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.