Non-Hormonal Option for Vaginal Symptoms

Mary Heim RPh FAAFM
Women’s Health Specialist

A critical symptom for post-menopausal women is vaginal dryness or pain. Vaginal atrophy is a common complication in menopause as estrogen levels decline. Atrophy does not improve with time and if untreated, can affect quality of life for women. The atrophy is not confined to the vaginal lining but can also be occurring in lining of the urinary/bladder system.

First line therapy for this condition is vaginal estrogen and many options are available both commercially and from your compounding pharmacy. Commercial options include Premarin® Vaginal cream which contains conjugated equine estrogens; Estrace® Vaginal cream, Vagifem® vaginal tablets and Estring® Vaginal ring, which all contain USP estradiol, a bio-identical estrogen. USP Estriol, a weaker bio-identical estrogen, is available from a compounding pharmacy either alone or in combination with other hormones such as estradiol, progesterone, testosterone or DHEA for vaginal use. The FDA has also recently approved Intrarosa® containing the hormone DHEA, for vaginal atrophy.

Women and physicians have been searching for a non-hormonal approach for those patients who can’t take hormones or simply do not wish to take hormones. Hyaluronic acid suppositories with cocoa butter or in a non-irritating vaginal base can be an effective treatment. A small study evaluated Premarin® Vaginal cream and 5mg/gm compound hyaluronic vaginal gel with respect to symptoms of atrophy, cellular maturation, and vaginal PH. The study showed dryness, itching, maturation index, and PH were relieved significantly in both groups with more improvement shown in hyaluronic group. Urinary incontinence only showed improved in the hyaluronic group.

Even with the small sample size, this study contributes to other literature available showing 5mg/gm vaginal hyaluronic acid as a good alternative for those patients wishing to avoid hormones but suffering from the symptoms of vaginal atrophy.

Jokar et al. Comaprison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopausal Women: A Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery. 2016 Jan: 4(1) 69-78.

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