The objective of this review is to provide a practical guide on the diagnosis and clinical management of urogenital atrophy. A literature search was done in Medline (1969-2008) for original reports, meta-analysis and guidelines in English on urogenital atrophy. This is a common menopausal problem and is caused by oestrogen deficiency. Fifteen per cent of pre-menopausal women and 40-57% of post-menopausal women have symptoms resulting from urogenital atrophy. However, less than 25% of these women receive medical care. Lubricants are temporary measures to relieve vaginal dryness during intercourse and moisturizers give longer symptomatic relief. Oestrogen given systemically or locally in all dosage regimens is effective, but topical vaginal application alone is preferred if systemic treatment is not needed. Treatment is long term and may be required for many years.