A Randomized, Single Center Pilot Study Comparing Hyaluronic Acid to Vaginal Estrogen for Treatment of Genitourinary Syndrome of Menopause

Inclusion Criteria: 1. Postmenopausal status as defined by amenorrhea for \>12 months or history of bilateral salpingo-oophrectomy or if the patient has had a hysterectomy and menopausal symptoms for \>1 year or FSH \> 40 2. Symptoms of GSM 3. Negative Pap smear as per ASCCP guidelines 4. Capable of giving informed consent 5. Ambulatory 6. Capable and willing to follow all study-relation procedures Exclusion Criteria: 1. Use of any HRT (systemic or local) or raloxifene within six weeks of proposed start date 2. History of estrogen-sensitive tumor 3. Undiagnosed vaginal bleeding in the past 12 months 4. History of thromboembolic event 5. Currently have or have had liver problem 6. Bleeding disorder 7. Impaired mental status 8. Prior pelvic irradiation 9. Active vaginal infection 10. Any medical reason the investigator deems incompatible with treatment with vaginal estrogen