EFFECTIVENESS OF VAGINAL ESTROGEN VS LASER THERAPY FOR POSTMENOPAUSAL ATROPHY: A COMPARATIVE STUDY OF TREATMENT MODALITIES
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Keywords
Vaginal atrophy, genitourinary syndrome of menopause, vaginal estrogen, laser therapy, postmenopausal symptoms, non-hormonal treatment, dyspareunia
Abstract
Background: Genitourinary syndrome of menopause (GSM) is one of the common complications in women which occurs after post menopause. Women with genitourinary syndrome experiences vaginal dryness, irritation and dyspareunia regarding treatment, vaginal estrogen was given but new treatments are introduced because of its effectiveness and the side effects of hormones cause by traditional management. Professional experts continue to debate which therapy method works better between vaginal estrogen and laser therapy therefore current research needs to be established for a complete review of evidence.
Objectives: his comprehensive review investigates how vaginal estrogen performs in relation to laser therapy when treating postmenopausal atrophy and also addresses their safety aspects. The review examines important symptomatic changes together with patient satisfaction and identifies safety complications of both interventions.
Methodology: A comprehensive search of studies between 2015 and 2024 was conducted within PubMed along with Scopus and Web of Science and the Cochrane Library databases. Two types of studies including Randomized Controlled Trials (RCTs) and Cohort studies and Systematic Reviews evaluated vaginal estrogen versus laser therapy for Germ Cell Mastitis. Researchers evaluated symptom relief together with vaginal health index scores and histological changes and adverse events in their analyses. The researchers used PRISMA standards to perform both data extraction and risk of bias assessment.
Results: Both vaginal estrogen and laser treatment show equivalent potential in subsiding GSM symptoms by decreasing vaginal dryness together with dyspareunia and urinary discomfort. Maximum symptom relief was witnessed more in laser therapy as compared to estrogen therapy. People expressed equal satisfaction with GSM treatment when using laser therapy or vaginal estrogen although laser therapy demanded multiple procedures at a higher initial expense. Users of both laser therapy and vaginal estrogen experienced low frequencies of adverse events yet laser treatment resulted in increased reports of immediate discomfort and localized skin irritation.
Conclusion: The treatment options of vaginal estrogen and laser therapy provide effective relief from GSM symptoms without causing significant side effects. Laser therapy stands as a suitable non-hormonal treatment option after estrogen in patients which are recommended by doctors to avoid hormonal treatments due to medical reasons. Additional research needs to provide detailed performance guidelines that help decide which therapy method is more suitable.
References
2. Aguiar, L. B., Politano, C. A., Costa-Paiva, L., & Juliato, C. R. T. (2020). Efficacy of fractional CO₂ laser, promestriene, and vaginal lubricant in the treatment of urinary symptoms in postmenopausal women: A randomized clinical trial. Lasers in Surgery and Medicine, 52(8), 713–720. https://doi.org/10.1002/lsm.23220
3. Bhide, A. A., Patel, P., Bhide, G. A., et al. (2022). Role of fractional CO₂ laser therapy in genitourinary syndrome of menopause: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 270, 45–53. https://doi.org/10.1016/j.ejogrb.2022.01.004
4. D'Oria, O., Giannini, A., Schiavi, M. C., et al. (2023). Carbon dioxide laser therapy for the management of genitourinary syndrome of menopause in gynecological cancer survivors: A narrative review. Experimental and Therapeutic Medicine, 25(1), 97. https://doi.org/10.3892/etm.2023.12297
5. Dutra, P. F. S. P., Heinke, T., Pinho, S. C., et al. (2021). Comparison of topical fractional CO₂ laser and vaginal estrogen for the treatment of genitourinary syndrome in postmenopausal women: A randomized controlled trial. Menopause, 28(7), 756–763. https://doi.org/10.1097/GME.0000000000001797
6. Eftekhar, T., Forooghifar, T., Khalili, T., Shariat, M., & Haghollahi, F. (2020). The effect of the CO₂ fractional laser or Premarin vaginal cream on improving sexual function in menopausal women: A randomized controlled trial. Journal of Lasers in Medical Sciences, 11(3), 292–298. https://doi.org/10.34172/jlms.2020.49
