Review of clinical studies on the use of agents based on sodium hyaluronate and phytoestrogens for the prevention and treatment of genitourinary syndrome of menopause

The perimenopausal transition represents a critical stage in the female lifespan, characterized by the progressive development of estrogen deficiency and the subsequent increased risk for the onset of multiple pathological conditions. A direct consequence of declining estrogen levels is the manifestation of genitourinary syndrome of menopause (GSM). Systemic menopausal hormone therapy, though effective in addressing estrogen deficiency, is not universally indicated; contraindications exist for certain patient populations, and some women decline hormonal treatment altogether. Consequently, the consideration of alternative, non-hormonal therapeutic modalities is of growing clinical relevance. Among such options are local preparations containing sodium hyaluronate and natural botanical extracts (including Trifolium pratense, Humulus lupulus, and Calendula officinalis), which have been studied for their efficacy in alleviating the symptoms of GSM. This review encompasses the analysis of 15 clinical trials, collectively comprising 969 women in the perimenopausal and postmenopausal periods who received alternative non-hormonal therapies. The mean age of participants was 55.4±5 years. The studied interventions involved topical administration (applied to the vulvar vestibule or intravaginally), utilizing metered creams, suppositories, or gels, either as monotherapy or within combination regimens, for treatment durations ranging from 1 to 3 months. The findings indicate that such therapies are associated with significant improvements in the condition of the vaginal mucosa, relief of dyspareunia, and restoration of sexual function, collectively contributing to an enhanced quality of life for affected women. KEYWORDS: evidence-based medicine, genitourinary syndrome of menopause, vulvavaginal atrophy, vaginal health index, hyaluronic acid, non-hormonal vaginal therapy. OR CITATION: Dobrokhotova Yu.E., Lapina I.A., Markova E.A., Katikova O.Yu. Review of clinical studies on the use of agents based on sodium hyaluronate and phytoestrogens for the prevention and treatment of genitourinary syndrome of menopause. Russian Journal of Woman and Child Health. 2025;8(2):114–123 (in Russ.). DOI: 10.32364/2618-8430-2025-8-2-4