Effects of Vulvovaginal Laser Therapy on Postmenopausal Vaginal Atrophy: A Prospective Study

Objective: About 45% of healthy postmenopausal women have symptoms related to vaginal atrophy that can affect quality of life, including self-esteem and relationships. Initial studies on laser therapy for postmenopausal vaginal atrophy have shown promising results, with reduction of signs of atrophy and improved quality of sexual life. The study was designed to evaluate the viability and efficacy of laser treatment for genitourinary syndrome during menopause. Materials and Methods: For this prospective cohort study, women with signs and symptoms of overt urogenital atrophy were enrolled between November 2014 and June 2016, after giving informed consent. A cycle of five treatments of the vagina, at 0, 1, 2, 3, and 6 months was performed using a CO2 laser (Mona Lisa Touch,(R) Smart Xide DOT, DEKA Laser, Florence, Italy) through a 360 degrees-calibrated probe. Patients were evaluated for reduction of signs and symptoms, and the Gloria Bachman Vaginal Health Index was used to reassess the patients at 3- and 6-month follow ups after the last session of laser therapy. When possible, patients completed the Short Form-12 (SF-2) and Female Sexual Function Index (FSFI) questionnaires at the 6-month follow up, and satisfaction with the therapy was scored on a 5-point Likert scale. Results: Forty-five women were recruited, of which 41 (91.1%) were postmenopausal. The average age of the patients was 59.7 years. The average time since menopause was 10.9 years. Twenty-five (55.5%) women were sexually active, and 26 (57.8%) had previous hysterectomies. Thirty-eight patients (84.4%) completed the 6-month follow-up after the fifth laser session. Twenty-seven of 30 patients (90%) with dryness who completed follow-up reported reduction of dryness, and 17 (89.5%) of the 19 patients with dyspareunia who completed follow-up reported reduction of dyspareunia. A visual analogue scale for scoring severity of symptoms and the FSFI and SF-12 questionnaires could not be used for all patients, as many of them were not well-educated and had difficulty answering the questions. There were no side-effects or complications reported, except for a few patients reporting discomfort during probe insertion and some reporting vaginal soreness. Conclusions: Vulvovaginal laser therapy appears to be a promising option for managing genitourinary symptoms of menopause. Further randomized controlled trials with long-term follow-up data are needed before routine use of the therapy for this indication.