Laser therapy for genitourinary syndrome of menopause: systematic review and meta-analysis of randomized controlled trial

• Main Authors: Lisieux de Lourdes Martins Nóbrega Pessoa (Author), Amaxsell Thiago Barros de Souza (Author), Ayane Cristine Alves Sarmento (Author), Ana Paula Ferreira Costa (Author), Isis Kelly dos Santos (Author), Eduardo Pereira de Azevedo (Author), Kleyton Santos de Medeiros (Author), Ana Katherine Gonçalves (Author), Ricardo Ney Cobucci (Author)
• Format: Book
• Published: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2024-06-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 0100-7203; 10.61622/rbgo/2024rbgo38
• Keywords: Menopause; Laser therapy; Postemenopause; Female urogenital diseases; Gynecology and obstetrics; RG1-991
• Source: Revista Brasileira de Ginecologia e Obstetrícia, Vol 46 (2024)

Abstract Objective: This meta-analysis of randomized controlled trials (RCTs) aimed to update evidence on the effectiveness and safety of laser therapy for treating genitourinary syndrome of menopause (GSM). Data sources: Manuscripts published until May 2023 were systematically searched in PubMed; Embase; Scopus; Web of Science; CENTRAL; CINAHL; and clinical trial databases (www.trialscentral.org, www.controlled-trials.com, and clinicaltrials.gov), with no language and year of publication restriction. Studies selection: RCTs with women diagnosed with GSM, and the intervention was vaginal laser therapy (CO2-laser or Er: YAG-laser) comparing with placebo (sham therapy), no treatment or vaginal estrogen therapy. Data collection: Two authors evaluated the publications for inclusion based on the title and abstract, followed by reviewing the relevant full-text articles. Disagreements during the review process were addressed by consensus, with the involvement of a third author. Data synthesis: Twelve RCTs, representing a total of 5147 participants, were included in this review. Vaginal health index (VHI) significantly improved in the carbon dioxide laser (CO2-laser) therapy group (MD=2.21; 95% CI=1.25 to 3.16), while dyspareunia (MD=−0.85; 95% CI=−1.59 to −0.10), dryness (MD=−0.62; 95% CI=−1.12 to −0.12) and burning (MD= −0.64; 95% CI=−1.28 to −0.01) decreased. No serious adverse effects were reported. Conclusion: CO2-laser increases VHI score and decreases dyspareunia, dryness and burning, especially when compared to sham-laser. However, the certainty of the evidence is low, thus preventing the recommendation of laser therapy for GSM management.