Anastrozole, fertility, menopause and sexual health

Anastrozole is designed for women whose ovaries have stopped making oestrogen, either through natural menopause, surgery to remove the ovaries, or monthly injections that switch the ovaries off. It lowers the small amount of oestrogen the body still makes in fat and other tissues. Because of that, it does not cause menopause in women who are already past it, but it deepens the low-oestrogen state, and many women notice hot flushes, vaginal dryness, lower sex drive or discomfort during sex. In women whose ovaries are still working, anastrozole on its own is not enough and can even stimulate the ovaries, which is why it is only used before menopause together with ovarian suppression. Anastrozole is not a contraceptive, and it could harm a developing baby, so pregnancy must be avoided while you take it. If there is any chance your ovaries could be working, for example if your periods stopped during chemotherapy, use a reliable non-hormonal method such as a copper coil or condoms, and tell your doctor straight away if periods return. Fertility itself depends mostly on your age and on earlier treatment such as chemotherapy, rather than on anastrozole. Some younger women with a strong wish for a baby have paused hormone therapy under specialist guidance to try for a pregnancy, then restarted afterwards. Sexual changes are common and very treatable, with moisturisers, lubricants and practical support, so please raise them rather than suffering in silence.

It is not a contraceptive

Use non-hormonal contraception if your ovaries might still be working.

Pregnancy must be avoided on treatment

Anastrozole could harm an unborn baby, so any pregnancy plan needs a specialist discussion first.

Sexual side effects can be eased

Dryness, pain and low desire are common, and there are practical ways to help.

These topics can feel difficult to raise, and the answers are not always tidy.

Fertility cannot be predicted exactly

Age, earlier chemotherapy and your egg reserve all play a part. Tests give clues but no firm answer.

Pausing treatment involves trade-offs

Early research on pausing hormone therapy for pregnancy is reassuring in the short term, but longer follow-up is still under way.

Sexual changes are very common

Many women on aromatase inhibitors notice dryness or pain. It is a medical side effect, not a personal failing.

What this page cannot tell you

It cannot tell you whether a pregnancy is safe for you. Your oncologist and a fertility specialist can.

Changes in desire and comfort affect couples, not just the person taking the tablet. Open conversation often eases the strain.

Explain the cause

Letting your partner know that low desire comes from the medicine, not from a change in feelings, removes a lot of worry.

Find other ways to be close

Touch, affection and time together matter. Intimacy does not have to mean intercourse every time.

Seek support together

A doctor, nurse or counsellor experienced in sexual health after cancer can help both of you.