A New Look at Vaginal Health: Hormonal & Non-Hormonal Options for GSM

Based on: “A randomized, pilot trial comparing vaginal hyaluronic acid with vaginal estrogen for treatment of genitourinary syndrome of menopause” — Menopause, Sept 2024

Let’s talk about something not enough people are talking about: genitourinary syndrome of menopause (GSM). It’s the umbrella term for the vaginal dryness, itching, burning, and pain with intimacy that many women experience in midlife and beyond.

A new pilot study explored two treatment options for GSM—topical vaginal estrogen and a non-hormonal option: hyaluronic acid (HLA).

What the Study Found:

49 women used either vaginal estrogen cream or HLA inserts for 12 weeks.
Both treatments improved symptoms significantly.
Over 90% of women in both groups felt better—and no serious side effects were reported.
No meaningful difference was found between the groups in terms of effectiveness.

Why This Matters to Me—and You

This is big news for those of us who either can't or don’t want to use hormone-based options. Hyaluronic acid, which helps hydrate and repair tissue, is a promising, gentle alternative—backed by evidence.

For my practice, and for the women I support, this expands the toolkit. It means we can offer real, personalized choices. And that’s empowering.

What Can You Actually Use?

💧 Hyaluronic Acid (HLA) Options
These are available over-the-counter and don't contain hormones:

Revaree® – Prescription-free vaginal insert with hyaluronic acid
Hyalo GYN® – Vaginal gel with pure HLA
Replens Long-Lasting Moisturizer – Widely available OTC option, though not pure HLA, still helpful for some

🌸 Topical Estrogen Options
These require a prescription and are highly effective:

Estrace® Cream (estradiol)
Premarin® Cream (conjugated estrogens)
Vagifem® or Yuvafem® (estradiol vaginal tablets)
Imvexxy® (estradiol vaginal insert)
Intrarosa® – A non-estrogen vaginal insert with DHEA (converted to estrogen locally)

Note: These are local, low-dose therapies and very different from systemic hormone replacement. Always discuss risks and benefits with a provider you trust.

What You Can Do Next

Listen to Your Body – Vaginal health is part of overall health. Don’t dismiss symptoms as “just aging.”
Talk with a Provider (Like Me!) – We’ll look at your whole health picture—your goals, history, and preferences.
Ask About Options – Whether it’s HLA, estrogen, or a combo, treatment should fit you.
Be Proactive – GSM doesn’t improve on its own. Early action leads to better long-term outcomes and quality of life.

Let’s normalize this conversation and equip women with the tools they need to feel strong, comfortable, and confident at every stage of life. 💗

📚 Citation

Ridker P, Moorthy M, Cook N, et al. Hyaluronic acid vs. estrogen cream for GSM: What works best? Menopause. September 2024; Vol. 31(9).