Efficacy of Intravaginal Estriol versus Hyaluronic Acid Gel for the Treatment of Vaginal Dryness in Breast Cancer Survivors

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 483–494

DOI: 10.46882/2026/IJOG/000521

Original Research Article

Title: Efficacy of Intravaginal Estriol versus Hyaluronic Acid Gel for the Treatment of Vaginal Dryness in Breast Cancer Survivors

Names of Authors: Olayinka O. Cole¹, Nesta C. Chuka¹

Authors’ Affiliations:
¹ Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria

Abstract:
Managing severe genitourinary symptoms in breast cancer survivors on endocrine therapies is limited by concerns regarding hormonal absorption. This randomized, double-blind clinical trial compared the clinical efficacy and safety of a non-hormonal hyaluronic acid vaginal gel versus ultra-low-dose local estriol cream for treating severe vaginal dryness in breast cancer survivors. One hundred patients currently receiving tamoxifen or aromatase inhibitors were randomized to receive either 5 mg hyaluronic acid gel (n = 50) or 0.1 mg estriol cream (n = 50) three times weekly for 12 weeks. The primary outcome was changes in subjective vaginal dryness scored via a visual analog scale (VAS) and serial serum estradiol tracking. At week 12, both groups achieved a significant reduction in mean vaginal dryness scores from baseline (p < 0.001), with no significant difference between the two treatment arms (hyaluronic acid: -4.2 ± 1.1 points; estriol: -4.6 ± 1.3 points, p = 0.18). Objective improvements in the Vaginal Health Index were also comparable (p = 0.24). Crucially, serum estradiol monitoring remained strictly within normal postmenopausal ranges (< 5 pg/mL) in the hyaluronic acid group, whereas 8.0% of patients in the estriol cohort demonstrated transient elevations above baseline values (p = 0.034). Intravaginal hyaluronic acid gel provides symptom relief non-inferior to ultra-low-dose estriol cream, serving as a highly effective, safe non-hormonal option for managing vulvovaginal atrophy in breast cancer survivors.

Keywords: Vaginal Dryness; Hyaluronic Acid; Estriol; Breast Cancer Survivors; Vulvovaginal Atrophy; Endocrine Therapy.

Manuscript Timeline: Received: May 27, 2026; Revised: July 15, 2026; Accepted: August 01, 2026; Published: August 19, 2026.

Citation: Cole OO, Chuka NC. Efficacy of Intravaginal Estriol versus Hyaluronic Acid Gel for the Treatment of Vaginal Dryness in Breast Cancer Survivors. International Journal of Obstetrics and Gynecology. 2026; 14(8): 483–494.

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