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A new hydrogel applied directly to vaginal tissues may help alleviate the negative impacts of menopause, according to a new study from scientists at the University of California San Diego. The results, published in Advanced Materials, could pave the way for a hormone-free treatment that alleviates vaginal dryness and pain caused by genitourinary syndrome of menopause (GSM), which negatively impacts quality of life for millions of women.

“We have developed a new material, which was designed specifically for the vagina,” said Karen Christman, a professor in the Shu Chien-Gene Lay Department of Bioengineering and the Sanford Stem Cell Institute at UC San Diego and one of the senior authors on the paper.

Genitourinary syndrome of menopause, or GSM, affects up to 85% of women over 40 years of age, with 30% to 60% suffering from vaginal dryness and pain. Women suffering from the condition report that it interferes with their sleep, sex life and ability to travel, work out and socialize. Importantly, 65% of women suffering from GSM report that they are not satisfied with the currently available prescription and over-the-counter treatments.

“An estimated 47 million women in the U.S. become menopausal every year, thus GSM represents a major public health issue that urgently needs investment,” said one of the senior authors of the paper, Dr. Marianna Alperin, a professor and vice chair for Translational Research in the Department of Obstetrics, Gynecology, and Reproductive Sciences and a co-director of the Center for Women’s Health Innovations through Scientific Discoveries, Engineering, and Medicine (WHISDEM) in the UC San Diego Institute of Engineering in Medicine.

The hormonal changes after menopause have a wide range of impacts on women’s health, including vaginal and lower urinary tract tissues. Vaginal tissues thin out. Blood vessels shrink, as do the connective tissue and smooth muscle layers that help the vagina expand during sexual activity and provide support for pelvic organs, such as the bladder, uterus and rectum. In addition, immune cells in the female reproductive tract change and start producing inflammatory proteins.

The current gold-standard treatment for GSM is low-dose vaginal estrogen therapy, which has been shown to be highly effective at thickening the lining of the vagina, which will thin in menopause. But this treatment doesn’t affect the deeper smooth muscle tissue in the vaginal wall that is responsible for the organ’s structure and function. In addition, a number of patients and even some clinicians still reject this treatment because of concerns that it might increase the risk of hormone-sensitive cancers–a concern that studies have shown is not warranted. The treatment is also costly and not always covered by insurance.

Bioengineers in Christman’s laboratory make hydrogels from the natural scaffolding of tissue, also known as the extracellular matrix. They have shown that these types of biomaterials help heal cardiac muscle tissue after a heart attack, among several other applications. These hydrogels for cardiac applications also have successfully been tested during a Phase 1 FDA-approved clinical trial.

Christman and colleagues partnered with the Alperin research group to see if hydrogels would constitute a good treatment for GSM.

“We are not looking to replace estrogen treatments,” said Emma Zelus, the first author of the Advanced Materials study, who is currently working as a preclinical research manager at the Sanford Stem Cell Institute. “We want to provide an alternative for patients and physicians who either do not want to use hormone-based therapy or for women for whom vaginal estrogen alone is insufficient.”

How the study was conducted

Researchers randomly assigned 24 menopausal rats to receive as a topical intravaginal application a daily dose of a solution containing either hydrogel at two different concentrations–6 or 8 milligrams per milliliter–or collagen or saline. After 14 days of treatment, researchers took samples of vaginal tissues and analyzed them.

They found that in rats that had received the hydrogel treatment, vaginal tissues appeared closer to those of pre-menopausal animals. In addition, treatment with the hydrogel led to an increase in smooth muscle thickness. Researchers also found that the 8 milligram dose seemed to be more effective, likely due to a higher concentration of extracellular matrix proteins.

Researchers sampled tissues from the animals in the first three days of treatment and found that the hydrogel was present not only in the surface layer but also in the muscular layer of the vaginal wall. They found that macrophages, which are part of the immune system, in particular responded to the hydrogel with increases in the kind of macrophage that helps with tissue repair.

Researchers also didn’t find any safety concerns or adverse effects on the rats during the study.

Next steps

Next steps include testing various concentrations of the hydrogel in a larger preclinical study over a longer period of time. The researchers also need to test whether the hydrogel can be administered less frequently–twice or three times a week rather than daily.

“We need a multidisciplinary approach to solving women’s health issues,” said Dr. Alperin, urogynecology and reconstructive pelvic surgery specialist at UC San Diego Health.

The research was supported in that part by the NIH National Institute on Aging and the NIH National Institute of Child Health and Human Development.

Christman is a cofounder of Ventrix Bio. Inc., which is commercializing a similar hydrogel technology for treating heart disease.

Reference: Zelus EI, Grime J, Saviola A, et al. Development of a vaginal extracellular matrix hydrogel for combating genitourinary syndrome of menopause. Adv Mater. 2025:2419977. doi: 10.1002/adma.202419977

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Research Highlights:

• Only 1 in 7 online stock images of blood pressure monitoring aligned with the procedures recommended by clinical guidelines.
• Online stock images depicting blood pressure monitoring in the home were approximately three times more accurate than images depicting blood pressure monitoring in a physician’s office, health care facility or hospital.
• This study is among the first to review online images of people having their blood pressure measured from major stock photo websites.

DALLAS, September 8, 2025 — Only 1 in 7 online stock photo images of blood pressure monitoring correctly show how blood pressure should be measured, contributing to potentially inaccurate readings at home and in physicians’ offices, health care facilities or hospitals, according to new research published today in Hypertension, an American Heart Association journal.

The study is one of the first to systematically evaluate the accuracy of online images depicting blood pressure measurements on major stock photo websites based on the 2023 International Consensus on Standardized Clinic Blood Pressure Measurement.

