Efficacy of Vaginal Laser Treatment for Symptomatic Relief of Vulvovaginal Atrophy in Postmenopausal Women

Introduction: As women age and go through menopause, the decrease in estrogen that occurs with this process causes many changes in the body, one being atrophy of the vaginal skin, The thinning and drying of the vaginal canal as well as the external vulvar skin can cause burning, dyspareunia, dysuria, and even contribute to vaginal infections, incontinence and urinary tract infections1. This paper aims to determine if laser therapy can be used vaginally to treat vulvovaginal atrophy in postmenopausal women with equal or better results than the current standard of care, estrogen cream. Methods: A literature search was performed using PubMed and Google Scholar in November 2019 using the terms “CO2 laser vulvovaginal atrophy OR laser genitourinary syndrome of menopause OR laser vaginal atrophy NOT rejuvenation NOT incontinence NOT cancer”. This search was limited to articles published in scholarly journals within the last five years and filtered for title of articles only. See below for other inclusion and exclusion criteria. Results: All seven studies included showed either a statistically significant improvement in the patient’s VVA with the use of laser therapy based on the measured outcomes or showed improvement with the laser therapy that was equal or not statistically significantly different from the control of vaginal estrogen cream. Discussion: Of the seven studies, three were cohort studies, and four were RCTs. Of the four RCTs, three used blinding. All of the studies were similar in their treatment methods but varied in their outcome measures and assessment timeline after treatment. Due to the two different types of studies analyzed, RCTs and cohort studies, it is hard to make comparisons between the two. This treatment is in early stages of research however, so all data is appreciated to gain insight. Conclusion: Overall the seven studies analyzed here show significant improvement of the patient’s GSM symptoms and quality of life, improvement in sexual function and objective improvement of pH, lubrication and vaginal maturation. While there are very few reported adverse effects and the data does show significant improvement in these studies, they are lacking in large sample size, long term follow up, comparable outcome measures and a lack of control group in some. The ability of three initial laser treatments, with possible yearly treatments after that, to show comparable results to every other night application of a vaginal cream is very promising and could vastly improve the quality of life in women dealing with this common health issue, but more evidence is needed. Based off the data found, the benefits of using laser therapy as a treatment for GSM/VVA outweighs the risks and adverse events but patients have to be aware this is still considered an off label option based on FDA approval. Recommendations can be made for use of laser therapy but significant patient education has to be done concurrently to make them aware of the reason for the lack of FDA approval at this time