Rose Stem Cell-Derived Exosome-Hyaluronic Acid Therapy for Recurrent Atrophic Vaginitis: A Case Report

Atrophic vaginitis (AV), which is an aspect of genitourinary syndrome of menopause (GSM), is caused by low levels of estrogen, which leads to weakening of the vaginal lining, vaginal dryness, vaginal irritation, and high vaginal pH. The side effects related to long-term use of hormonal therapies are the primary reason for the search for non-hormonal therapeutic options. In this case report, a 41-year-old perimenopausal female presented with recurrent vaginal discomfort, vaginal dryness, pruritus, and occasional offensive vaginal discharge that had not responded to repeated antimicrobial therapy. The clinical examination revealed that the mucosa was pale and thinned, without signs of infection, and lactobacilli levels were reduced. The first biopsy revealed benign, mature squamous mucosa with mild atrophy, focal basal cell hyperplasia, focal glycogen deposition, and fibrous stroma. She underwent three sessions of stem cell exosomes-hyaluronic acid at 3- to 4-week intervals. The intervention consisted of rose stem cell-derived exosomes supplied as a lyophilized freeze-dried powder, reconstituted with hyaluronic acid solution before administration. The product contained approximately 3 billion exosomes in a 2.5 mL vial, with a reported nanoparticle size range of 50-100 nm and purity above 90%. The preparation was stored at 2-8 °C and administered intravaginally using electroporation followed by topical application. Follow-up biopsy demonstrated a categorical increase in epithelial thickness (approximately 2.5 mm), retained maturation, slight residual atrophy, no glycogen on PAS-D, or abnormal fibrovascular stroma, and no dysplasia. The patient reported symptomatic relief, and follow-up assessment showed partial structural mucosal changes without dysplasia or malignancy on short-term biopsy. No short-term local adverse events, such as irritation, bleeding, infection, hypersensitivity, or worsening discharge, were reported during the available follow-up. However, this single uncontrolled case cannot establish long-term safety or treatment efficacy.