Genitourinary menopausal syndrome is identified, according to different data, in 50—90% of postmenopausal women, and in 15% of women the symptoms begin as early as 40—49 years old. The trigger of the genitourinary menopausal syndrome is estrogen deficiency, which occurs due to a decrease and cessation of the oestrogen-synthesizing function of the ovaries. On the basis of the authors’ analysis of the literature it is shown that, apart from oestrogen deficiency, other mechanisms may be involved in the pathogenesis of vulvovaginal atrophy. It is possible that a deficiency of other steroids, an increase in lipid peroxidation and a failure of the antioxidant defense system, or a dysbiotic gut exacerbate changes associated with oestrogen deprivation, and may be a resolving factor in symptomatic vulvovaginal atrophy and the genitourinary menopausal syndrome. Further studies are needed to more precisely estimate the contribution of various risk factors and pathogenesis mechanisms in the formation of genitourinary menopausal syndrome and vulvovaginal atrophy.