Tamoxifen has been the standard adjuvant therapy for patients with breast cancer for several decades. Various recently completed adjuvant trials using aromatase inhibitors have shown the superiority of these agents over Tamoxifen or placebo, when used in post-menopausal 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. Various management issues from a practical angle for oncologists are discussed for the effective use of these agents, with an evidence-based approach.