One of the most common experiences of menopause are the changes that occur on the external genital tissue and intravaginal tissue that can then also affect urinary function. This is called genitourinary atrophy or atrophic vulvovaginitis and now coined, genitourinary syndrome of menopause (GSM). Symptoms can include one or more of the following: vulvovaginal discomfort, itching, burning, tingling, dryness, thinning of tissue, pain, pain with vaginal penetration related to dryness and/or tightness of vaginal opening, post coital bleeding, vaginal discharge, bladder leakage, urinary incontinence. These symptoms can affect comfort and quality of life with up to 40% of menopausal women being affected in their sex life, 17% in their confidence, 13% in their partner relationship and 7% in their social life.
There are many options to address these genitourinary atrophic changes and symptoms…the most studied and effective is vulvovaginal estrogen…which can be used with safety and effectiveness. There are some nuances to that statement in women with a history of breast cancer. None the less, some women seek other options including over the counter lubricants, over the counter moisturizers, and herbal/nutrient agents. One such item that has been subject to a small amount of research is Hyaluronic acid.
Vaginal estrogen in all sizes and shapes (creams, rings, tablets, ovule inserts, suppositories), is the gold standard for treating vaginal atrophy. Creams are the gold standard for application externally, to the vulva when the condition causes itching and burring and pain on the vulvar tissue.
Many women prefer to start with non-hormonal treatment options for vaginal atrophy or may have a history of an estrogen sensitive cancer of the uterus or breast, that make it preferred to start with a non-hormonal option. The intravaginal topical application of a moisturizing agent, such as hyaluronic acid (HA), represents one such non-hormonal option for relief of vaginal atrophy. The purpose of the study reported here, was to summarize the evidence regarding the efficacy of topical HA compared to topical estrogen in postmenopausal women with vaginal atrophy. An extensive literature search covered English-published studies from several databases up until February 2023. The counting of studies included a direct comparison between topical hyaluronic acid and topical estrogen. Six studies were included. Comparisons showed that both interventions were significantly effective in alleviating the symptoms of vaginal atrophy and pain with vaginal penetration (dyspareunia) as well as improving vaginal pH and cell maturation index. However, comparisons in most studies showed that estrogen was superior to hyaluronic acid in relieving vaginal symptoms and improving vaginal pH, dyspareunia, and the cell maturation index. While there is no evidence to show the superiority of hyaluronic acid to estrogen in the treatment of postmenopausal vaginal atrophy, the effectiveness of hyaluronic acid seems to be comparable to estrogen and should be considered as a viable alternative to estrogen in most cases.
Reference: Comparison of the Efficacy of Vaginal Hyaluronic Acid to Estrogen for the Treatment of Vaginal Atrophy in Postmenopausal Women: A Systematic Review
Albalawi N, Almonhammadi M, Albalawi A. Cureus 2023 Aug 27;15(8)
