I had very mild hot flashes with Tamoxifen but it was making my periods space out and putting me into menopause. No issues with it really. Then I had to get a complete hysterectomy with ovaries and everything else removed. My oncologist switched me to Letrozole. Brutal joint pain. I think took tries on both Exemestate and Anastrazole. Joint pain persisted so I’m back on Tamoxifen. The joint pain for me was debilitating. I could barely lift a glass full of water. My oncologist felt an AI was a better, stronger drug. My suggestion is to try one and if that doesn’t work try another.