Incidence of breast cancer (BC), particularly in younger women, has increased in last decade. About forty percent of all BC are observed in women under the age of 50 years and, accordingly, in pre-menopausal women. Luminal-like is the most common subtype. Pre-menopausal status is associated with clinical, social and psychological issues that must be addressed as part of oncology care to guarantee the best global health outcomes after treatment. This review aims to answer the most common questions on endocrine treatment in pre-menopausal women. In particular, it focuses on the decision-making process that drives the choice about ovarian function suppression, use of aromatase inhibitors, and duration of therapy.