Vulvovaginal atrophy is a frequently neglected symptom of menopause. While an estimated 10–40% of women are affected by the progressive symptoms of vaginal dryness, irritation, itching, dysuria and dyspareunia, only a quarter of symptomatic women are believed to seek medical attention. Until recently, treatments for vulvovaginal atrophy were limited to often insufficient or inappropriate oral estrogen therapies and over-the-counter lubricants and moisturizers. Currently, a broader range of treatments, which address symptom reduction and estrogen restoration to affected tissue, are being developed. Among these treatments are local estrogen, selective estrogen receptor modulators, tissue-selective estrogen complexes, local androgens, dehydroepiandrosterone, oxytocin, phytoestrogens and nonhormonal options. The aim of this article is to discuss current treatments for vulvovaginal atrophy. In addition, we will discuss alternative therapies and explore emerging strategies for care.