Role of estrogen in urogenital atrophy is well established. Low-dose, vaginally administered estrogens have an important role in the treatment of urogenital atrophy in postmenopausal women and appear to be as effective as systemic preparations. The newer estriol and estradiol-containing vaginal hormone therapies are safe for short-term use. The vaginal delivery of estrogen causes enhancement of the efficacy of treatment of urogenital symptoms and avoids the need for daily dosage of systemic hormone replacement therapy (HRT). Estrogen replacement therapy may be efficacious in the treatment of women with recurrent lower urinary tract infections.