Objective: To study the efficacy and safety of neoadjuvant endocrine therapy for postmenopausal hormone receptor positive breast cancer. Methods: A prospective non-randomized controlled clinical study, 116 cases of postmenopausal ER/PR≥50%, Her-2 negative T2–3N0M0 breast cancer patients, according to the freedom of choosing to enter the neoadjuvant endocrine therapy group or neoadjuvant chemotherapy group, the imaging and pathology of efficiency and safety was observed. Results: The objective response rate and clinical benefit rate were 81.43%, 97.14% in endocrine group, 80.44% and 98.12% of the chemotherapy group, with no significant difference between two groups (P>0.05); ultrasound complete response (uCR) and pathological complete response (pCR) rate (15.72%, 10.00%) in endocrine group was significant higher than the chemotherapy group (10.87%, 6.52%), the difference was statistical (P<0.05); adverse reaction rate was 11.43% in endocrine group. The side effects were mild facial flushing and bone and joint pain, and in the chemotherapy group adverse reaction rate was 100%, and the performance of myelosuppression and gastrointestinal reactions were heavier, the difference has statistical significance (P<0.05). Conclusion: There is no difference in the overall clinical efficacy of neoadjuvant endocrine therapy and neoadjuvant chemotherapy on axillary lymph node negative Luminal breast cancer after menopause, but uCR/pCR was significantly higher than that of the latter, there are significant differences, and the side effect is tolerate, so neoadjuvant endocrine therapy is a safe and effective treatment .