“We expected that about 50% of images would be accurate, however, our findings were worse than expected,” said lead author Alta Schutte, Ph.D., a professor of cardiovascular medicine at the University of New South Wales Sydney, and co-lead of the cardiovascular program at The George Institute for Global Health in Australia. “Because people tend to remember images better than words — a phenomenon known as the picture-superiority effect — inaccurate visuals could have serious public health consequences.”

Nearly half of all adults in the U.S. have high blood pressure, according to the American Heart Association. (From 2017 to 2020, 122.4 million adults in the U.S., or 46.7%, had high blood pressure; source: American Heart Association’s 2025 Heart Disease and Stroke Statistics)

“More people are checking their blood pressure at home. But because of the inaccurate depictions online – even on reputable websites – it is very likely that people who look for information on the internet about blood pressure will see these images and may use the incorrect technique at home. If this happens, people will get blood pressure readings that are either too high or too low, which can lead to wrong conclusions about their blood pressure and possibly too much or too little treatment when these blood pressure measures are shared with their health care team,” Schutte said.

The analysis found:

• Only 14% of more than 1,000 images depicting adults having their blood pressure measured were accurate.
• Deviations from clinical guidelines that contributed to photo inaccuracy included:
  • the individual’s back was not supported (73%);
  • the whole forearm was not resting on a flat surface or table (55%);
  • using a manual self-pumping device instead of an electronic or battery-operated upper-arm device (52%);
  • feet were dangling rather than flat on the floor (36%);
  • the health care professional (23%) and patient (18%) were talking while taking the measurement;
  • mid-arm was not at heart level (19%);
  • people had their legs crossed (13%);
  • the patient was not sitting (5%); and
  • the blood pressure cuff was placed over clothing (12%) rather than the bare arm.
• 25% of images showing self-measurement of blood pressure at home were accurate compared to only 8% of images depicting blood pressure measurements in a physician’s office, health care facility or hospital.
• Images depicting blood pressure measurements taken by the patient themselves or another person were 6 times more likely to show accurate techniques compared to images showing blood pressure measured by a health care professional.

“There have been many interesting studies about errors in blood pressure measurement and the blood pressure effect of such errors, for example, if the cuff on the upper arm is not held at heart level. This is the first evaluation of publicly available images of blood pressure measurement to highlight the problem with inaccurate images,” Schutte said.

“It is important for people to understand how to measure their blood pressure correctly. Inaccurate readings in clinics are also a very common problem. We want everyone to know how health care professionals should take blood pressure measurements so they can identify any mistakes if the procedure is not followed correctly,” she said.

Chair of the American Heart Association’s 2025 high blood pressure guideline writing committee released last month, Daniel Jones, M.D., FAHA, said, “This study highlights the importance of using accurate images to demonstrate the proper technique for measuring blood pressure. Home blood pressure monitoring is recommended for patients to help confirm an office diagnosis of high blood pressure and to monitor, track progress and tailor care as part of an integrated care plan.” Jones, who was not involved in this study, is also a past volunteer president of the American Heart Association (2007-2008) and currently dean and professor emeritus of the University of Mississippi School of Medicine.

The American Heart Association has resources to help people learn proper blood pressure measurement techniques.

The study has several limitations. Some images were incomplete; for instance, less than a quarter of them showed whether the person had their feet crossed or flat on the floor. If these details were clear, it might affect accuracy levels. Although the included photos were not penalized based on features that were not visually assessable, the findings may be affected. Additionally, the stock images used in this study were probably not created with the International Consensus Guidelines in mind. So, any errors found likely do not stem from an intentional misrepresentation of proper technique, yet these are the images that are typically used by the media and website developers.

Study background and details:

• The analysis used a Google search conducted on July 22, 2024, to identify a comprehensive list of 11 major online stock photo sites (123rf, Adobe Stock, Alamy, Bigstockphoto, Dreamstime, Flickr, Freepik, Getty Images, iStock, Pikwizard and Shutterstock).

• The first 100 photos from each online stock photo site were downloaded for further screening. Stock photo sites with more than 10% duplicate images were excluded. Cartoon or fictional images, AI-generated images or photos without people were also excluded.

• Of 121,000 images, 1,106 photos identified with the search term “blood pressure check” in adults were each reviewed by two reviewers. Overall, about 63% of the images were in a physician’s office or hospital, while about 37% showed home blood pressure monitoring in a home setting.

• Blood pressure measurements were performed by a health care professional in 72.8% of the photos, 24.5% were done by the patient and 2.7% were taken by other people.

• Conflicts (reviewers not agreeing) of each online image were resolved in two stages. First, two reviewers independently examined the stock photos, then met as a group to discuss the screening criteria and determine if the image accurately depicted correct blood pressure measuring techniques. Blood pressure measurements depicted in the images were checked for accuracy based on: whether the patient or the person taking the measurement was talking or laughing; the patient’s position: sitting, whether their whole forearm was resting on the table, mid-arm at heart level, back supported by a chair, legs uncrossed, and feet flat on the floor; the type of blood pressure measurement device: an electronic upper-arm device instead of a manual device; and the blood pressure cuff: placed on a bare arm.

“We have noted photos with wrong techniques on the websites of major health organizations and universities. We urge these organizations, media outlets, stock photo creators, web developers, medical journalists, and researchers to take a closer look at their online images. They should check that all images show how to measure blood pressure accurately and represent the proper techniques to reduce the likelihood of incorrect blood pressure readings at home and in clinical settings,” Schutte said.

Co-authors, disclosures and funding sources are listed in the manuscript.