If you’ve been diagnosed with hormone-receptor-positive breast cancer and you’ve navigated the big hurdles of surgery, chemotherapy, or radiation, your doctor might mention something called Exemestane as part of your follow-up. And if you’ve never heard of it before, don’t panic, you’re not alone.

Exemestane is just one of those low-key, behind-the-scenes drugs that doesn’t receive much fanfare, yet has a very significant role in keeping breast cancer from returning.

So let’s discuss what it is, how it functions, why you may need it, and what you can expect if you are prescribed this long-term medication.

What Is Exemestane?
Exemestane (commercial name Aromasin) is a drug from a class of medicines referred to as aromatase inhibitors. It’s a hormone therapy and not a chemotherapy agent, and it’s usually applied in postmenopausal women with HR+ breast cancer.

Why hormone therapy? Because certain kinds of breast cancer are fueled by estrogen. If we can keep the body from producing or delivering estrogen, we can starve those cancer cells and keep them less likely to return.

That’s what Exemestane does, it acts to decrease estrogen levels in the body.

How Does It Work
Your body makes estrogen naturally. Most of it in premenopausal women comes from the ovaries. However, after menopause, estrogen continues to be produced in smaller quantities by an enzyme called aromatase, which takes other hormones and converts them into estrogen.
Exemestane inhibits aromatase, and that lowers the production of estrogen. Lower estrogen means fewer fuel supplies for any residual breast cancer cells.

It’s taken once daily as a tablet, often at the same time each day, with or without food. It’s an easy regimen, but the long-term impact can be significant.

Who Is It Suitable For?
Exemestane is usually prescribed for:
Postmenopausal women with hormone receptor-positive breast cancer
Women who have finished 2–3 years of another hormone treatment (such as tamoxifen) and are changing to Exemestane for the final 2–3 years
Women with early-stage breast cancer to lower the risk of recurrence.

In a few instances, women with advanced or metastatic breast cancer

If you’re not yet postmenopausal, your doctor might add Exemestane to other drugs to shut down your ovaries, basically sending your body into menopause so the drug can be effective.

Why Would You Be Treated With It?
One of the objectives once surgery or chemotherapy is finished is to prevent the cancer from returning. Hormone therapy such as Exemestane is one of the key players in that prevention strategy, particularly if your tumour is hormone receptor-positive for estrogen or progesterone.
Research has indicated that aromatase inhibitors such as Exemestane can reduce recurrence risk, and in some instances, decrease the risk of new cancer in the opposite breast.

Although it’s not a sure thing, it’s an active choice that can make a significant impact in the long run.

How Long Will You Take It?
Typically, Exemestane is taken for 5 years, perhaps after 2–3 years on tamoxifen. Overall, hormone therapy may go on for 5 to 10 years, depending on your risk factors and medical history.

Yes, it does seem like a long time, but keep in mind: that it’s a low-maintenance, once-a-day pill with great protective benefits.

And if at any point the side effects become too difficult, your oncologist can adjust the plan. You’re not locked in without support.

What Are the Side Effects?
Let’s talk honestly: Exemestane does come with side effects. That’s because it lowers estrogen, and estrogen isn’t just about reproduction, it helps regulate your bones, joints, mood, and more.
Common side effects include:
Joint or muscle pain
Hot flashes or night sweats
Fatigue
Headaches
Trouble sleeping
Mood swings or low mood
Bone thinning (osteoporosis)
All these side effects differ between individuals. Some feel perfectly okay, while others may feel sore or more emotional.
Good news: Most side effects can be managed with the proper care. Over-the-counter pain medication, exercise regularly, stretching, and medicines or supplements that strengthen bones (such as calcium and vitamin D) can assist.

It’s also key to keep in touch with your doctor regarding how you’re doing. You don’t need to “tough it out” on your own.

What About Bone Health?
One of the larger issues with aromatase inhibitors is the thinning of the bones or osteoporosis. Because estrogen works to keep bones healthy, reducing it can result in loss of bone over time.
That’s why your doctor may:
Suggest a DEXA scan to test bone density.
Prescribe bisphosphonates (such as zoledronic acid) to assist in protecting your bones.
Recommend lifestyle modifications, such as weight-bearing activities, strength training, and calcium foods.
Taking care of your bones on Exemestane is equally as important as taking the pill itself. You will want to remain strong and healthy in the long term.

Can You Still Have a Normal Life on Exemestane?
Yes.

Exemestane is being taken by many women while they work, have families, travel, and enjoy full lives. It will take some adjusting, perhaps with joint aches or low energy, but after your body gets used to the new regimen, it becomes routine.

The most important thing is to be patient with yourself. Healing from breast cancer is not just physical, it’s emotional and mental too. You’re still in recovery, even if the treatments have ended.

Give yourself grace. Take breaks. Prioritize rest. And celebrate small victories.

One Small Pill, One Big Impact
At first blush, Exemestane doesn’t sound like a big deal. It’s not some melodramatic chemo treatment or life-changing operation. But in the realm of breast cancer therapy, it serves a potent supporting function, like a firm hand that keeps the recurrence door locked tight.

It’s understandable to feel overwhelmed at the prospect of being on medication for 5 to 10 years. But don’t forget why you’re doing this: to keep your future safe. To set yourself up for the best chance at staying healthy. To be able to go forward with confidence.

Speak with your doctors. Rely on your community. And don’t be afraid to reach out for help when you need it.

You’re not only living. You’re entering a new book. Exemestane is just one of the devices that assist you in writing it.