The Genitourinary syndrome of menopause (GSM) is a progressive urogenital condition caused by declining estrogen and androgen levels during menopause transition and menopause. Changes in the vulvovaginal and lower urinary tract tissues result in a range of genital, sexual, and urinary symptoms. With increasing life expectancy, the impact of GSM on the quality of life, sexual function, and urogenital health is becoming more evident. Healthcare providers should screen women for symptoms, diagnose, counsel, and treat women with GSM to optimize symptom control. First-line therapies for mild symptoms limited to vaginal dryness or dyspareunia include nonhormonal vaginal lubricants and moisturizers. For moderate-to-severe GSM, low-dose vaginal estrogen therapy, vaginal DHEA, and oral SERM ospemifene are safe and effective options. Vulvovaginal energy-based devices offer a choice to women in whom vaginal estrogen is contraindicated, but long-term safety is not known.