Menopause is a natural phase in a woman’s aging process defined as the absence of menstrual periods for 12 consecutive months with no further pathological or physiological causes. With “Genitourinary syndrome of menopause (GSM)” we usually describe the collection of symptoms resulting from changes to the internal and external genitalia and lower urinary tract. The most common symptoms are vaginal dryness, itching, irritation, and dyspareunia. GSM may have a significant impact on quality of life and sexual function of women affected. The aim of this review is to make a brief reflection about the use of ultralow-concentration estriol vaginal gel in the treatment of GSM symptoms and its impact on sexuality and quality of life of the patients.