CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis

Abstract

Background: Genitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image.

Aim: We aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM.

Methods: MEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren's Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121.

Outcomes: Effects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods.

Results: A total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in VVA and/or GSM symptoms (dryness, dyspareunia, itching, burning, dysuria). The pooled mean differences for the symptoms were: dryness -5.15 (95% CI:-5.72,-4.58; P < .001; I²:62%; n = 296), dyspareunia -5.27 (95% CI:-5.93,-4.62; P < .001; I²:68%; n = 296), itching -2.75 (95% CI:-4.0,-1.51; P < .001; I²:93%; n = 281), burning -2.66 (95% CI:-3.75, -1.57; P < .001; I²:86%; n = 296) and dysuria -2.14 (95% CI:-3.41,-0.87; P < .001; I²:95%; n = 281). FSFI, WHIS and VMV scores also improved significantly. The pooled mean differences for these scores were: FSFI 10.8 (95% CI:8.41,13.37; P < .001; I²:84%; n = 273), WHIS 8.29 (95% CI:6.16,10.42; P < .001; I²:95%; n = 262) and VMV 30.4 (95% CI:22.38,38.55; P < .001; I²:24%; n = 68). CO2-Laser application showed a beneficial safety profile and no major adverse events were reported.

Clinical implications: Vaginal laser treatment resulted in both a statistically and clinically significant improvement in GSM symptoms. FSFI improved significantly in all 8 included studies but it reached a clinically relevant level only in 2 of them.

Strengths & limitations: The strength of the current meta-analysis is the comprehensive literature search. We reported data from a high number of patients (1,152) and high number of laser applications (more than 3,800). The main limitations are related to the high heterogeneity of the included studies investigating laser effects. Moreover, most of them are single center and nonrandomized studies.

Conclusion: The data suggest that CO2-Laser is a safe energy-based therapeutic option for the management of VVA and/or GSM symptoms in postmenopausal women; however, the quality of the body of evidence is "very low" or "low". Filippini M, Porcari I, Ruffolo AF, et al., CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:452-470.

Keywords: Genitourinary Syndrome of Menopause (GSM); Menopause; Vaginal CO2-Laser; Vulvo-Vaginal Atrophy (VVA).