‘Very low’ evidence supports CO2 laser for genitourinary syndrome of menopause

Among postmenopausal women, CO2-laser therapy was a “safe energy-based therapeutic option” for management of the genitourinary syndrome of menopause; however, the quality of evidence is “very low or low,” researchers wrote.

According to a previous report, 50% to 70% of postmenopausal women experience symptoms of genitourinary syndrome of menopause (GSM), which has also been called vulvovaginal atrophy, atrophic vaginitis and urogenital atrophy. In addition, about 15% of premenopausal women experience the condition. Symptoms include vaginal dryness, painful sex and/or urination and reduced lubrication.

“Despite the frequency of this condition and its impact on quality of life, GSM is underdiagnosed and undertreated,” Maurizio Filippini, MD, of the department of obstetrics and gynecology at the Hospital State of the Republic of San Marino, and colleagues wrote in the Journal of Sexual Medicine. “This is both due to the belief that GSM symptoms are natural part of aging and considered something to live with and the physicians’ poor awareness about GSM prevalence and symptoms.

According to Filippini and colleagues, CO2-laser therapy is gaining popularity as a second-line nonpharmacological treatment option for GSM, particularly among women who do not respond to or have contraindications to hormone therapy.

To gauge the laser treatment’s efficacy, Filippini and colleagues performed a systematic review and meta-analysis of 25 studies — 19 of which were conducted in the U.S. or Europe — that included 1,152 women (median age, 57.9 years) who underwent more than 3,800 laser applications. The analysis excluded women with a history of gynecological and/or breast cancer; pelvic organ prolapse stage 2 or higher; pain around their vagina opening; inflammation or irritation around their vagina or vulva; genital pain before, after or during sex; and/or vaginal dryness and dyspareunia due to any cause other than GSM.

Filippini and colleagues reported that after CO2-laser treatment, there were significant improvements in many of the women’s GSM symptoms: dryness (pooled mean difference = –5.15; 95% CI, –5.72 to –4.58); genital pain before, after or during sex (pooled mean difference = –5.27; 95% CI, –5.93 to –4.62); itching (pooled mean difference = –2.75; 95% CI, –4 to –1.51); burning (pooled mean difference = –2.66; 95% CI, –3.75 to –1.57); and painful urination (pooled mean difference = –2.14; 95% CI, –3.41 to –0.87). Significant improvements were also seen in the Female Sexual Function Index (pooled mean difference = 10.8; 95% CI, 8.41-13.37); Vaginal Health Index (pooled mean difference = 8.29; 95% CI, 6.16-10.42); and Vaginal Maturation Value (pooled mean difference = 30.4; 95% CI, 22.38-38.55).

The main limitations to the findings include the high level of heterogeneity as well as the type of trials that were included in the analysis, most of which were nonrandomized and single center, the researchers wrote.

“Even though data concerning laser-related side effects are of low quality, no major adverse events have been reported, neither during nor after laser administration,” Filippini and colleagues wrote. “Safety of this therapy is strictly related to adhesion of manufacturer’s suggested settings, operator skills and experience. Therefore, in carefully selected patients, CO2 laser procedure could represent a safe and effective procedure for GSM, despite quality of the body of evidence is very low or low.”

References:

Angelou K, et al. Cureus. 2020;doi:10.7759/cureus.7586.

Filippino M, et al. J Sex Med. 2022;doi:10.1016/j.jsxm.2021.12.010.