Aromatase inhibitors are designed to inhibit the action of the enzyme aromatase, which converts androgens into estrogens by a process called aromatization. Aromatase inhibitors include Arimidex ( anastrozole ), Femara ( letrozole ), and Aromasin ( exemestane ). Aromatase inhibitors generally are used for estrogen receptor positive (ER+) breast cancer in postmenopausal women.
Since the growth of ER+ (i.e., estrogen sensitive) breast cancer is promoted by estrogen, use of aromatase inhibitors to reduce the production of estrogen in the body is designed to suppress ER+ breast cancer recurrence.
Aromatase inhibitors normally are not used to treat breast cancer in premenopausal women unless accompanied by ovarian function suppression. This is because inhibiting aromatase does not affect the production of estrogen by the ovaries, which are the most abundant source of estrogen in premenopausal women. To the extent that an aromatase inhibitor did decrease the production of estrogen in a premenopausal woman, the decrease would tend to stimulate the ovaries to increase androgen production, thereby neutralizing the effect of the aromatase inhibitor.
This webpage lists foods that inhibit aromatase and/or enhance the treatment effects of aromatase inhibitors. It also lists foods, supplements and other exposures that can increase aromatase or otherwise interfere with aromatase inhibitor treatment.
The food lists, which are updated continually as new research becomes available, have been developed based solely on the results of published academic studies. Clicking on any of the foods will take you to its webpage, which contains specific information concerning that food's relationship to breast cancer (including its overall ranking, for example, highly recommended or recommended in moderation), as well as links to supporting studies.
For a list of foods that naturally inhibit aromatase, see Foods that act as aromatase inhibitors . Note that not all foods that inhibit aromatase are safe to consume during aromatase inhibitor treatment.
The following foods (or major bioactive components) have been found to inhibit aromatase or to enhance the effectiveness of aromatase inhibitors and are recommended during treatment:
Aromatase inhibitors should be taken at the same time every day. Arimidex and Femara can be taken with or without food. Aromasin should be taken after a meal to avoid nausea or indigestion. For the same reason, some women benefit from taking Aromasin at night.
The following have been found to increase aromatase or estrogen or to reduce the effectiveness of aromatase inhibitors and should be limited or avoided during treatment:
There is no supplement or combination of supplements that has been proven to reliably reduce the risk of ER+ breast cancer recurrence in women. When a beneficial micronutrient is administered at low doses by consuming food, it is likely to have subtle chemopreventive effects, whereas when the same micronutrient is administered at a high dose in a supplement, it is more likely to have pharmacological effects, with mostly unknown results. It is best to obtain beneficial compounds by consuming food, if possible. Supplements should be used if medically necessary or to make up for deficiencies that are difficult to correct through diet.
The supplements below generally been found to be safe and beneficial for patients taking aromatase inhibitors:
SupplementDosageCoQ10 (if needed for heart health)100 to 400 mg/dayFish oil (from wild-caught fish)1000 to 2000 mg/dayVitamin D1000 to 2000 IU/dayPlease consult your oncology team for advice concerning your situation and dosages. It might make sense to be tested for deficiency in vitamin D and plan for follow up to determine if your reading has reached a desirable level.
The supplements below have been found specifically to increase estrogen or aromatase, reduce the effectiveness of aromatase inhibitors, or increase their side effects, and should be avoided during treatment. That is not to say that most other supplements are safe to take — there are no relevant scientific studies concerning the interactions between most supplements and aromatase inhibitors.
Cigarette smoking has also been found to sharply reduce the effectiveness of treatment with aromatase inhibitors. The heart medication digoxin has also been shown to have estrogenic effects that could potentially interfere with aromatase inhibitor treatment.To varying degrees, women taking aromatase inhibitors experience menopausal symptoms such as increases in joint disorders, bone fractures, and vaginal/urogenital atrophy, in addition to weight gain and higher cholesterol (especially for those switching from tamoxifen). Please see our article on aromatase inhibitor-associated weight gain . Weight gain after diagnosis has been shown to increase hot flashes in breast cancer survivors using aromatase inhibitors. There are some foods that can reduce menopausal side effects while at the same time reducing the risk of breast cancer recurrence.
The following foods (or major components) have been shown to help reduce some of the side effects of aromatase inhibitors:
Moderate to vigorous physical activity, particularly aerobic exercise , has been shown to be associated with lower risk of bone fractures in women being treated with aromatase inhibitors. Aspirin appears to be safe to take for pain during aromatase inhibitor treatment. Women should not use copper bracelets or copper compression garments to relieve arthritis pain. Copper has been shown to contribute to angiogenesis and metastasis of breast cancer.
Low-dose vaginal estrogen, which is used to relieve vaginal dryness and related urogenital atrophy, appears to be safe for use for postmenopausal women after aromatase inhibitor treatment has been completed.
The estrogen deprivation caused by aromatase inhibitors can also cause some of the symptoms of chemo brain in some women. These symptoms appear to improve within a year after endocrine treatment ends (chemo brain may last longer if chemotherapy was part of breast cancer treatment). One major 2021 study found no links between use of endocrine treatments in non-metastatic breast cancer and risk of subsequent dementia.
The following should be limited during aromatase inhibitor treatment since high consumption could contribute to bone loss:
A 2021 study reported that aromatase inhibitor-induced bone loss appears to be partially reversible after treatment is completed.
We suggest that estrogen sensitive breast cancer patients and survivors eat a wide variety of the foods from our recommended list and limit or avoid those on our avoid list, in addition to paying particular attention to the foods, spices and supplements on the lists above. Please see our article on how to optimize your breast cancer diet for information on what to eat during all stages of treatment and recovery.
Below are links to recent studies on aromatase inhibitor treatment. See also the aromatase inhibitors tag and Foods that increase or reduce aromatase activity.