Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women

Eur J Obstet Gynecol Reprod Biol. 2016 Dec:207:125-128. doi: 10.1016/j.ejogrb.2016.10.018. Epub 2016 Nov 1.


Objective: To assess whether the orally administered combination of hyaluronic acid (HA), chondroitin sulfate (CS), curcumin and quercetin could be effective in preventing recurrent cystitis in postmenopausal women and whether its efficacy was conditioned by the concurrent use of local estrogen therapy.

Study design: This was a prospective evaluation of 145 postmenopausal women consecutively recruited from the database of three different investigators. All women should have mild-to-moderate urogenital atrophy and a history of recurrent urinary tract infections (≥2 episodes within 6 months or ≥3 episodes within 12 months documented by positive urine cultures) during the last year. Patients were assigned to three different therapeutic regimens: the first group was treated only with vaginal estrogens, the second group only with HA, CS, curcumin and quercetin per os, and the third group was treated with HA, CS, curcumin and quercetin associated with local estrogens. We evaluated the number of patients with <2 infective episodes in the 6-month follow-up and <3 episodes in the 12-month follow-up (main aim definition) and the reduction of related symptoms through a Visual Analog Scale (VAS) and the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale. Student's t-test and chi-squared test were used for data analysis as appropriate.

Results: At 6-month follow up, the main aim rate was 8%, 11.1% and 25% in the three groups, respectively (p<0.05 compared to baseline only in group 3). Although the reduction in the number of recurrent episodes became significant in all groups at 1 year follow-up, the main aim rate was almost double in women receiving both local estrogens and oral therapy (group 3) compared to those receiving single treatments. The improvement of related symptoms was significant in all groups at 12-month follow-up.

Conclusions: In postmenopausal women, the combination of HA, CS, curcumin and quercetin per os was effective in preventing recurrent urinary tract infections, especially if administered with vaginal estrogen therapy.

Keywords: Curcumin; Estrogen; Glycosaminoglycans; Quercetin; Urinary tract infections.

Publication types

  • Controlled Clinical Trial
  • Multicenter Study

MeSH terms

  • Aging*
  • Anti-Infective Agents, Urinary / adverse effects
  • Anti-Infective Agents, Urinary / therapeutic use
  • Antioxidants / adverse effects
  • Antioxidants / therapeutic use
  • Atrophic Vaginitis / complications
  • Atrophic Vaginitis / drug therapy
  • Atrophic Vaginitis / physiopathology
  • Chondroitin Sulfates / adverse effects
  • Chondroitin Sulfates / therapeutic use*
  • Combined Modality Therapy / adverse effects
  • Curcumin / adverse effects
  • Curcumin / therapeutic use*
  • Dietary Supplements* / adverse effects
  • Disease Resistance / drug effects
  • Estriol / adverse effects
  • Estriol / therapeutic use
  • Estrogen Replacement Therapy / adverse effects
  • Estrogens / adverse effects
  • Estrogens / therapeutic use
  • Female
  • Humans
  • Hyaluronic Acid / adverse effects
  • Hyaluronic Acid / therapeutic use*
  • Middle Aged
  • Postmenopause
  • Quercetin / adverse effects
  • Quercetin / therapeutic use*
  • Secondary Prevention
  • Severity of Illness Index
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / microbiology
  • Urinary Tract Infections / prevention & control*
  • Urinary Tract Infections / urine
  • Vaginal Creams, Foams, and Jellies / adverse effects
  • Vaginal Creams, Foams, and Jellies / therapeutic use


  • Anti-Infective Agents, Urinary
  • Antioxidants
  • Estrogens
  • Vaginal Creams, Foams, and Jellies
  • Hyaluronic Acid
  • Chondroitin Sulfates
  • Quercetin
  • Estriol
  • Curcumin