Treating menopause — MHT and beyond

Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society.

Key Points Question Is vaginal laser treatment safe and effective for genitourinary syndrome of menopause in survivors of breast cancer receiving aromatase inhibitors? Findings In this randomized clinical trial with 84 participants in 2 parallel study groups, both groups received a first-line therapy based on nonhormonal moisturizers and vaginal vibrator stimulation, and participants were randomized to receive 5 weekly sessions of fractional carbon dioxide laser therapy or sham laser therapy. No differences were observed between groups in safety or efficacy outcomes at the 6-month follow-up. Meaning These findings suggest that although vaginal laser treatment was safe, it was not more effective than first-line therapy with placebo treatment in survivors of breast cancer receiving aromatase inhibitors.

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Effect of Fractional Carbon Dioxide vs Sham Laser on Sexual Function in Survivors of Breast Cancer Receiving Aromatase Inhibitors for Genitourinary Syndrome of Menopause

Despite significant controversy, vaginal laser therapy continues to be used for treatment of many gynecologic and pelvic conditions including vaginal atrophy, vaginal dryness, dyspareunia, urinary incontinence and pelvic pain. This commentary reviews the controversy surrounding vaginal laser therapy and summarizes the important distinction between ablative and non-ablative vaginal lasers. While much research is still needed, the article describes what is important for healthcare professionals to know before making the decision to integrate this technology into their clinical practice.

Vaginal laser therapy for gynecologic conditions: re-examining the controversy and where do we go from here.

Vaginal laser therapy versus hyaluronic acid suppositories for women with symptoms of urogenital atrophy after treatment for breast cancer: A randomized controlled trial.

Vaginal laser therapy for genitourinary syndrome of menopause - systematic review.

New therapeutic options are being considered to treat genitourinary syndrome of menopause (GSM), such as vaginal laser, ospemifene, or prasterone, but there is no explicit agreement in the scientific community for its use. Some concerns have arisen on how to evaluate the improvement of GSM symptoms. In 2003, the FDA suggested possible end points for this purpose: change in severity of symptoms, change in vaginal pH, and change in vaginal maturation index (VMI). Contrarily, the most common assessment tools used to quantify severity and improvement of GSM nowadays are the visual analog scale of GSM symptoms, the vaginal health index, and the female sexual function index. In our opinion, subjective and objective variables to evaluate GSM can be differentiated, and not many of the considered objective outcomes are used in the recent literature assessing GSM. There is the possibility that some therapies present only subjective improvement, giving place to a possible placebo effect that is not being evaluated. To conclude, there is a demand to evaluate whether vaginal pH and VMI are enough to assess objectively GSM changes or new objective approaches should be audited.

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Laura Ribera

Papers

Vaginal laser therapy for genitourinary syndrome of menopause - systematic review.

Genitourinary Syndrome of Menopause Assessment Tools