Medical Oncologist
Medicines
Exemestane side effects: the complete list and timeline
Exemestane side effects mostly come from lowering oestrogen and often feel like strong menopause symptoms. This page lists the very common, common and rare effects, shows when each tends to appear over weeks, months and years, explains how exemestane compares with other hormone tablets, and gives practical ways to ease the symptoms that bother women most.
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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
- What side effects can exemestane cause, and when do they appear?
- Side effects grouped by how often they occur
- When side effects typically appear
- The vocabulary, in plain language
- What side effect lists do not tell you
- Easing the most common side effects
- How exemestane side effects compare with other hormone tablets
- Myths about exemestane side effects
- Common questions about exemestane side effects
The short answer
What side effects can exemestane cause, and when do they appear?
Most side effects of exemestane come from lowering oestrogen, so they often feel like strong menopause symptoms. The most common are hot flushes, sweating, joint and muscle aches, tiredness, trouble sleeping and headaches. Many women also notice nausea, changes in appetite, low mood, dizziness, vaginal dryness or lower sex drive. Some develop swelling in the hands or feet, mild hair thinning, a skin rash, tingling in the fingers from carpal tunnel syndrome, or tummy upset such as constipation or diarrhoea. Because exemestane is steroidal, a few women notice oily skin or spots. Over the longer term, exemestane can thin the bones and increase the chance of fractures, and it can raise cholesterol, which is why bone scans and blood tests are part of follow-up. Less common effects include changes in liver blood tests and, rarely, allergic reactions. Side effects tend to follow a pattern. Hot flushes, headache and nausea often appear in the first few weeks. Joint aches and tiredness usually build over the first few months. Bone and cholesterol changes develop quietly over years. Not everyone gets side effects, and many that appear early settle with time. Compared with tamoxifen, exemestane carries a lower risk of blood clots and womb problems but more bone and joint effects. If any side effect is affecting your daily life, tell your team rather than stopping, because help is usually available.
Menopause-type symptoms are most common
Hot flushes, sweats, aches, tiredness and poor sleep top the list.
Bones need long-term care
Bone thinning develops slowly, so checks and prevention start early.
Many effects ease with time
Early symptoms often settle, and practical help exists for those that do not.
This page gives general information only and does not list every possible effect. Read the leaflet in your pack.The full picture
Side effects grouped by how often they occur
Being on a list does not mean you will get it.
Very common
Hot flushes, increased sweating, joint and muscle pain, tiredness, difficulty sleeping, headache and nausea.
Common
Low mood, dizziness, loss of appetite, tummy pain, constipation or diarrhoea, rash, hair thinning, swollen hands or feet, carpal tunnel syndrome, and bone thinning.
Less common or rare
Drowsiness, muscle weakness, changes in liver tests, inflammation of the liver and allergic reactions.
Your pack leaflet has the complete official list.Get urgent medical help for
These are rare but need prompt attention.
Urgent symptoms
- Swelling of the face, lips or throat, or trouble breathing
- Yellow skin or eyes, or dark urine
- Chest pain or sudden breathlessness
Timeline
When side effects typically appear
Time on treatment
What some women notice
First few weeks
Hot flushes, sweating, headache, nausea and sleep changes
First few months
Joint aches, stiffness, tiredness and sometimes low mood
First year
Vaginal dryness, lower sex drive, hair thinning or weight change
Over several years
Gradual bone thinning and possible cholesterol changes
After stopping
Most side effects ease over weeks to months
Words you may hear
The vocabulary, in plain language
- Hot flush
- A sudden feeling of heat in the face, neck and chest, often with sweating and a racing heart.
- Osteoporosis
- Bones that have become thin and weak enough to break more easily.
- Fluid retention
- Swelling, often in the ankles, feet or hands, caused by fluid building up in tissues.
- Liver function tests
- Blood tests that check how well the liver is working.
- Vaginal atrophy
- Thinning and dryness of the vaginal lining caused by low oestrogen.
- Patient information leaflet
- The folded paper in your medicine pack listing uses, doses and side effects.
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Being straight with you
What side effect lists do not tell you
Lists can make a medicine sound worse, or sometimes better, than it will be for you.
