Medical Oncologist
Medicines
Exemestane, fertility, menopause and sexual health
Exemestane lowers oestrogen, which can affect periods, fertility, hot flushes, vaginal comfort and sexual desire. This page explains why younger women take it only with ovarian suppression, why pregnancy must be avoided, what to know if you hope to have a baby later, and practical ways to ease menopause and sexual symptoms during treatment.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- How does exemestane affect fertility, menopause and your sex life?
- Four areas exemestane can affect
- Fertility and menopause questions at a glance
- The vocabulary, in plain language
- Where the answers are less clear
- If you hope to have a baby in the future
- Easing menopause and sexual symptoms
- Myths about exemestane, fertility and sex
- Common questions about exemestane and fertility
The short answer
How does exemestane affect fertility, menopause and your sex life?
Exemestane is a hormone tablet that lowers oestrogen, and oestrogen shapes many parts of a woman's life, from periods and fertility to sleep, mood, vaginal comfort and sexual desire. Exemestane on its own is meant for women who have already been through menopause. If you are younger and your periods have not stopped for good, exemestane is only used together with treatment that switches off your ovaries, such as regular injections or surgery to remove the ovaries. Used alone before menopause, it can actually stimulate the ovaries, so it would not work properly. While you take exemestane, you should not become pregnant, because it may harm a developing baby, and you should not breastfeed. If periods have stopped after chemotherapy, that does not always mean menopause, since the ovaries can wake up again, so reliable non-hormonal contraception is often still needed. Lower oestrogen commonly brings hot flushes, night sweats, vaginal dryness, lower sex drive and discomfort during sex. These changes are common, they are not your fault, and there are practical ways to ease them. If you hope to have a baby in the future, talk to your team early. Options may include fertility preservation before treatment, or in some cases a planned pause in hormone therapy after a period of treatment.
Not for use alone before menopause
Younger women take exemestane only alongside treatment that switches the ovaries off.
Pregnancy must be avoided
Use non-hormonal contraception if there is any chance you could become pregnant.
Sexual changes can be helped
Moisturisers, lubricants and open conversations make a real difference for many women.
This page gives general information only. Your oncology team can advise on your own situation.What changes
Four areas exemestane can affect
Knowing what to expect helps you ask for the right support.
Fertility
Exemestane is not a fertility-damaging chemotherapy, but years of hormone therapy mean waiting, and fertility naturally falls with age during that time.
Menopause symptoms
Hot flushes, night sweats, poor sleep and mood changes are common, especially in the first months.
Vaginal and bladder comfort
Low oestrogen thins the vaginal lining, causing dryness, soreness, itching and sometimes more urine infections.
Regular vaginal moisturisers can help, even when you are not having sex.Desire and intimacy
Lower sex drive, tiredness and changes in body image can all affect intimacy and relationships.
Worth raising with your team
- Pain or bleeding during sex
- Periods returning while on treatment
- Plans for a future pregnancy
Quick check
Fertility and menopause questions at a glance
Question
General answer
Can I get pregnant on exemestane?
You must not, as it may harm a baby; use non-hormonal contraception if pregnancy is possible
Is the contraceptive pill allowed?
Hormonal contraception is usually avoided; a copper coil or condoms are common choices
Can I breastfeed?
Breastfeeding is not recommended while taking exemestane
Is HRT an option for hot flushes?
No, because it adds back oestrogen; non-hormonal approaches are used instead
Can I pause treatment to have a baby?
Sometimes, after careful discussion and usually after a period of treatment
Words you may hear
The vocabulary, in plain language
- Ovarian suppression
- Injections such as goserelin, or surgery, that stop the ovaries making oestrogen.
- Premenopausal
- Your ovaries are still working, even if periods are irregular or have paused.
- Fertility preservation
- Freezing eggs or embryos before treatment so you may use them later.
- Vaginal moisturiser
- A non-hormonal gel used a few times a week to keep the vaginal lining comfortable.
- Lubricant
- A water-based or silicone-based product used during sex to reduce friction and pain.
- Vaginal atrophy
- Thinning and dryness of the vaginal lining caused by low oestrogen.
Talk to our team
Have a question about your situation?
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
Call 1800 202 8726
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Being straight with you
Where the answers are less clear
Much of the advice here is well established, but some questions still lack firm evidence.
Pregnancy after hormone therapy
Research on pausing treatment to try for a baby is reassuring so far, but follow-up is still relatively short. Your team will talk through what is known and what is not.
Vaginal oestrogen
Low-dose vaginal oestrogen is usually avoided with aromatase inhibitors, because even small amounts absorbed into the blood may matter. Some specialists consider it for severe symptoms after careful discussion.
