While it may not be the most common, or comfortable topic of conversation, vaginal dryness affects many women at some point during their lives. Around 17% of women aged 18-50 report dealing with vaginal dryness, and that number increases to about 50% in postmenopausal women.1 This number is unfortunately likely even higher due to women who may not report their symptoms.
Caused by declining estrogen levels, vaginal dryness is linked to symptoms such as itching, burning, irritation and pain during sex that can negatively impact intimacy and general quality of life.2 These symptoms are collectively known as genitourinary syndrome of menopause (GSM) in the medical world, and they affect up to 84% of postmenopausal women.3
Given how prevalent vaginal dryness is, it’s not surprising that over-the-counter treatment options, including lubricants and moisturizers, as well as natural remedies like coconut oil, are available. But are any of these options as effective as prescription, hormone-based treatments?
To help answer this question, Bonafide® recently sponsored a head-to-head, clinical trial, conducted by the Grossman NYU School of Medicine, of hyaluronic acid-based vaginal inserts (HLA), in the form of Revaree, versus vaginal estrogen cream (estradiol – 0.01%). The study found that vaginally inserted hyaluronic acid, the key ingredient in Revaree, has effects comparable to estrogen cream (estradiol – 0.01%).
Let’s take a closer look at the various vaginal dryness management options available and break down the findings of this important clinical trial.
Why is Vaginal Dryness Common During Peri/Menopause?
Estrogen helps to keep vaginal tissue moist and pliant. When estrogen levels begin to fluctuate during perimenopause, vulvar and vaginal tissues may become drier, thinner and less flexible.4 Lower estrogen can also cause a decrease in vaginal lubrication, which contributes to dryness.
It’s worth noting that the menopausal transition isn’t the only time when declining estrogen levels can lead to vaginal dryness. Women who are breastfeeding, taking certain medications or undergoing cancer treatment are among those who may experience vaginal dryness triggered by hormone changes.5
How is Vaginal Dryness Commonly Treated?
There are a number of management options available for vaginal dryness and its related symptoms. “Since there is no “one size fits all treatment”, there are a variety of effective options available for managing vaginal dryness,” said Dr. Alyssa Dweck, Bonafide’s Chief Medical Officer. These options include:
- Hyaluronic Acid-based products, such as Revaree, which contains the highest over the counter dosage at 5 mg, are available for vaginal use. “Hyaluronic acid has been shown to retain 1000x its weight in water, which allows for its amazing moisturizing properties,” Dr. Dweck explains. “It is naturally occurring in our bodies, but declines with age and menopause, which can contribute to dryness and its associated symptoms.”6
- Lubricants (water based or silicone based), which are typically used on demand for the management of vaginal dryness and to enhance pleasure or ease insertion during intimacy. “Lubricants do not typically address the root cause of dryness nor are they optimal for longer-term chronic issue of vaginal dryness, but are helpful on an as needed basis,” says Dr. Dweck.7 “Some lubricants are formulated with chemicals that might irritate sensitive tissues; one should check ingredients prior to use if sensitive.”
- Coconut oil, which is frequently used as a DIY option for managing vaginal dryness. “It can be applied as a solid intravaginally, as it melts immediately on contact - it may also be used on the vulva for moisture,” Dr. Dweck advises.8
- Vaginal estrogen, which is often considered the gold standard option and is available as a cream, vaginal insert or vaginal ring. “Estrogen is a hormone and is not always appropriate for those with contraindication or preference to avoid use,” says Dr. Dweck. “With that said, estrogen cream is indicated to manage vaginal dryness, dyspareunia (painful sex) and to aid in preventing UTIs.”9
Comparing Hyaluronic Acid and Estrogen Cream
Recently, clinical research comparing hyaluronic acid vaginal inserts, in the form of Revaree, to vaginal estrogen cream (estradiol – 0.01%) was conducted in the form of an independent study run by NYU Grossman School of Medicine. In the open-label, randomized trial, individuals diagnosed with GSM participated in a 12-week study wherein they were randomly assigned to receive one of two potential treatments: a hyaluronic acid vaginal insert (Revaree) or a topical vaginal estrogen cream (estradiol – 0.01%). They were found to work equally well for addressing this specific set of symptoms.
“Findings suggested that Revaree is not inferior to estrogen cream and may be a great option for anyone looking to manage the symptoms of vaginal dryness, without hormones,” Dr. Dweck explains. “This is especially important for those who have to or prefer to avoid products containing hormones when managing their vaginal symptoms.”
