Emre Mat, İsmail Bağlar, Esra Keles
Southern Clinics of Istanbul Eurasia - 2025;36(3):279-285
Objective: The objective of this study was to compare the efficacy of a non-hormonal alternatives, vaginal hyaluronic acid, oral probiotics, to a standard of care therapy, vaginal estrodiol, for the treatment of genitourinary syndrome of menopause (GSM). Methods: This prospective study was conducted in the Obstetrics and Gynecology Clinic of the Education and Research Hospital between June and September 2024. Women with GSM were assigned to hyaluronic acid vaginal ovules, estradiol vaginal tablets or oral probiotics for 8 wk. The primary outcome was the change in the Vaginal Health Index (VHI) score. Secondary outcomes included changes in the Female Sexual Distress Scale-Revised (FSDS-R) and the Menopause Rating Scale (MRS). Results: Sixty participants (vaginal estrogen=20, vaginal HA=20, oral probiotic=20) provided data at week 8. All three treatment groups showed statistically significant improvements in VHI scores and significant reductions in FSDS-R and MRS scores from baseline to week 8 (p<0.001) for within-group comparisons). Changes in FSDS-R scores were similar across all three groups (p=0.176). No treatment-related serious adverse events occurred. Conclusion: This study found that vaginal estradiol, vaginal hyaluronic acid, and oral probiotics led to significant improvements in vaginal health, reductions in sexual distress, and alleviation of menopausal symptoms in women with GSM. In addition, oral probiotics and vaginal hyaluronic acid may represent promising non-hormonal alternatives for the management of GSM, particularly for women who prefer to avoid hormone therapy.
