There is a strong need to provide practical, evidence-based guidelines for evaluating and treating common menopausal symptoms following breast cancer. Menopausal symptoms are a frequent and troublesome side-effect of breast cancer therapy in women of all ages. Hot flashes, night sweats, sexual dysfunction, poor sleep and tiredness frequently occur following breast cancer treatment. Vasomotor symptoms, particularly hot flashes, appear to be more severe than in women who have not had breast cancer treatment. Atrophic vaginitis affects many women using endocrine therapy for breast cancer, particularly those using aromatase inhibitors. Sexual dysfunction may be related to atrophic vaginitis but also to changes in body image, libido and self-esteem. Across all trials of adjuvant endocrine therapy, vasomotor symptoms such as hot flashes are the most common side-effect. Up to 20% of breast cancer patients consider stopping or actually cease endocrine therapy because of menopausal symptoms, primarily hot flashes, despite its established role in reducing recurrence. The recommended duration of initial adjuvant endocrine therapy is 5 years and some patients may benefit from a further 5 years of treatment. With such long-term treatment duration, it is critical to address morbidity associated with treatment side-effects in an effort to optimize adherence to therapy and quality of life.