Hyaluronic acid vaginal gel effective for vaginal dryness

Posted on July 31, 2013


North American Menopause Society’s First to Know e-newsletter showcased our Executive Director Dr. Holly L. Thacker’s review of hyaluronic acid vaginal gel and it’s effectiveness for vaginal dryness in women.

Chen J, Geng L, Song X, Li H, Giordan N, Liao Q.
Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013;10(6):1575-1584.

Level of evidence: I.

Summary. A hyaluronic acid vaginal gel performed as well as an estriol (not estradiol) cream to relieve vaginal dryness in this randomized, controlled but open-label trial in postmenopausal women. A total of 133 women completed the study (67 who used hyaluronic acid and 66 who used estriol cream). Both groups applied the treatments every 3 days for a total of 10 applications. Mean vaginal dryness scores improved 84% in the hyaluronic acid group and 89% in the estriol group by the final visit, demonstrating no significant difference. The improvements in dyspareunia were not as strong but were not significantly different (24% in the hyaluronic acid group and 27% in the estriol group). Improvements in vaginal itching (63% and 67%, respectively) and burning (86% and 88%, respectively) were also not significantly different. The vaginal microflora and endometrial thickness also did not differ significantly, but vaginal pH was significantly lower in the estriol group. Adverse events included vulvovaginal candidiasis and bacterial vaginosis in the hyaluronic acid group and mild increased endometrial thickness, vulvar itching, asymptomatic and mild bacterial vaginosis, and vaginal itching in the estriol group. The authors concluded that the gel is a valid and safe option for patients unwilling or unable to consider an estrogen therapy.

Comment. The topic of this year’s Pre-Meeting Symposium at the NAMS Annual Meeting is “Vulvovaginal Health: Let’s Talk About It.” Vulvovaginal atrophy can cause vaginal dryness, dyspareunia, and resultant female sexual dysfunction and urogenital discomfort. It is a common, relevant, and undertreated problem for many women. NAMS does assert that nonestrogen, over-the-counter lubricants should be used first for vaginal atrophy.1 I disagree, because this does not improve the integrity of the urogenital tissues. However, many women are concerned about using lowdose local vaginal estrogen creams, tablets, or vaginal rings. Local vaginal dehydroepiandrosterone has shown improvement in vulvovaginal atrophy, dyspareunia, and sexual dysfunction2; however, it remains in phase 3 trials. Recently, the first nonestrogen, oral agent to treat moderate to severe dyspareunia and vulvovaginal atrophy (ospemiphene [Osphena 60 mg], taken daily with food) has been approved.3

Many women remain leery of any prescription medications to treat local vaginal dryness. Furthermore, not all vaginal dryness is caused by vaginal atrophy, and not all dyspareunia is caused by vaginal atrophy. Having a nonhormonal vaginal gel to reduce dryness is very helpful because it has a high safety profile and no hormone-like adverse effects. Hyaluronic acid, which is part of the extracellular matrix and one of the glycosaminoglycans secreted during tissue repair, was compared with vaginal estriol in this study. Although the hyaluronic gel did not reduce vaginal pH like the estriol, it rapidly reduced vaginal dryness symptoms.

Holly L. Thacker MD, FACP, CCD, NCMP
Professor and Chair, Center for
Specialized Women’s Health
OB-GYN and Women’s Health Institute
Cleveland Clinic Lerner College of Medicine of CWRU
Executive Director, Speaking of Women’s Health
Cleveland, OH

References
1. North American Menopause Society. The role of local vaginal estrogen for the treatment of vaginal atrophy in postmenopausal women; 2007 position statement of The North American Menopause Society. Menopause. 2007; 14(3 pt 1):355-369.

2. Labrie F, Archer D, Bouchard C, et al. Intravaginal dehydroepiandrosterone (Prasterone), a physiologic and highly effective treatment of vaginal atrophy. Menopause. 2009;16(5):907-922.

3. Bachmann GA, Komi JO; Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause. 2010;17(3):480-486.

Read the entire July 2013 issue of the NAMS First to Know.