Comparison of Hyaluronic Acid with Vitamin E Vaginal Pessaries on Maturation of Vaginal Epithelium in Postmenopausal Women

Document Type : Original Article


1 Lecturer of Midwifery.Department of Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Assistant Professor of Pharmaciotix. Department of Pharmaciotix, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Lecturer of Vital Statistics.Faculty of Health , Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

4 Department of Patology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


Background and Objective: Following hot flashes, the second, most common and bothersome menopausal complaint is vaginal atrophy. This symptoms causes vaginal or vulvar dryness, dyspareunia, vaginismus or itching that can significantly affect quality of life. The aim of this study was to compare the effectiveness of vaginal perssaried containing sodium hyaloronate or vitamin E for the treatment of atrophic vaginitis.
Subjects and Methods: This randomized, double-blind clinical trial study was carried out at 17 Shahrivar health center (an educational center in Ahvaz, Iran) from August to December 2010. Forty postmenopausal women with  symptoms  of  vaginal  atrophy were randomized in two groups to administer vaginal  perssaries  of  5  mg  sodium hyaloronate (n=20) or 1mg vitamin E (n=20) for 8 weeks. Vaginal maturation was measured and compared in both groups. The data were analyzed using independent t-test and Paired t test, in SPSS version 16.0. P-values less than 0.05 were considered statistically significant.
Results:The results showed that the vaginal maturation values were significantly improved at both treatment groups (P<0.001). However, the mean maturation value in sodium hyaluronate group was significantly higher when compared with vitamin E group (P<0.001).
Conclusion: Sodium hyaluronate and vitamin E increased  maturation of vaginal epithelium, but improvement was  greater in sodium hyaluronate group. Therefore, sodium hyaluronate vaginal  pessary  is  suggested as an ulternative in women who  do not want  to or cannot  use estrogen  treatment of vaginal  atrophy.


1-Seyed Alavi  GH. [The  Menopausal  Period]. Tehran:  Nashre Jahad; 1995. p.4. [In Persian]
2-Speroff L, Glass RH, Kase NG. Clinical gynecology endocrinology and Infertility. 5thed. Baltimor, MD: Williams & Wilkins; 2005. p. 621-777.
3-Shifren Jl, Schiff I. Menopause. In: Berek JS. Berek & Novak's Gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. P. 1323-42.
4-Kazemian  A, Broomandfar KH, Ghanadi AR, Noorian K. [Effects of valerian on menopausal hot flash]. J Shahre-Kord Med Univ 2006;8(2): 35-40. [In Persian]
5-Sadat Hashemi  SM,  Ghorbani  R,  Kalalian H, Majdabadi Askari H, Kaveei  B, Khalajabadi  Farahani  F. [Parametric  Estimation  of  Age  Patterns  at  Natural Menopause  in  shahrood; Semnan Province, Iran, 2007].  Semnan University Med Sci J 2009;3:29-35. [In Persian]
6- Speroff  L, Marc  A, Fritz  MA. Menopause  and  the  perimenopausal  transition. 2005:621-88.
7-Costantino  D,  Guaraldi  C.  Effectiveness  and  safety  of  vaginal  suppositories   for  the treatment  of  the  vaginal  atrophy  in  postmenopausal  women:  an  open,   non-controlled clinical trial.  Eur Rev Med Pharmacol Sci 2008;12(6):411-6.
8-Palacios  S. Managing  urogenital  atrophy.  Maturitas 2009;63(4):315–8.
9- Johnston SL, Farrell SA, Bouchard C, Farrell SA, Beckerson LA, Comeau M, et al. The  detection   and   management  of  vaginal  atrophy.  J Obstet  Gynaecol  Can  2004;26(5):503–15.
10-Marx P, Schade G, Wilbourn S, Blank S, Moyer DL, Nett R. Low-dose (0.3 mg)  synthetic  conjugated  estrogens A  is  effective  for  managing  atrophic  vaginitis.  Maturitas 2004;47(1):47–54.
11-Carpenter  JS . The  Hot  Flash  Related  Daily  Interference   Scale : a tool  for  assessing  the impact  of  hot  flashes  on  quality  of  life  following  breast  cancer .J Pain Symptom Manage 2001;22(6):979-89.
12-Ekin M,  Yasar L, Savan K, Temur M, Uhri M, Gencer I, 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(3):539-43.
13-Checa MA, Garrido A, Prat M, Conangla M, Rueda C, Carreras R.  A comparison  of  raloxifene  and  calcium plus  Vitamin  D  on  vaginal  atrophy  after  discontinuation  of long-standing  postmenopausal  hormone  therapy  in  osteoporotic  women. A  randomized, masked-evaluator,  one-year, prospective  study.  Maturitas 2005;52(1):70–7.
14-Morali G, Polatti  F, Metelitsa  EN, Mascarucci P, Magnani P, Marrè GB.  Open, non-controlled clinical studies to assess the efficacy and safety of a medical device in form of gel topically and intravaginally used  in postmenopausal women with genital atrophy.  Arzneimittelforschung 2006;56(3):230-8.
15-Le Donne M, Caruso C, Mancuso A, Costa G, Iemmo R, Pizzimenti G, et al. The  effect of vaginally administered genistein in comparison with hyaluronic acid on atrophic  epithelium  in  postmenopause. Arch  Gynecol  Obstet  2011;283(6):1319-23.
16-Karaosmanoglu O, Cogendez E, Sozen H, Asoglu MR, Akdemir Y, Eren S. Hyaluronic acid in the treatment of postmenopausal women with atrophic vaginitis. Int J Gynecol Obstet 2011;113(2):156-7.
17-Ziaei  S, Kazemnejad  A, Zareai  M . The effect of vitamin E on hot flashes in menopausal  women. Gynecol  Obstet  Invest 2007;64(4):204-7.
18-McLAREN HC. Vitamin E in the menopause. Br Med J 1949;2(4641):1378–81.