My understanding of Letrozole and other AI’s is that it stops the production of estrogen by other areas of the body(not the ovaries). There are actually different forms of estrogen produced in various areas of the body and Letrozole does nothing to stop the ovaries from producing their type of estrogen. That is why it is only given to post menopausal women.
Even though my body went into chemo induced menopause my ovaries started functioning again enough for periods to return around 18 months after my last chemo. My onc kept me on Tamoxifen because it does block all types of estrogen including the type produced by the ovaries, until we knew whether I would stay in menopause or not (I was 47 and premenopausal before chemo). When my ovaries started functioning again the decision was to remove them so I could safely change from Tamoxifen to Femara. I was 49 then. Have been on Femara for 3 years now.