Non-Hormonal Approaches to Genitourinary Syndrome of Menopause: The Emerging Role of Hyaluronic Acid in Personalized Post-Reproductive Care

Non-Hormonal Approaches to Genitourinary Syndrome of Menopause: The Emerging Role of Hyaluronic Acid in Personalized Post-Reproductive Care | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 4 September 2025 V1 Latest version Share on Non-Hormonal Approaches to Genitourinary Syndrome of Menopause: The Emerging Role of Hyaluronic Acid in Personalized Post-Reproductive Care Authors : Marco Menabrito 0000-0002-4743-8670 [email protected] and Joaquim Calaf Authors Info & Affiliations https://doi.org/10.22541/au.175696960.06659066/v1 191 views 107 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Genitourinary syndrome of menopause (GSM) is a prevalent, progressive condition arising from reduced oestrogen levels after natural or induced menopause. It affects up to 70% of postmenopausal women worldwide yet remains widely underdiagnosed and undertreated. Symptoms span genital, urinary, and sexual domains, often persisting without intervention and significantly impairing quality of life and intimate relationships. Local oestrogen therapy remains the most effective intervention, but many women have contraindications or prefer to avoid hormones, creating a need for safe and effective non-hormonal alternatives. This review summarises the pathophysiology of GSM and evaluates the evidence for non-hormonal therapies, including lubricants, moisturisers, selective oestrogen receptor modulators, dehydroepiandrosterone, energy-based devices, and particularly hyaluronic acid (HA). HA is a naturally occurring glycosaminoglycan with hydrating and viscoelastic properties, delivered via topical or injectable formulations. Clinical studies, including randomised controlled trials of hybrid cooperative complex HA (HCC-HA), demonstrate improvements in dryness, dyspareunia, and sexual function, with good tolerability and high patient satisfaction. Injectable HCC-HA offers longer-lasting benefits than topical HA, particularly for women with contraindications to oestrogen, such as breast cancer survivors. Despite encouraging results, current evidence is limited by small sample sizes, short follow-up, and heterogeneity in study protocols. HCC-HA is an emerging therapy that is beginning to gain recognition, though it is not yet formally included in national guidelines in the United Kingdom, Europe, or the United States. At present, access is primarily through specialist and private practice. Future research should prioritise large multicentre trials, long-term safety data, cost-effectiveness analyses, and qualitative work on patient preferences. In the interim, HCC-HA may be considered within individualised, multimodal strategies, supported by shared decision-making and clear counselling on benefits and uncertainties. Supplementary Material File (structure_review paper_ibsa_draft 8.0 - 31-aug-2025 clean.docx) Download 1.44 MB Information & Authors Information Version history V1 Version 1 04 September 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords genitourinary medicine gynaecology: in the elderly menopause menopause: endocrinology Authors Affiliations Marco Menabrito 0000-0002-4743-8670 [email protected] IBSA Pharma View all articles by this author Joaquim Calaf Universitat Autònoma de Barcelona View all articles by this author Metrics & Citations Metrics Article Usage 191 views 107 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Marco Menabrito, Joaquim Calaf. Non-Hormonal Approaches to Genitourinary Syndrome of Menopause: The Emerging Role of Hyaluronic Acid in Personalized Post-Reproductive Care. Authorea . 04 September 2025. DOI: https://doi.org/10.22541/au.175696960.06659066/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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