What this page cannot tell you
It cannot tell you your own chance of a future pregnancy or which symptom treatment will suit you. A fertility specialist and your oncologist can assess that.
Thinking about a family
If you hope to have a baby in the future
Wanting a family after breast cancer is common and entirely reasonable. Raising it early gives you the most choices.
Before hormone therapy starts
Egg or embryo freezing is usually done before chemotherapy or hormone treatment. Special stimulation methods keep oestrogen levels lower during the process. Ask for a fertility referral as soon as you can.
A planned pause
For some women with early breast cancer, a planned break from hormone therapy after a period of treatment may be possible, to try for a pregnancy. Treatment is then restarted to complete the full course. Your team will advise on timing, including how long to wait after the last exemestane tablet before trying.
Talk before you stop
Never stop exemestane or your ovarian suppression injections on your own to try for a baby.
Practical help
Easing menopause and sexual symptoms
You do not have to accept difficult symptoms in silence. Small changes often help.
Hot flushes and night sweats
Layered cotton clothing, a fan, cutting down on caffeine, alcohol and spicy food, and regular exercise may help. For troublesome flushes, doctors sometimes suggest non-hormonal medicines such as venlafaxine or gabapentin.
Dryness and painful sex
Use a vaginal moisturiser regularly and a lubricant during sex. Take more time for arousal, and try positions that give you more control. A women's health physiotherapist can help if muscles tighten from expecting pain.
Talking with your partner
Explaining that changes come from treatment, not from lost interest, can ease pressure. Closeness does not always have to mean penetrative sex.
Commonly believed
Myths about exemestane, fertility and sex
No periods means I cannot get pregnant.
Ovaries can recover after chemotherapy, so pregnancy may still be possible without periods.
Exemestane makes me permanently infertile.
It is not known to damage eggs directly, but the years of treatment and age can lower fertility.
Sex could make the cancer come back.
Sex does not cause breast cancer to return, and intimacy is safe during hormone therapy.
Losing interest in sex is just something to live with.
Practical steps and specialist support often help, so it is worth raising at your appointments.
Questions we are asked
Common questions about exemestane and fertility
My periods came back while on exemestane. What should I do?
Tell your oncology team promptly. Returning periods suggest your ovaries are active, which means exemestane may not be lowering oestrogen enough and pregnancy could be possible. Your team may check hormone levels, add or adjust ovarian suppression, or consider a different hormone treatment. Use condoms in the meantime.
Which contraception is safe while I take exemestane?
Non-hormonal methods are usually recommended, such as a copper coil or condoms. Pills, patches, implants and hormone-releasing coils are generally avoided after hormone receptor positive breast cancer. Ovarian suppression injections are not a reliable contraceptive on their own, so ask your team what suits you.
Will exemestane bring on menopause?
Exemestane does not cause menopause by itself. In younger women, the injections or surgery used to switch off the ovaries create a menopause-like state, and exemestane then keeps oestrogen low. After ovary removal, this is permanent. After injections stop, the ovaries often recover, depending on your age.
How long after stopping exemestane can I try for a baby?
Your team will advise a waiting period after your last tablet so the medicine clears from your body, often a few months. The exact advice depends on your cancer, your age and whether you are pausing or finishing treatment. A fertility specialist can also help plan the best time to try.
Can I have sex while taking exemestane?
Yes. Sex does not affect how the medicine works, and intimacy is safe during treatment. The main challenges are dryness, discomfort and low desire. A lubricant, a regular vaginal moisturiser and patience usually help, and your team can refer you for more support if needed.
Can I use coconut oil or petroleum jelly as a lubricant?
Water-based or silicone-based lubricants made for intimate use are usually preferred. Oils can weaken latex condoms and some people find they irritate the vagina or raise the risk of infection. Choose products without perfume, warming agents or glycerine if you have sensitive skin.
Why is HRT not allowed for my hot flushes?
HRT puts oestrogen back into the body, which works against exemestane and may encourage hormone receptor positive cancer to grow. Instead, lifestyle changes and non-hormonal medicines are used. Some women also find cognitive behavioural therapy helps them cope with flushes and night sweats.
Should I freeze eggs if I am about to start exemestane?
If you may want children and have not had chemotherapy yet, ask for an urgent fertility referral before treatment begins. If hormone therapy is starting straight after surgery, a brief delay for egg or embryo freezing may still be possible. Your oncologist and fertility specialist will decide together.
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Sources
- Macmillan Cancer Support — Exemestane
- Cancer Research UK — Exemestane (Aromasin)
- American Cancer Society — Pregnancy After Breast Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.