Balance Activ Hervitality Vaginal Dryness Pessaries
This is a reasonable non-hormonal option for vaginal dryness, and the main ingredient, hyaluronic acid, does have a decent body of evidence behind it. However, the product itself has not been properly tested in a randomised controlled trial, and some of the marketing language, particularly "clinically proven" and "restores elasticity," goes further than the evidence actually supports. The guidelines are clear that vaginal oestrogen is the most effective treatment for menopausal vaginal dryness, so if a moisturiser alone is not giving you enough relief, it is worth talking to your GP about that option too.
What it is:
Balance Activ Hervitality pessaries are over-the-counter pessaries inserted at bedtime. They melt at body temperature to release their active ingredients: hyaluronic acid, vitamin E, vitamin A, and aloe vera extract. The waxy base means they are not compatible with condoms.
What do the guidelines say?
NICE [1], BMS/BSSM [2], NAMS [3], and EMAS [4] all recognise non-hormonal vaginal moisturisers as an appropriate treatment option. NICE recommends vaginal oestrogen as first-line but specifically recommends non-hormonal moisturisers for women with a history of breast cancer [1]. NAMS lists them as first-line for mild to moderate symptoms [3]. EMAS includes hyaluronic acid-based products by name as an option [4]. No guideline names this specific product. They refer to the category, not the brand.
What does the evidence say?
This specific product: One open-label study with no control group tested suppositories with the same hyaluronic acid/vitamin E/vitamin A combination in 150 postmenopausal women and reported symptom improvements [5]. Without a placebo group, this cannot tell us how much was due to the product itself. It is not an RCT.
Hyaluronic acid: The strongest evidence of any ingredient here. Multiple systematic reviews [6][7] and a 2025 meta-analysis of placebo-controlled RCTs [9] found it significantly improves vaginal dryness, quality of life, and sexual function, with a safety profile comparable to vaginal oestrogen. A 2024 pilot RCT found no difference between hyaluronic acid suppositories and vaginal oestrogen cream over 12 weeks [8]. Evidence rated moderate quality. Most studies are short-term and small.
Vitamin E: A 2022 systematic review found only four eligible RCTs [10]. One small trial (42 women) showed benefit over placebo; another (52 women) showed improvement but oestrogen cream worked faster [11]. Too early to draw firm conclusions. No major society recommends it yet [10].
Aloe vera: One small RCT (60 women) found it comparable to oestrogen cream over 6 weeks [12]. A single small study is not enough to be confident.
Vitamin A: No RCTs found testing it independently for menopausal vaginal dryness. Its contribution is unknown.
Semisynthetic glycerides: The suppository base (carrier), not an active ingredient.
References
[1] NICE. Menopause: identification and management (NG23). Updated November 2024. Available at: https://www.nice.org.uk/guidance/ng23. No PMID (clinical guideline).
[2] BSSM. Position statement for management of genitourinary syndrome of the menopause (GSM). 2024. Available at: https://bssm.org.uk/wp-content/uploads/2024/03/BSSM-Position-statement-for-management-of-genitourinary-syndrome-of-the-menopause-GSM.pdf. No PMID (clinical guideline).
[3] Faubion S et al. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause 2020;27:976-992. PMID: 32852449. https://pubmed.ncbi.nlm.nih.gov/32852449/
[4] EMAS. Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide. Maturitas 2021;148:34-38. Available at: https://www.maturitas.org/article/S0378-5122(21)00061-X/fulltext. No PMID listed in search (clinical guideline).
[5] Costantino D, Guaraldi C. Effectiveness and safety of vaginal suppositories for the treatment of the vaginal atrophy in postmenopausal women: an open, non-controlled clinical trial. Eur Rev Med Pharmacol Sci 2008;12:411-416. PMID: 19146203. https://pubmed.ncbi.nlm.nih.gov/19146203/
[6] dos Santos CCM et al. Hyaluronic acid in postmenopause vaginal atrophy: a systematic review. J Sex Med 2021;18:156-166. PMID: 33293236. https://pubmed.ncbi.nlm.nih.gov/33293236/
[7] Sayed GH et al. Comparison of the efficacy of vaginal hyaluronic acid to estrogen for the treatment of vaginal atrophy in postmenopausal women: a systematic review. Cureus 2023;15:e44191. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10520994/
[8] Agrawal S et al. A randomized, pilot trial comparing vaginal hyaluronic acid to vaginal estrogen for the treatment of genitourinary syndrome of menopause. Menopause 2024;31:750-755. PMID: 39042017. https://pubmed.ncbi.nlm.nih.gov/39042017/
[9] Dahab S et al. Hyaluronic acid for vaginal health and quality of life in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Int J Gynecol Obstet 2025 (published online). Available at: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.70887
[10] Bauer E et al. Vaginal vitamin E for treatment of genitourinary syndrome of menopause: a systematic review of randomized controlled trials. J Menopausal Med 2022;28:9-16. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9086347/
[11] Parnan Emamverdikhan A et al. A survey of the therapeutic effects of vitamin E suppositories on vaginal atrophy in postmenopausal women. Iran J Nurs Midwifery Res 2016;21:475-481. PMID: 27904630. https://pubmed.ncbi.nlm.nih.gov/27904630/
[12] Poordast T et al. Aloe vera; a new treatment for atrophic vaginitis, a randomized double-blinded controlled trial. J Ethnopharmacol 2021;270:113760. PMID: 33383112. https://pubmed.ncbi.nlm.nih.gov/33383112/
Vitamin E
Vitamin A
Aloe vera
Glycerin
Hyaluronic acid
Water
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