7. Faubion, S. S., Sood, R., & Kapoor, E. (2021). Genitourinary syndrome of menopause: Management strategies for the clinician. Mayo Clinic Proceedings, 96(7), 1985–1998. https://doi.org/10.1016/j.mayocp.2021.02.028
8. Jang, Y.-C., Leung, C. Y., & Huang, H.-L. (2022). Comparison of severity of genitourinary syndrome of menopause symptoms after carbon dioxide laser vs vaginal estrogen therapy: A systematic review and meta-analysis. JAMA Network Open, 5(9), e2232124. https://doi.org/10.1001/jamanetworkopen.2022.32124
9. Khamis, Y., Abdelhakim, A. M., Labib, K., et al. (2021). Vaginal CO₂ laser therapy versus sham for genitourinary syndrome of menopause management: A systematic review and meta-analysis of randomized controlled trials. Menopause, 28(11), 1316–1322. https://doi.org/10.1097/GME.0000000000001845
10. Li, F., Picard-Fortin, V., Maheux-Lacroix, S., et al. (2021). The efficacy of vaginal laser and other energy-based treatments on genital symptoms in postmenopausal women: A systematic review and meta-analysis. Journal of Minimally Invasive Gynecology, 28(3), 668–683. https://doi.org/10.1016/j.jmig.2020.08.001
11. Mension, S., et al. (2021). Laser therapy for genitourinary syndrome of menopause: Systematic review and meta-analysis. Revista Brasileira de Ginecologia e Obstetrícia, 43(1), 54–62. https://doi.org/10.1055/s-0040-1718440
12. Mili, N., Paschou, S. A., Armeni, A., Georgopoulos, N., Goulis, D. G., & Lambrinoudaki, I. (2021). Genitourinary syndrome of menopause: A systematic review on prevalence and treatment. Menopause, 28(6), 706–716. https://doi.org/10.1097/GME.0000000000001757
13. Paraiso, M. F. R., Ferrando, C. A., Sokol, E. R., et al. (2020). A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET trial. Menopause, 27(1), 50–56. https://doi.org/10.1097/GME.0000000000001416
14. Portman, D. J., & Gass, M. L. S. (2014). Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause, 21(10), 1063–1068. https://doi.org/10.1097/GME.0000000000000329
15. Sokol, E. R., Karram, M. M., & Parish, S. J. (2019). Efficacy and safety of fractional CO₂ laser treatment compared with topical estriol treatment for symptoms of genitourinary syndrome of menopause: A randomized clinical trial. Menopause, 26(8), 833–839. https://doi.org/10.1097/GME.0000000000001326
16. Stute, P., & Wildt, L. (2020). Laser therapy for the restoration of vaginal function. Maturitas, 134, 1–3. https://doi.org/10.1016/j.maturitas.2020.01.001
17. Tadir, Y., Gaspar, A., Lev-Sagie, A., et al. (2017). Light and energy-based therapeutics for genitourinary syndrome of menopause: Consensus and controversies. Lasers in Surgery and Medicine, 49(2), 137–159. https://doi.org/10.1002/lsm.22637
18. US Food and Drug Administration. (2018). Statement from FDA Commissioner Scott Gottlieb, MD, on efforts to safeguard women’s health from deceptive health claims and significant risks related to devices marketed for use in medical procedures for “vaginal rejuvenation.” Retrieved from https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-efforts-safeguard-womens-health-deceptive-health-claims
19. Weber, M. A., Limpens, J., & Roovers, J. P. (2015). Assessment of vaginal atrophy: A review. International Urogynecology Journal, 26(1), 15–28. https://doi.org/10.1007/s00192-014-2528-6
20. Wurz, G. T., Kao, C. J., & DeGregorio, M. W. (2021). Genitourinary syndrome of menopause: Vaginal estrogen use in women with a history of breast cancer. Oncology, 35(8), 462–471. https://doi.org/10.1200/JCO.21.00123
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Rashida Khan
Specialist Obstetrics and Gynecology, American Medical Center, Dubai, UAE
Joman Alshereida
Emirates Health Services, Ras Al Khaimah, UAE
Hafsa Ilyas
Lahore Medical and Dental College, Lahore/ Ghurki Hospital, Lahore, Pak
Maryum Noor Malik
Senior Registrar Obs/ Gynae, CMH Kharian Medical College, Kharian, Pak
Akasha Farooq
Advanced international Hospital, Islamabad, Pak
Rayan Osama Mohamed Abdelrahim
National Ribat University, Khartoum, Sudan
Maysoon Hassan Mohieldin
National Ribat University, Khartoum, Sudan
Raghad Mhd Bassam Alachkar Alhmawi
Thumbay University Hospital, Ajman, UAE
Gulnoor Aqeel Dar
Fatima Jinnah Medical University, Lahore, Pak
Rimla Ijaz
Registrar Gynaecology and Obstetrics, CMH Rawalpindi, Pak