Revaree® vs. Vaginal Estrogen Cream: Is Hyaluronic Acid an Effective Treatment for Vaginal Dryness?

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%).

Bonafide's Hormone-free Remedy for Vaginal Dryness

Revaree^® is a hormone-free, hyaluronic acid-based solution designed to treat vaginal dryness and associated symptoms of burning, irritation and painful sex.

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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

1. https://www.womens-health-concern.org/wp-content/uploads/2022/12/25-WHC-FACTSHEET-VaginalDryness-NOV2022-B.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212735/
3. https://www.frontiersin.org/articles/10.3389/frph.2021.779398/full
4. ​​https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-the-vagina-and-vulva
5. 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
6. https://www.health.harvard.edu/blog/the-hype-on-hyaluronic-acid-2020012318653
7. https://www.acog.org/womens-health/experts-and-stories/the-latest/experiencing-vaginal-dryness-heres-what-you-need-to-know
8. ​​https://www.medicalnewstoday.com/articles/324873
9. https://www.mayoclinic.org/drugs-supplements/estrogen-vaginal-route/description/drg-20069459
10. https://www.medscape.com/viewarticle/996968