Tamoxifen has been the standard adjuvant therapy for patients with breast cancer for the last several decades. Several recently completed adjuvant trials using aromatase inhibitors have shown the superiority of these agents over Tamoxifen or placebo, when used in postmenopausal women. The results from these trials present a challenging situation for practicing oncologists with regards to the choice, duration, sequence of therapy, follow up and side effects of aromatase inhibitors. We have discussed various management issues from a practical angle for oncologists to effectively use these agents, with an evidence-based approach.