Not every symptom is from the tablet
Natural menopause, earlier chemotherapy, ageing and worry can all cause similar symptoms. In trials, some women taking a dummy tablet also reported aches and flushes.
Severity varies widely
Two women on the same tablet can have very different experiences. Frequency lists say nothing about how bothersome a symptom is.
What this page cannot tell you
It cannot predict which side effects you will get. Keeping a symptom diary for your first months gives your team the best information.
Practical help
Easing the most common side effects
Small changes can make a real difference to how you feel day to day.
Hot flushes and sweats
Wear layers, keep a fan nearby, and cut back on caffeine, alcohol and spicy food. For troublesome flushes, non-hormonal medicines such as venlafaxine or gabapentin may be offered.
Aches and tiredness
Regular walking and strength exercises have the best evidence. Paracetamol and pacing your day also help.
Low mood and sleep
Keep a regular bedtime, limit screens at night and talk to someone you trust. Tell your team if low mood lasts more than a couple of weeks, as counselling or medicine can help.
Vaginal dryness
Non-hormonal vaginal moisturisers used regularly, and lubricants during sex, relieve discomfort for many women.
In context
How exemestane side effects compare with other hormone tablets
Understanding the differences can help if your team suggests a switch.
Compared with letrozole and anastrozole
The overall pattern is very similar. Exemestane may cause mild androgen-type effects, such as oily skin, that the others do not.
Compared with tamoxifen
Exemestane has a lower risk of blood clots and of changes in the womb lining, but more joint pain and bone thinning. Hot flushes occur with both.
Commonly believed
Myths about exemestane side effects
Exemestane causes hair loss like chemotherapy.
Some women notice mild thinning, but complete hair loss is not expected.
Feeling fine on the tablet means it is not working.
Side effects do not show how well the tablet protects you.
Side effects will last the whole five years.
Many early symptoms settle within months, and help is available for those that persist.
Exemestane lowers my immunity.
It is not known to weaken the immune system or cause the low blood counts seen with chemotherapy.
Questions we are asked
Common questions about exemestane side effects
Do side effects of exemestane get better over time?
Often, yes. Hot flushes, headaches and nausea commonly ease after the first few months as your body adjusts. Joint aches can take longer and may persist for some women. Bone thinning does not improve on its own during treatment, which is why prevention and monitoring are important.
Can exemestane cause depression?
Low mood is a recognised side effect, and the stress of cancer adds to it. If you feel low, anxious or lose interest in things for more than a couple of weeks, tell your team or doctor. Talking therapies and some antidepressants can be used safely with exemestane.
Will exemestane make me gain weight?
Some women gain weight on hormone therapy, while others do not. Changes in appetite, lower activity from joint pain, menopause and earlier treatment all play a part. Regular movement and balanced meals help, and your team can refer you to a dietitian if needed.
Is swelling in my ankles caused by exemestane?
Mild swelling of the hands or feet is a known side effect. Raising your legs, gentle walking and avoiding long periods of standing can help. Swelling in one leg only, especially with pain or redness, or swelling with breathlessness, needs prompt medical advice to rule out other causes.
Can exemestane affect my eyes or vision?
Eye problems are not a common side effect of exemestane, unlike some changes linked with tamoxifen. Dry eyes can occur with low oestrogen. Any sudden change in vision, eye pain or flashing lights should be checked promptly by an eye doctor.
Should I be worried about vaginal bleeding on exemestane?
Vaginal bleeding is not an expected side effect of exemestane after menopause. It could mean your ovaries are active again or have another cause that needs checking. Tell your team promptly so they can arrange the right tests.
Does exemestane cause memory problems?
Some women describe forgetfulness or poor concentration during hormone therapy. Research is mixed on whether aromatase inhibitors cause this directly, and poor sleep, tiredness and stress often contribute. Lists, reminders and good sleep habits can help. Mention it if it affects daily life.
What should I do if a side effect becomes unbearable?
Contact your oncology team before stopping. They may suggest treatments for the symptom, a short planned break, or a switch to letrozole, anastrozole or tamoxifen. Most women can find an approach that lets them continue hormone therapy more comfortably.
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Sources
- Cancer Research UK — Exemestane (Aromasin)
- Macmillan Cancer Support — Exemestane
- MedlinePlus — Exemestane
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.