A hüvelyi CO₂-lézer-kezelés rövid távú hatásai a menopausalis genitourinalis szindróma tüneteire

Abstract

Introduction: Genitourinary syndrome of menopause (GSM) affects up to 40–57% of postmenopausal women. Intravaginal microablative fractional CO2 laser is a new proposal for the management of GSM, although the evidence of safety and efficacy of the procedure appears to be insufficient. Aim: The aim of the study was to assess the efficacy of fractional CO2 laser for the treatment of GSM at the Department of Obstetrics and Gynecology of the University of Debrecen. Method: Postmenopausal women with symptoms of GSM underwent three sessions of microablative fractional rejuvenation CO2 laser therapy at 4–6 weeks intervals. Vaginal health index (VHI) scores were completed before each treatment and at 6 weeks follow-up as an objective measurement and visual analog scale was used to assess subjective complaints. Statistical analysis included Student’s paired two-sampling t-test for the measure of statistical significance using the standard cutoff for significance p<0.05. Results: 51 women participated (mean age 57.0 ± 9.9 y). Average VHI score was 14.0 ± 4.9 before treatment, 15.0 ± 4.7 after the first session, 18.2 ± 4.6 after the second treatment and 19.5 ± 4.9 at follow-up. The improvement of VHI score was statistically significant between all sessions. Average VAS score was 15.6 ± 14.1 before treatment, 9.0 ± 10.8 after the first session, 5.9 ± 9.2 after the second treatment and 3.4 ± 7.5 at follow-up. The improvement of VAS score was statistically also significant between all sessions. Conclusions: Our study suggests that the fractional CO2 laser is an effective and safe treatment of symptoms associated with GSM. Orv Hetil. 2019; 160(41): 1617–1622.

Nonestrogen Therapies for Treatment of Genitourinary Syndrome of Menopause

“…1), resulting in 143 publications. Of these publications, we reviewed eight comparative studies 10–17 and four single-group studies 18–21 for vaginal DHEA, 13 comparative studies 22–34 and eight single-group studies 35–42 for oral ospemifene, 11 comparative studies 43–53 and 41 single-group studies 54–94 for microablative fractional carbon dioxide (CO 2 ) laser, two comparative studies 95,96 and three single-group studies 97–99 for Erbium:YAG laser, seven comparative studies 100-106 and one single-group study 107 for the polycarbophil-based vaginal moisturizer, six comparative studies 108–113 and one single-group study 114 for testosterone, 25 comparative studies 115–138 for oral tibolone, and seven comparative studies 139–145 and five single-group studies 146–150 for vaginal hyaluronic acid. A list of reviewed publications can be found in Appendix 2 (available online at http://links.lww.com/AOG/D289), and summarized findings can be found in Tables 1 and 2.…”

“…Microablative fractional CO 2 laser was evaluated in 41 single-group studies, 54–94 six randomized controlled trials (RCTs) compared with vaginal estrogen, 43,46–50 four RCTS to sham laser, 44,51–53 one three-arm study that included CO 2 laser, sham laser and estrogen, 45 and one study with and without ospemifene. 94 In comparing CO 2 laser with estrogen, subjective atrophy symptoms were improved compared with before treatment with both therapies in two studies 48,49 (n=224, moderate quality), and laser was favored over estrogen in one study 46 (n=24, moderate quality).…”

“…53 Subjective symptoms of atrophy 51–53 and UDI-6 score 51,53 were either equal to sham or favored laser. With regard to the 41 single-group studies, laser showed improvement in the VHI (20 studies, n=1,060), 54–56,58,59,62,63,71,72,78,80,81,83,85–88,91,93 subjective symptoms of dryness (19 studies, n=1,036), 56,60,63,65,66,75–79,81,84–89,91,92 dyspareunia (18 studies, n=1,347), 56,60,63,64,66,75–78,80,81,84–89,91 FSFI (21 studies, n=1,070), 54–57,59,62,63,65,67,71,73,74,77,81–83,85,86,89,91,93 and overall satisfaction (11 studies, n=152). 59,61,63,75,76,82,83,85,86,91,93 Five single-group studies 61,75,76,83,86 and two RCTs 43,49 looked at adverse events and pain with procedure (n=365), and found no significant problems.…”

“…With regard to the 41 single-group studies, laser showed improvement in the VHI (20 studies, n51,060), [54][55][56]58,59,62,63,71,72,78,80,81,83,[85][86][87][88]91,93 subjective symptoms of dryness (19 studies, n51,036), 56,60,63,65,66,[75][76][77][78][79]81,[84][85][86][87][88][89]91,92 dyspareunia (18 studies, n51,347), 56,60,63,64,66,[75][76][77][78]80,81,[84][85][86][87]…”

Genito Urinary Syndrome of Menopause (GSM) or Vulvo-vaginal Atrophy (VVA) an Unspoken Sorrow

“…There are very few options available, local ET seems superior to others but still not very much effective in compare to placebo. Kozma et al confidently concluded from their study that fractional CO2 Laser is an effective and safe treatment of symptoms associated with GSM [49]. In addition REVIVE study suggests women are concern about long-term use and safety of vaginal ET [50].…”