She continues to detail that, while both hyaluronic acid and estrogen cream are generally well-tolerated, “all estrogen products come with a black box warning regarding risk of estrogen use, including breast cancer, uterine cancer or cardiovascular events.” She adds that these risks and side effects are extremely unlikely with vaginal estrogen, but the warning label applies to any product containing estrogen.
“The recent NYU Grossman School of Medicine study demonstrated the promising potential of
vaginal hyaluronic acid, in this case Revaree, as an effective, non-hormonal alternative to estrogen cream,” says Trisha VanDusseldorp, Senior Director of Clinical Research at Bonafide. “This development is pivotal for many women pursuing safer options due to concerns about the side effects and health risks potentially associated with hormonal treatments, as well as personal preference.”
“Bonafide champions a research-driven approach grounded in innovation and a deep respect for women’s unique biological and physiological needs,” VanDusseldorp adds. “More evidence-based, non-hormonal options are needed and desired by women, and this is a step in the right direction to provide those options.”
"Women often need to decide between different therapies for genitourinary syndrome of menopause," study author Benjamin Brucker, MD, recently told Medscape Medical News.10 "Now we can help counsel them about this formulation of HLA."
Resources
- https://www.womens-health-concern.org/wp-content/uploads/2022/12/25-WHC-FACTSHEET-VaginalDryness-NOV2022-B.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212735/
- https://www.frontiersin.org/articles/10.3389/frph.2021.779398/full
- https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
- https://www.acog.org/womens-health/experts-and-stories/the-latest/experiencing-vaginal-dryness-heres-what-you-need-to-know#:~:text=Low%20estrogen%20and%20vaginal%20dryness,can%20dry%20out%20vaginal%20tissue
- https://www.health.harvard.edu/blog/the-hype-on-hyaluronic-acid-2020012318653
- https://www.acog.org/womens-health/experts-and-stories/the-latest/experiencing-vaginal-dryness-heres-what-you-need-to-know
- https://www.medicalnewstoday.com/articles/324873
- https://www.mayoclinic.org/drugs-supplements/estrogen-vaginal-route/description/drg-20069459
- https://www.medscape.com/viewarticle/996968
Comments
Post commentI’ve conducted a “self” clinical study and tried all of the above mentioned solutions. IMHO I think that estrogen cream is the most effective in actually changing the root cause of the problem; the HA insert does help to moisturize but it’s more for relief of symptoms as opposed to actually changing the nature of vaginal tissue. Surprisingly, the estrogen cream is not messy and does not leak out. Whereas the HA insert can pop out very easily and creates more of a discharge. Ideally, if you can use both then that is a winning combination.
I LOVE Revaree! It is the only thing that has helped me feel normal. Physicians kept wanting me to use vaginal estrogen and it was horrible! Raised blood pressure and migraines. Then I discovered Revaree and my life has been saved!
I was about 5 months into hormone supressant therapy for breast cancer when I began noticing painful or very uncomfortable intercourse. I was embarrassed to bring it up with my husband or any of my doctors for almost a full year. I finally had an epithany that the dryness and pain might be caused by the lack of hormones due to the medications, which I’ll be on for a total of about ten years (that’s the current guess). I called my Gynocologist and made an appointment for a full exam to eliminate any other problems, or new symptoms. she diagnosed me with vaginal dryness and highly encouraged me to try Reveree Plus. She emphasized that it was the only hormone-free product on the market – aside from plain coconut oil which she said we could use as a lubricant as desired. I explained all this to my husband right after the appointment. He was apologetic that he had been causing me discomfort and pain. Now after almost six weeks we both can tell the difference, though there are still times when there is some discomfort the pain is diminishing and I will continue to use it until after I’m taken off the hormone supressant drugs. I should have spoken up sooner. My advice is to say something about it to your partner and, if you are on hormone supressant drugs for cancer, talk to all of your doctors. Ask about Reveree and Reveree Plus. For your comfort and enjoyment – Don’t wait.
For me, it’s not one or the other, but both, like a Dynamic Duo. Bonafide helps with dryness and estradiol helps thicken the skin. I am 60, postmenopausal, married over 3 decades, and have intercourse daily. More than once sometimes. This fun couldn’t happen without Bonafide and estradiol cream.
I really would like to try this please, because sex do hurt me now after the removal of my cervix.