Anatomically described as a “potential space,” the vagina is a highly estrogen-responsive organ, and its biology changes dramatically at menopause. After menopause, many women experience vaginal dryness and/or dyspareunia, which are caused primarily by regression of the vaginal epithelium.Unlike vasomotor symptoms, which typically resolve overtime, vaginal atrophy remains a persistent consequence of the menopausal transition. This article discusses current trends and potential future treatments that may improve choices for menopausal and postmenopausal women.