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


February 22, 2022

2 minute read


Disclosures: Healio Primary Care could not confirm the relevant financial information at the time of publication.


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

According to a previous report, 50% to 70% of postmenopausal women have symptoms of genitourinary syndrome of menopause (GSM), also known as vulvovaginal atrophy, atrophic vaginitis, and urogenital atrophy. In addition, about 15% of premenopausal women suffer from the disease. Symptoms include vaginal dryness, painful intercourse and/or urination, and reduced lubrication.


The researchers described the strength of evidence in support of CO2 laser therapy for genitourinary syndrome of menopause as “very weak or weak”.
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“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 of the State Hospital of the Republic of San Marino, and his colleagues wrote in the Journal of Sexual Medicine. “This is due both to the belief that GSM symptoms are a natural part of aging and seen as something to live with, and to physicians’ low awareness of the prevalence and symptoms of GSM.

According to Filippini and colleagues, CO2 laser therapy is gaining popularity as a second-line, non-pharmacological treatment option for GSM, especially in women who are unresponsive or have contraindications to hormone therapy. .

To assess the effectiveness of laser treatment, Filippini and colleagues performed a systematic review and meta-analysis of 25 studies – 19 of which were conducted in the United States or Europe – involving 1,152 women (median age, 57.9 years) having undergone more than 3,800 laser treatments. apps. The analysis excluded women with a history of gynecological and/or breast cancer; stage 2 or higher pelvic organ prolapse; pain around the opening of their vagina; inflammation or irritation around the vagina or vulva; genital pain before, after or during intercourse; 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 women’s GSM symptoms: dryness (pooled mean difference = -5.15; 95% CI, -5.72 to -4.58); genital pain before, after or during intercourse (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 of the results include the high level of heterogeneity as well as the type of trials included in the analysis, most of which were non-randomised and single-center, the researchers wrote.

“Even though the data regarding laser-related side effects are of low quality, no major adverse events were reported either during or after laser administration,” Filippini and colleagues wrote. “The safety of this therapy is strictly related to adherence to the manufacturer’s suggested settings, and the skill and experience of the operator. Therefore, in carefully selected patients, the CO2 laser procedure might represent a safe and effective procedure for GSM, even if the quality of the body of evidence is very low or low.

The references:

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

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

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