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@callalloo

There are two different things going on: the effects of the medicine in terms of what it does in the body to result in estrogen depletion and, secondly, the effects of estrogen depletion.

I haven't seen any studies that attribute all of the side effects of the aromatase inhibitors strictly to their result (the blockage of estrogen production) and none to how they work to achieve that. I guess we can't look at cases where women had hysterectomies, in comparison, as they don't result in zero estrogen production but it would be interesting to identify if an estrogen-less state has significant side effects beyond what is already known.

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Replies to "There are two different things going on: the effects of the medicine in terms of what..."

Patients taking aromatase inhibitors are post-menopause, so their ovaries' estrogen production is similar to that of those who had hysterectomies. Neither group is in an "estrogen-less state." Aromatase inhibitors affect estrogen produced by the adrenals. It stands to reason that reducing estrogen by "natural" methods (I don't know what these would be) would produce hot flashes and joint pains and perhaps other side effects that result from further reduction of estrogen in the body.