Breast cancer remains the leading cause of cancer-related mortality in premenopausal women. Multiple advances in local and systemic therapies have dramatically improved outcomes in women with hormone receptor-positive early-stage breast cancer. Despite these advances, early and late relapses occur. Therefore, multiple adjuvant endocrine therapy trials have been conducted with the goal of decreasing breast cancer recurrence and mortality. Recently, large international trials evaluating extended endocrine therapy and ovarian suppression with and without tamoxifen or exemestane have been reported. These studies add to the large body of existing data on adjuvant endocrine therapy in premenopausal women with breast cancer and provide additional therapeutic options in those at high risk of disease recurrence. This review will synthesize the most recent data and promote an evidence-based approach, highlighting quality-of-life concerns, to considering adjuvant endocrine therapies in premenopausal women.