Menopause is associated with a marked reduction in endogenous estrogen production. Lower levels of circulating blood estrogen have various deleterious effects, including those on the lower urinary tract. The vaginal epithelium becomes atrophied and dry, which can cause vaginal discomfort, itching, and dyspareunia. The epithelium may become inflamed and contribute to urinary symptoms, including frequency, urgency, dysuria, and incontinence. Diminished estrogen effects on periurethral tissues can contribute to pelvic laxity and stress incontinence. Changes in vaginal pH and normal flora may predispose older women to urinary tract infection. Although estrogen replacement therapy can result in maturation of the vaginal epithelium, the optimal form of administration and the dosage regimen for improving symptoms and quality of life of the geriatric female population have not been well studied.