Fractional CO2 laser therapy is used to manage pelvic-floor dysfunction, and may have regenerative properties, causing histological changes in the connective tissues and cellular components.
To investigate the treatment's role in GSM management, Dr. Ahmed Mohamed Abdelhakim of Cairo University and colleagues conducted a systematic review and meta-analysis comparing fractional CO2 laser therapy with sham placebo. Three randomized controlled trials involving a total of 164 postmenopausal women with GSM met the inclusion criteria.
Treatment with the CO2 laser significantly improved vaginal symptoms, with a pooled mean improvement of 0.46 on the Vaginal Assessment Scale, which ranges from 0 to 3 (P=0.004). It also significantly improved sexual and urinary symptoms.
A greater proportion of women were satisfied with laser treatment than with sham treatment (risk ratio, 1.98; P=0.004), the researchers report in Menopause.
Fractional CO2 laser represents just one of the treatment options for GSM, explained Dr. Stephanie Faubion, director of the Mayo Clinic Women's Health, in Jacksonville, Florida, and medical director of the North American Menopause Society.
"There are many proven and effective therapies for treatment of GSM of menopause, including low-dose local hormonal treatments such as vaginal estrogen, vaginal DHEA, and the oral selective estrogen-receptor modulator ospemifene," she told Reuters Health by email.
Dr. Faubion, who wasn't involved in the review, said laser therapy, if ultimately found to be safe and effective, could offer a "non-hormonal option for women in whom even low-dose hormonal therapies are not recommended." Additionally, she said, the therapy could be more convenient option for some women who prefer not to take medication on a regular basis.
While the study suggests the laser may indeed be a promising approach to GSM of menopause, there is still a lack of long-term data on its effects, said Dr. Susann Clifford, assistant professor in the Department of Obstetrics and Gynecology at Duke University School of Medicine, in Durham, North Carolina, in an email to Reuters Health.
Dr. Clifford, who wasn't involved in this study, added that while "this meta-analysis is a good start, further studies with more subjects comparing the laser to sham therapy will be needed to better assess this exciting new treatment option."
She added that the CO2 laser is currently not covered by insurance, and the out-of-pocket expense may limit accessibility for many women. Additionally, while the lasers are approved for 'use in gynecology,' they are not approved specifically for the treatment of GSM, which will further keep the regimen from gaining coverage by insurance.
As such, estrogen may continue to remain the gold standard treatment for GSM, said Dr. Clifford. "For some women, estrogen is contraindicated, such as women with history of ER+ breast cancer, and other women are unwilling to use estrogen due to concerns regarding safety of hormone use," she noted. "For these women, the use of the CO2 laser has added a new modality to the small arsenal available for treatment."
The study had no funding, and the researchers report no conflicts of interest.
SOURCE: https://bit.ly/3sDzKys Menopause, online August 9, 2021.
By Reuters Staff
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