Efficacy of CO<sub>2</sub> laser treatment in postmenopausal women with vulvovaginal atrophy: A meta‐analysis

Liu, Meichen; Li, Fengyong; Zhou, Yu; Cao, Yujiao; Li, Senkai; Li, Qiang

doi:10.1002/ijgo.13973

Cited by 14 publications

(25 citation statements)

References 31 publications

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“…The increase in life expectancy of women necessitates further scientific study and the development of appropriate therapies for the relief of GSM symptoms that can be used for all women [ 20 , 21 , 22 ]. GSM is a factor that impacts the quality of life and affects a broad age group [ 1 , 3 , 4 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of increasing the population size for further long-term evaluations of the parameters should not be ruled out. Although the principles of laser therapy are established in medicine, especially in dermatology, this study provides new and unprecedented therapeutic perspectives regarding the application of laser technology in gynecology because it is free from side effects and possible endometrial repercussions caused by using hormones [ 21 , 22 ]. Currently, a better understanding of the duration of the effects of this method and its long-term consequences and the functions of these processes at the epithelial, cellular, and nuclear levels is necessary.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Fractional Laser on Steroid Receptors in GSM Patients

Pinho,

Heinke,

Dutra

et al. 2023

Bioengineering

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Background: To compare the efficacy of CO2 fractional laser with that of topical estriol for treating genitourinary syndrome of menopause and to investigate the relationship between epithelial thickness and vaginal atrophy. Methods: Twenty-five menopausal women were randomized to receive either laser or estrogen treatment. Vaginal biopsies before and after treatment were compared to assess the amount and distribution of estrogen and progesterone receptors. Results: Estrogen receptor levels were statistically similar between groups before and after treatment. Although there was no change over time in the estrogen group, an increase in receptor levels was confirmed in the laser group. Changes in estrogen receptor levels showed no association with treatment. Progesterone receptor levels were statistically similar between groups throughout treatment. There was no change over time in both groups. These changes displayed no association with the type of treatment. There was no significant correlation between epithelium thickness and estrogen or progesterone receptor levels. Conclusions: Estrogen and progesterone receptor levels increased and were maintained, respectively, in the vaginal epithelium in both groups. There was no significant relationship between epithelium thickness and receptor density. Laser therapy had similar outcomes to the gold standard without involving the disadvantages of hormone therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of Fractional Laser on Steroid Receptors in GSM Patients

Pinho,

Heinke,

Dutra

et al. 2023

Bioengineering

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“…A previous meta-analysis of observational studies suggested laser therapy is likely to be effective in improvement of GSM, which was in accordance with our meta-analysis of 6 RCTs with relatively consistent study designs. In our analysis, all included studies applied the laser regimen of 2 to 3 sessions with an interval of 4 to 6 weeks .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Severity of Genitourinary Syndrome of Menopause Symptoms After Carbon Dioxide Laser vs Vaginal Estrogen Therapy

2022

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ImportanceVaginal estrogen for genitourinary syndrome of menopause (GSM) should be used with caution in women with contraindications, highlighting the need for effective treatment alternatives.ObjectiveTo compare the severity of GSM after vaginal laser vs estrogen therapy.Data SourcesThe PubMed, Embase, and Cochrane Library databases were searched for articles published from database inception to April 8, 2022, with no language restrictions. Reference lists were also searched.Study SelectionRandomized clinical trials (RCTs) that compared the use of lasers with vaginal estrogen in adults were selected.Data Extraction and SynthesisTwo investigators independently extracted data from included studies. The Cochrane risk of bias tool for RCTs was used to assess risk of bias of each study. A random-effects model was used to pool mean differences (MDs) with 95% CIs.Main Outcomes and MeasuresPrimary outcomes were Vaginal Analog Scale (VAS; higher scores indicate severer symptoms), Vaginal Health Index (VHI; higher scores indicate better vaginal health), Vaginal Maturation Index (VMI; higher scores indicate higher estrogen effect on the vaginal epithelium), Female Sexual Function Index (FSFI; higher scores indicate better female sexual function), and Sexual Quotient–Female (SQ-F; higher scores indicate better female sexual function) questionnaire scores. Urinary symptoms were assessed as an additional outcome. Data analyses were performed from April 9 to 12, 2022.ResultsA total of 6 RCTs with 270 women with GSM were included (135 were randomized to laser therapy and 135 to estrogen therapy; mean age ranged from 54.6 to 61.0 years). No significant differences were found between carbon dioxide laser and vaginal estrogen from baseline to the end of follow-up in overall VAS scores (MD, −0.16; 95% CI, −0.67 to 0.36; I2, 33.31%), VHI (MD, 0.20; 95% CI, −0.56 to 0.97; I2, 83.25%), VMI (MD, −0.56; 95% CI, −1.14 to 0.02; I2, 35.07%), FSFI (MD, −0.04; 95% CI, −0.45 to 0.36; I2, 41.60%), and SQ-F (P = .37 based on 1 study). Other questionnaire-based outcome measures demonstrated no difference between groups from baseline to the end of follow-up for changes in urinary symptoms.Conclusions and RelevanceThis systematic review and meta-analysis of RCTs found that vaginal laser treatment is associated with similar improvement in genitourinary symptoms as vaginal estrogen therapy. Further research is needed to test whether vaginal laser therapy could be a potential treatment option for women with contraindications to vaginal estrogen.

