Proactive things you can do include a bone density scan - if you don't know what your bone density is, best to find out now as Letrozole can have a thinning effect. If you know the score when you start, and monitor it, it's easy to know if it's having any impact and then consider ways to minimise it. Mine was very good to begin with, and while there has been some impact, I have now got to the stage (nearly 6 years) where the possibility of stopping scares me a great deal less than not starting! Vaginal dryness is another possible side effect, it can be rectified, and the Let's Talk About Vaginas group here is highly informative. And finally, hot flushes, joint pain, night sweats, arthritis type symptoms? I have had none at all. It's a mad swings and roundabouts game, best wishes!