title: Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial.
abstract: BACKGROUND
  Vaginal atrophy is a common complication in menopause which does not improve with time and, if untreated, can affect the quality of life for women. The aim of this study was to compare the effectiveness of the vaginal cream of hyaluronic acid and conjugated estrogen (Premarin) in treatment of vaginal atrophy.
  
  
  METHODS
  This study was a randomized controlled clinical trial on 56 menopausal women with symptoms of vaginal atrophy; they were randomly allocated to two groups (recipient conjugated estrogen and hyaluronic acid). The severity of each sign of atrophy was evaluated by visual analog signals (VAS) and on the basis of a four point scale. Also to recognize the cellular maturation with pap smear and the maturation degree were calculated according to the formula and scores 0-100. As to the vaginal PH, we used PH marker band, the rate of which was divided into 4 degrees. Data were analyzed using SPSS, version 20, and P≤0.05 was considered as significant.
  
  
  RESULTS
  The results of this study showed that the symptoms of vaginal atrophy compared with the baseline level were relieved significantly in both groups. Dryness, itching, maturation index, PH and composite score of the vaginal symptoms were relieved significantly in both groups (P<0.001). Dyspareunia in Premarin (P<0.05) and hyaluronic acid (P<0.001) decreased compared with pre-treatment. Urinary incontinence only showed improvement in the hyaluronic acid group (P<0.05). Improvement in urinary incontinence, dryness, maturation index (P<0.05) and composite score of vaginal symptoms (P<0.001) in the hyaluronic acid group was better than those in the Premarin group.
  
  
  CONCLUSIONS
  According to the results of the present study, hyaluronic acid and conjugated estrogen improved the symptoms of vaginal atrophy. But hyaluronic acid was more effective and this drug is suggested for those who do not want to or cannot take local hormone treatment.
  
  
  BACKGROUND
  IRCT2013022712644N1.
authors.affiliation: Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Azam
authors.initials: A
authors.lastname: Jokar
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Tayebe
authors.initials: T
authors.lastname: Davari
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine and Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Nasrin
authors.initials: N
authors.lastname: Asadi
authors.affiliation: Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Fateme
authors.initials: F
authors.lastname: Ahmadi
authors.affiliation: Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sedighe
authors.initials: S
authors.lastname: Foruhari
keywords: Atrophic vaginitis; Estrogen; Hyaluronic acid; Menopause