which is concerning. The radiologist said she zapped it really well during radiation! Time will tell. I’m 75 and trusting in the Lord.)

Take care ladies! ❤️🙏🌷💕

To ruffianfan55: I take exemestane. A few months ago I had an episode of BPPV--frightening, because I was driving at the time. However, I did not stop exemestane, but did eye retraining exercises (check Web) for a week or so--and haven't had any more trouble!

As for your acceptance of a 7% risk of recurrence, may I point out that
1) you may easily live 20 years more --these days 90 is common!
2) 7% in risk terms is large. Recently scientists calculated that the risk of a meteor they had been watching, actually hitting the moon was about 4%. This was considered a very large risk!
3) There's a good chance that even if your BVVP is caused (or made worse) by anastrozole, you can do something about it, while continuing to take it. Please note--I had one episode months ago, and none since! And did not stop my AI.

I hate the thought of anyone having a recurrence unnecessarily!

@ruffianfan55 I saw a physical therapist about heel pain, and she looked at swollen toes. Said I need to get a referral to the skin and soft tissue dept. One swollen toe has pushed against the next toe creating a huge and painful callous. She also referred me to a foot surgeon re amputation of this troublesome toe. I may not want to do that. I will talk to my oncologist about possible relationship of Anastrozole and swollen fingers and toes.
2 more years on this med I think,
Oh, my, what fun and games. Best to you.

@peggydobbs
Thank you, Peggy, for your reply. My BPPV episode was quite severe, it occurred while I was at work and I ended up staying in the hospital for 3 nights. I was sent home with a walker, but never used it. Still, my equilibrium was severely affected, but I just kept doing what I could. I went back to work almost 3 weeks later, and am still not 100% 6 weeks out. I don’t want to go through that again, but most people with BPPV do have subsequent attacks. I will talk to the Ent Doc when I finally get to see them on April 10. I did have radiation for my cancer which reduced the chance of recurrence by 10-15%. It was almost all DCIS with a tiny focus of IDC that was completely removed with the biopsy, none was seen in the lumpectomy specimen. The tumor was < 1 mm, margins were all clear and radiation was optional for me, but I elected to have it. Many women opt out of aromatase inhibitors without even trying them, which I wouldn’t advise either. I have a 93% chance of no recurrence, I can live with that. If the Ent Doc has any knowledge of the effect of aromatase inhibitors on vestibular disease, I will gladly take their advice, but I’m betting that they don’t. There is no treatment for BPPV, except taking HRT reduces your chances of it by a lot! Of course, that’s not an option for me. Best wishes to you, and I really appreciate your input!

@libraryladycak
Thank you so much for your reply! I’m so glad that you’ve “done your 5 years” and can stop the anastrozole! I was so hoping to be able to do that, too, but, my vertigo, like yours, was severe and greatly affected my life. Best wishes to you and please give an update after your MRI. I plan to update after I see the ENT doc. Hugs, 💚

Hi Ruffianfan55:
I'm impressed with how astute you are, putting together that anastrozole could cause vestibular disease.
I take Tamoxifen and last summer I had the first of three vertigo attacks. I landed in the hospital the first time.
They told me the same, "Probable BPPV". I was sent to a PT, who performed the Epley maneuver and she did some other diagnostics but nothing changed and I've had two more vertigo attacks since. I can't imagine having this happen while driving but I don't drive and my fear is having it happen while I'm crossing a busy street. Like you, I have tinnitus and for me, mild hearing loss. I'm seventy-one. My balance has been slightly off now for over a year. I had no idea what might be causing this.
After reading your post I looked up Hormones and Vestibular disease and sure enough, lack of estrogen can cause both balance and hearing issues.
I don't have anything to offer you, except you might be interested in this https://vestibular.org/article/coping-support/living-with-a-vestibular-disorder/hormones/ Scroll down to where the topic is Estrogen.
It had never crossed my mind that the hormone blocker might be causing this. Thank you for your post. Up to now it all seemed to come out of nowhere. I talked with my PCP but it never crossed my mind to even tell my oncologist. Many thanks for your post.

The best person to answer your question is the oncologist. I have not heard this as a side effect nor do I know any breast cancer patients who have this. But anything is possible. I do have a number of friends that have the same thing you have and it is usually crystals in the ear drum that cause the dizziness and subsequent vomiting. There are exercises to do to reposition the head and neck and it does go away but it is unnerving when it happens.

@megunique Unfortunately, it’s not. My oncologist told me “anastrozole doesn’t cause dizziness”, and I replied, “It’s written as a warning on the container”. She then had to back track. Oncologists, understandably, focus on treatment protocol and not on side effects. In the world of breast cancer, while devastating to me, my cancer was not catastrophic, I didn’t require chemo or even radiation. My oncologist has many patients whose treatment is much more complex and with a worse prognosis. One hopes that oncologists stay on top of all of the side effects of treatment, but they are usually overworked and stressed, so they focus on treatment which is quite a lot by itself. The aromatase inhibitors probably don’t cause BPPV without the patient having underlying factors that predispose them to it. Age (over 65) sex (F) and osteopenia/osteoporosis are known risk factors for it. Women who take HRT have much lower rates of BPPV, there is definitely a link. If I were younger, had a different diagnosis, etc, I would certainly carry on with the anastrozole. Even though the Epley maneuver ended my attack, my equilibrium was awful for a couple of weeks and is still not back entirely. I am 71 and very active. I walk every day, do Body Pump 4 times a week and still work part time as a microbiologist at a large, teaching hospital. Not being able to live my life really depressed me and the thought of another attack terrifies me, particularly when I discovered that most victims have at least one more.
There is a shortage of physicians today, quite evident throughout my diagnosis and treatment for both breast cancer and BPPV. Since I work for a large hospital, the employees are given some preference for scheduling appointments, etc. Even with that benefit, I had my BPPV attack on Feb 20 and am finally seeing an ENT doctor on April 10! I couldn’t get PT until almost a month after my attack, when I scarcely needed it anymore. I do feel for the medical staff, they are gong as fast as they can. I plan to see what the ENT doctor can tell me before making a final decision.
Thank you for your comments and best wishes.

That is very interesting and I am always happy to learn something new. We sound very similar. I am 75 and diagnosed at 69. Stage 1A IDC and had lumpectomy, radiation and anastrazole. I did not need chemo as I was right on the border line with a 27 Onco Type. Weighing the factors and possible short and long term effects and the small amount of difference in it not returning, I chose no chemo but I did do radiation and hormone therapy. Radiation as fine; it is the years after radiation when you see the changes in the soft tissue and fibrosis. But still it was an easy decision for me because I had no lymph node involvement and clean margins and I wanted to zap any possible wandering minute cells. Anastrazole was fine in the first 3.5 years; well fine except I could not sleep. But the last 1 to 1.5 years sleep deprivation was worse (the longer you are on it the more the effects are and it changed my metabolism. I do am active- strength training 3 days a week and walking another 2-3 days. But that last year it got harder and harder to control my weight. It is always a personal decision. I don't know where you live but I am blessed to be in a major medical complex and all my doctors and nurses were fabulous. I had a better diagnosis than most but still my oncologist always listened to me. I found that if you asked if the hormone blocker could cause x, y or z; she would always respond "it could". But I realized she wanted me to stay on it and if the side effects did not bother me much, she minimized it. She did offer me Tamoxifin but those side effects were undesirable and not the first choice for the cancer I had. I would say it has taken me about 6 months after I stopped the hormone blocker that my body is coming back to something more normal. Best wishes to you.