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“…Juliet, Cutera 360°sequential pulses, 1 cm apart; 2 passes 1st is ablative, 2nd is coagulative [40] Hybrid Er:YAG 2940 nm/ 1470 nm diode Diva, Sciton Automated tx, choose 90°,190°, or 360°NA lidocaine gel) may be applied to the vulva for 10 min before external genital treatment with fractional devices and affords adequate pain control.…”

Section: Preoperative Physical Examination and Testingmentioning

confidence: 99%

“…The settings on the device are provided by each manufacturer. [30][31][32][33][34][35][36][37][38][39][40] In general, the fluence (for microablative CO 2 laser) is in the low range of approximately 250-300 mJ/cm 2 and the spacing of the microbeams is approximately 1 mm apart. The handpiece is inserted fully into the vault.…”

Section: Vulvovaginal Protocolmentioning

confidence: 99%

Light and energy‐based therapeutics for genitourinary applications: Consensus on protocols and best practices

et al. 2023

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Background: Lasers and energy-based technologies have been developed for genitourinary applications over the past several decades. Aims: This consensus article aims to categorize the published articles and clinical trial data that culminated in protocol development of technology for genitourinary applications, and to develop consistent parameters in future clinical trials. Materials and Methods: The published articles and clinical trials data on lasers and energy-based devices applied to genitourinary conditions were categorized according to device and condition and consensus developed on protocols and parameters.Results: The devices in genitourinary applications were classified as fractional lasers, radiofrequency and high-intensity focused electromagnetic field therapy. The consensus of the protocols and parameters based upon the published clinical trials of their application to the vaginal and urologic conditions associated with genitourinary syndrome of menopause was developed and organized according to device and condition. Discussion: The status of FDA clearances and future pathways are discussed. Conclusions: This consensus article categorizes and presents the protocols and practices for the main classes of lasers and energy-based devices for genitourinary applications in future clinical trials.

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Efficacy of CO₂ laser treatment in postmenopausal women with vulvovaginal atrophy: A meta‐analysis

Cited by 14 publications

References 31 publications

Efficacy of Fractional Laser on Steroid Receptors in GSM Patients

Efficacy of Fractional Laser on Steroid Receptors in GSM Patients

Comparison of Severity of Genitourinary Syndrome of Menopause Symptoms After Carbon Dioxide Laser vs Vaginal Estrogen Therapy

Light and energy‐based therapeutics for genitourinary applications: Consensus on protocols and best practices

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Efficacy of CO2 laser treatment in postmenopausal women with vulvovaginal atrophy: A meta‐analysis

Cited by 14 publications

References 31 publications

Efficacy of Fractional Laser on Steroid Receptors in GSM Patients

Efficacy of Fractional Laser on Steroid Receptors in GSM Patients

Comparison of Severity of Genitourinary Syndrome of Menopause Symptoms After Carbon Dioxide Laser vs Vaginal Estrogen Therapy

Light and energy‐based therapeutics for genitourinary applications: Consensus on protocols and best practices

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Efficacy of CO₂ laser treatment in postmenopausal women with vulvovaginal atrophy: A meta‐analysis