Exemestane: Quick Guide for Patients and Clinicians

Exemestane is a pill used to treat hormone‑positive breast cancer after surgery or radiation. It belongs to the aromatase‑inhibitor family, which means it blocks the body’s ability to turn testosterone into estrogen. Lower estrogen levels help stop cancer cells from growing.

How Exemestane Works and Who It’s For

Women who have gone through menopause and whose tumors need estrogen are the main candidates for exemexane. The drug shuts down the aromatase enzyme, so less estrogen is made. Doctors usually give it when other hormone therapies, like tamoxifen, aren’t enough or cause side effects.

The standard dose is one 25‑mg tablet taken every day, with or without food. Most people stay on it for five years, but the exact length depends on the doctor’s plan and how the patient tolerates the drug.

Bleeding Risk and the CRUSADE Score

While exemestane isn’t a blood‑thinner, it can still affect bleeding risk in a few ways. Some patients notice easy bruising or nosebleeds, especially if they’re also taking aspirin, NSAIDs, or anticoagulants. That’s where the CRUSADE Bleeding Score comes in. The score looks at factors like age, blood pressure, kidney function, and use of blood‑thinners to predict how likely a person is to bleed during treatment.

If a patient’s CRUSADE score is high, the doctor may check labs more often, lower the dose of any added blood‑thinner, or switch to a different cancer drug. It’s a simple tool that helps balance cancer control with safety.

Here are the most common side effects you might see with exemestane:

• Hot flashes – similar to menopause symptoms.
• Joint or muscle pain – often called arthralgia.
• Fatigue – feeling tired even after rest.
• Bone loss – doctors may prescribe calcium, vitamin D, or a bisphosphonate.
• Gastro‑intestinal upset – nausea or mild stomach pain.

Most side effects are mild and improve after a few weeks. If you notice severe bruising, bleeding gums, or blood in urine or stool, call your doctor right away. Those signs could mean a bleeding problem that needs a quick check.

Drug interactions matter, too. Avoid taking high‑dose ibuprofen, warfarin, or other anticoagulants without talking to your clinician. Some herbal supplements, like ginkgo or garlic, can also thin blood and raise the risk of bleeding.

Monitoring is straightforward. Your doctor will likely order blood work every 3‑6 months to look at liver function, cholesterol, and bone density. If you’re on a blood‑thinner, they’ll check the INR or other clotting numbers more often.

Practical tips to stay safe while on exemestane:

1. Take the pill at the same time every day – consistency helps keep hormone levels stable.
2. Keep a simple diary of any new bruises, nosebleeds, or gum bleeding.
3. Stay active, but avoid high‑impact sports if you have fragile bones.
4. Ask your pharmacist for a medication review if you add new prescriptions or supplements.
5. Follow the doctor’s schedule for bone‑density scans and blood tests.

Exemestane can be a powerful part of breast‑cancer treatment, but it works best when you and your care team keep an eye on bleeding risk. Using the CRUSADE score, watching for side effects, and staying on top of lab checks makes the therapy safer and more effective.

Got more questions? Talk to your oncologist or pharmacist. They can explain how exemestane fits into your overall plan and what steps you need to take to keep bleeding risk low.