Is vaginal hyaluronic acid a good option for vaginal dryness?
Zoe is a 35-year-old who gave birth to her first child about 6 months ago. She had a relatively smooth pregnancy and delivery; however, she has noticed vaginal dryness and pain with sex since reintroducing intimacy about 3 months ago. She went to the doctor who told her everything “looked fine” and that her symptoms are “normal” when breastfeeding and pumping. She can’t help but think there must be something to help make intimacy more comfortable instead of just waiting for her “hormones to settle” when she decides it is the right time to stop breastfeeding.
Sandra is a 60-year-old female who has been happily married for 30 years; however, she has been experiencing feelings of vaginal irritation that have progressively worsened over time. She has been told this is “normal” when experiencing hormonal changes associated with menopause. She refuses to accept that this sensation is the new “normal” for the next 30 years of her life.
Both Sandra and Zoe are experiencing two of the main reasons an individual would experience vaginal irritation, such as dryness, burning, stinging, and painful intercourse. The hormonal fluctuations that occur with labor and delivery, lactating, and menopause can cause estrogen levels to drop and can contribute to these symptoms. Vaginal estrogen has wonderful research to support its use in these concerns; however, there are times where patients may be on a long wait list to see their medical provider, or they prefer not to use a hormonal means to address their symptoms. Luckily, there is an alternative with vaginal hyaluronic acid.
Sexual dysfunction can occur in 40-80% of women during the first months after delivery.1 A female’s body will experience a reduction in estrogen after delivery that will continue if she chooses to lactate because the increased prolactin levels decrease the production of estrogen. A reduction in estrogen can contribute to vaginal dryness, burning, or itching.1 This was occurring in Zoe’s case.
Hyaluronic acid (HA) has hydrating properties that can continue to assist with vaginal tissue lubrication.1 It also assists with wound healing by increasing the number of cells in the area and encouraging blood vessel growth which promotes increased blood flow. This can be helpful in those who experience tearing or episiotomies during their delivery.1
A study looked at the use of hyaluronic acid in the postpartum period specifically comparing women who used HA every 3 days for 12 consecutive weeks as compared to those that did not use any vaginal product.1 The women who used the HA had improved sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and reduced pain. Additionally, those who used HA demonstrated a decrease in vaginal pH to the levels of non-pregnant women, which is helpful to fight infection and keep a balanced vaginal microbiome.1
Vaginal pH is typically 3.5 to 4.5; however, with postpartum lactation and menopause there is a typically an increase in vaginal pH and, during menopause, a thinning of the vaginal epithelium (cells that make up the wall of the vagina).2
Unfortunately, it is not uncommon for women, like Sandra, to experience unpleasant symptoms associated with menopause, including night sweats, flushing, menstrual cycle changes, vaginal dryness, itching, painful intercourse, and stress urinary incontinence. Women will experience vaginal atrophy which means that the tissues in the vaginal and vulva region will change. About 10-40% of women will experience symptoms associated with atrophy, such as vaginal dryness, but only about 25% will seek treatment. Luckily, HA has been found to conserve water molecules which helps with moistening.3
A study compared the use of conjugated estrogen, called Premarin, and a vaginal cream consisting of hyaluronic acid to determine the outcome on vaginal atrophy over 8 weeks.3 Both estrogen and HA were found to improve the symptoms of vaginal atrophy, including dryness, itching, pH, and painful intercourse (dyspareunia). Interestingly, urinary incontinence only showed improvement in the hyaluronic acid group in this study.3 This means that women have options to address their needs!
Options can be especially important for those that may be hesitant to undergo a hormonal treatment, like local estrogen, despite research indicating that it is safe and effective. For example, greater than 50% of women who have undergone treatment for breast cancer (BC) will experience changes in the vulvar region including atrophy, vaginal dryness, and painful intercourse.4 Unfortunately, these changes will not resolve without treatment and will often worsen over time if not addressed. A study compared two non-hormonal therapies called intravaginal laser therapy and hyaluronic acid suppositories. Both have been found to improve atrophy changes and stress urinary incontinence (SUI). The laser therapy group received 2 sessions 1 month apart and the HA group applied the suppositories daily for 10 days and then every 3rd day for 3 months. Both groups were found to improve vaginal atrophy and mucosal appearance without a difference between the two groups meaning one option was not significantly better than the other.4
As a pelvic floor physical therapist, I am always looking for complementary options during a patient’s rehab to ensure that all symptom contributors are addressed. If you are experiencing vaginal dryness, itching, burning, and painful penetration, especially while lactating or experiencing menopause, your vaginal tissues may require further hydration. If you are waiting to see your physician for a prescription or want to try a non-hormonal avenue for personal reasons, vaginal hyaluronic acid may be an appropriate alternative. Keep in mind that vaginal HA needs to be used consistently over time to ensure full benefits as compared to sporadic or occasional use. As always, please feel free to ask your medical provider if this an appropriate option for you!
Written by Jordan Schmidt, PT, DPT
References
- Gustavino, C., Sala, P., Cusini, N., Gravina, B., Ronzini, C., Marcolin, D., Vellone, V. G., Paudice, M., Nappi, R., Costantini, S., Ferrero, S., & Barra, F. (2021). Efficacy and safety of prolonged-release hyaluronic acid derivative vaginal application in the postpartum period: a prospective randomised clinical trial. Annals of medicine, 53(1), 1589–1597. https://doi.org/10.1080/07853890.2021.1974083
- Stute P. (2013). Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief?. Archives of gynecology and obstetrics, 288(6), 1199–1201. https://doi.org/10.1007/s00404-013-3068-5
- Jokar, A., Davari, T., Asadi, N., Ahmadi, F., & Foruhari, S. (2016). Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial. International journal of community based nursing and midwifery, 4(1), 69–78.
- Gold, D., Nicolay, L., Avian, A., Greimel, E., Balic, M., Pristauz-Telsnigg, G., Tamussino, K., & Trutnovsky, G. (2023). Vaginal laser therapy versus hyaluronic acid suppositories for women with symptoms of urogenital atrophy after treatment for breast cancer: A randomized controlled trial. Maturitas, 167, 1–7. https://doi.org/10.1016/j.maturitas.2022.08.013
