Comparison of the effect of hyaluronic acid and estrogen on atrophic vaginitis in menopausal women: A systematic review

Abstract

This systematic review was conducted to compare the effectiveness of hyaluronic acid and estrogen on symptoms of atrophic vaginitis (primary outcomes) and corresponding side effects (secondary outcome). We reviewed all parallel clinical trials, systematically, to compare the effectiveness of hyaluronic acid and estrogen on atrophic vaginitis. We searched Pubmed, Embase, Web of Sciences, Cochrane library, Scopus, Google Scholar, Magiran, Scientific Information Database (Iran) and Iranian Registry of Clinical Trials, from inception to July 2018 and the reference lists of retrieved articles. Two reviewers used the Cochrane collaboration tool to assess the risk of bias independently. Five parallel controlled trials with 372 participants were included in the present systematic review. One trial reported estrogen superiority to hyaluronic acid in improving the symptoms of atrophic vaginitis. Three trials failed to show a significant statistical difference between the intervention groups. Only a trial with a high risk of bias in random allocation and blinding indicated that hyaluronic acid was more effective than estrogen in improving the symptoms of atrophic vaginitis. Hyaluronic acid is an effective drug with few side effects for the treatment of atrophic vaginitis symptoms; however, better designed trials are required to show the statistical superiority of hyaluronic acid to vaginal estrogen.

Keywords

Atrophic vaginitis estrogens hyaluronic acid menopause post menopause

Get full access to this article

View all access options for this article.

References

Grady

Clinical practice. Management of menopausal symptoms.

N Engl J Med 2006; 355: 2338–2347.

Castelo-Branco

Rostro

Treatment of atrophic vaginitis.

Therapy 2007; 4: 349–353.

Santoro

Komi

Prevalence and impact of vaginal symptoms among postmenopausal women.

J Sex Med 2009; 6: 2133–2142.

Le Donne

Caruso

Mancuso

et al . The effect of vaginally administered genistein in comparison with hyaluronic acid on atrophic epithelium in postmenopause. Arch Gynecol Obstet 2011; 283: 1319–1323.

DiBonaventura

Luo

Moffatt

et al . The association between vulvovaginal atrophy symptoms and quality of life among postmenopausal women in the United States and Western Europe. J Womens Health 2015; 24: 713–722.

Castelo-Branco

Cancelo

Villero

et al . Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005; 52: S46–S52.

NAMS Position Statement. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause 2013; 20: 888–902. DOI: 10.1097/GME.0b013e3182a122c2.

Baber

Panay

Fenton

2016 IMS recommendations on women’s midlife health and menopause hormone therapy.

Climacteric 2016; 19: 109–150.

Ekin

Yasar

Savan

et al . The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Arch Gynecol Obstet 2011; 283: 539–543.

10.

Sudha

Rose

MH.

Beneficial effects of hyaluronic acid.

Adv Food Nutr Res 2014; 72: 137–176.

11.

Galia

Micali

Puzzolo

et al . Oral low-molecular weight hyaluronic acid in the treatment of atrophic vaginitis. IJCM 2014; 5: 617–624.

12.

Higgins

JPT

Altman

Gøtzsche

et al . The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. The BMJ 2011; 343: d5928.

13.

Chen

Geng

Song

et al . 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: 1575–1584.

14.

Jokar

Davari

Asadi

et al . Comparison of the hyaluronic acid vaginal cream and conjugated estrogen used in treatment of vaginal atrophy of menopause women: a randomized controlled clinical trial. IJCBNM 2016; 4: 69–78.

15.

Duque-Estrada

Vivian

Mariane Martins

et al . Perceived efficacy of vaginal dryness relief: a comparative clinical study between sodium hyaluronate vaginal gel vs . promestriene cream. ASM 2017; 7: 34–43.

16.

Lee

Kim

Lee

et al . Therapeutic approaches to atrophic vaginitis in postmenopausal women: a systematic review with a network meta-analysis of randomized controlled trials. J Menopausal Med 2018; 24: 1–10.

17.

Origoni

Cimmino

Carminati

et al . Postmenopausal vulvovaginal atrophy (VVA) is positively improved by topical hyaluronic acid application. A prospective, observational study. Eur Rev Med Pharmacol Sci 2016; 20: 4190–4195.

18.

Sinha

Ewies

AAA.

Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview.

Climacteric 2013; 16: 305–312.

19.

Liu

Gan

et al . The effects of hyaluronic acid vaginal gel on the vaginal epithelium of ovariectomized rats. Gynecol Endocrinol 2015; 31: 208–213.

20.

Tersigni

Di Simone

Tempestilli

et al . Non-hormonal treatment of vulvo-vaginal atrophy-related symptoms in post-menopausal women. J Obstet Gynaecol 2015; 35: 835–838.

21.

Stute

Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief.

Arch Gynecol Obstet 2013; 288: 1199–1201.

22.

Karaosmanoglu

Cogendez

Sozen

et al . Hyaluronic acid in the treatment of postmenopausal women with atrophic vaginitis. Int J Gynaecol Obstet 2011; 113: 156–157.