Hyaluronic acid, estrogen yield similar improvements for vaginal atrophy

Key takeaways:

• At 12 weeks, vaginal hyaluronic acid and vaginal estrogen were associated with genitourinary syndrome of menopause improvements.
• Researchers saw no clinically meaningful differences between treatment groups.

At 12 weeks, vaginal hyaluronic acid and vaginal estrogen were associated with similar benefits in the treatment of atrophic vaginitis, known as genitourinary syndrome of menopause, according to results of a pilot trial.

“To provide women and providers with a spectrum of options they feel comfortable with for genitourinary syndrome of menopause, exploring nonhormone therapies, like vaginal hyaluronic acid, are important,” Surbhi Agrawal, MD, urogynecology fellow in the department of urogynecology and pelvic reconstructive surgery at the University of Pennsylvania, and colleagues wrote in Menopause. “Only a few studies involving vaginal hyaluronic acid have been completed thus far, and they have been small and mostly used internationally available formulations of hyaluronic acid and estrogen.”

Agrawal and colleagues conducted a randomized, parallel-arm pilot trial with 49 women (mean age, 60 years) with genitourinary syndrome of menopause. All women were randomly assigned to a vaginal hyaluronic acid suppository with an FDA-approved vaginal lubricant and moisturizer made of 5 mg hyaluronic acid sodium salt and a base of semi-synthetic glycerides (n = 23) or vaginal estrogen cream with an FDA-approved low-dose cream made of 100 g estradiol per 1 g cream (n = 26) for 12 weeks. Researchers assessed differences between women treated with vaginal hyaluronic acid or vaginal estrogen.

Primary outcome was vulvovaginal symptom questionnaire score. Secondary outcomes included the Female Sexual Function Index, the vaginal symptom index, visual analog scale for dyspareunia, vaginal itching, vaginal dryness, Patient Global Impression of Improvement, vaginal maturation index and vaginal pH.

Overall, 45 women had data at 12 weeks of treatment. Vaginal dryness was the most commonly reported symptom of genitourinary syndrome of menopause, reported by 100% of women in the vaginal hyaluronic acid group and 96.2% of women in the vaginal estrogen group.

Researchers observed no difference in overall vulvovaginal symptom questionnaire scores between women who received vaginal hyaluronic acid or vaginal estrogen. At 12 weeks, both treatment groups experienced improvement in genitourinary syndrome of menopause as measured by the vulvovaginal symptom questionnaire

During the study period, visual analog scale, the vaginal symptom index, total Female Sexual Function Index and vaginal pH scores improved with no differences in improvement observed between women who received vaginal hyaluronic acid or vaginal estrogen.

After 12 weeks of treatment, 96% of women who received vaginal estrogen and 91% of women who received vaginal hyaluronic acid reported improvement in genitourinary syndrome of menopause on the Patient Global Impression of Improvement score.

“Vaginal hyaluronic acid may be a promising nonhormone alternative for genitourinary syndrome of menopause treatment, but larger, adequately powered trials are needed to establish noninferiority,” the researchers wrote.