Premature ovarian failure is a common consequence of systemic treatment for premenopausal breast cancer. Vasomotor symptoms and sexual dysfunction occur frequently in women who have an abrupt menopause from chemotherapy or ovarian suppression. However, current fertility may be impaired even in women who are menstruating after chemotherapy, and survivors are at high risk for permanent ovarian failure at a young age. Hot flashes can be managed with venlaxafine, gabapentin, or-potentially-stress management. Providing advice on treating vaginal dryness and brief sexual counseling can often alleviate sexual dysfunction. Options for fertility preservation remain limited but are improving rapidly. Distress about interrupted childbearing has a long-term impact on the quality of life.