The aim of the study is to evaluate the safety and efficacy of the vaginal gel with HMW HA in women with genitourinary syndromes due to either menopause or other causes such as the patients after ovarian or breast cancer diagnosis and treatment.

It was recognized that GSM is likely to be underdiagnosed and undertreated9. The North American Menopause Society (NAMS) issued the treatment guideline of GSM in 2014 and encouraged the physicians and nurses to pursue menopausal women to check if they have genitourinary syndrome. GSM is considered a progressive condition in menopausal women, and the primary goal of treatment strategy is symptom relief. Options include lifestyle changes, non-hormonal, and hormonal treatments. Hormonal therapies include both topical and systemic approaches. However, many women reported that substantial concerns about the long-term safety of hormonal products.The patients are aware of the possible relationship between cancer, heart disease, stroke, and estrogen-based treatments10. For considering long-term treatment strategy, estrogen free products of vaginal lubricant or vaginal moisturizer are recommended as first line treatment for those with mild to moderate syndrome.

1. Subjects who have the relevant syndromes of vulvovaginal atrophy, and who are

   1. In the status of menopause (≥12 months after the last menstrual cycle); or
   2. FSH > 40 mIU/ml and estradiol level < 20 pg/ml; or
   3. bilateral ovary resection; or
   4. the patients, i.e. breast cancer patients, who completed cancer therapy

2. Subjects have self-identified at least one of mild to moderate or severe symptoms listed below that are the most bothersome to her.

   1. Vaginal dryness
   2. Vaginal and/or vulvar irritation/itching
   3. Dysuria
   4. Vaginal pain associated with sexual activity
   5. Vaginal bleeding associated with sexual activity

3. Subjects are willing to comply with all aspects of the study and have signed informed consent form.

Exclusion Criteria:

1. Subjects have been diagnosed with cervical or vaginal malignant neoplasms
2. Subjects with abnormal undiagnostic genital bleeding
3. Subject with active vaginal infection
4. Subjects with vaginal pH value < 4.5
5. Subjects are under hormone replacement therapy within three months
6. Subjects are under phytoestrogen treatment within two month
7. Subjects use of vaginal douche, lubricant or moisturizer in one week
8. Subjects are hypersensitive to sodium hyaluronate, carrageenan

Women who suffer genitourinary syndrome of Menopause