Efficacy of Fractionated Carbon Dioxide Laser for the Treatment of Genitourinary Syndrome of Menopause: A Systematic Review and Meta-analysis.

Abstract

Objective: To evaluate the short-term effectiveness of fractional CO2 laser for the treatment of genitourinary syndrome of menopause.

Data sources: Systematic review was performed of PubMed, Scopus, Web of Science, Cinhal, MEDLINE, and ClinicalTrials.gov.

Methods of study selection: The included studies had to meet the following criteria: 1) The sample consisted exclusively of women diagnosed with genitourinary syndrome of menopause; 2) at least one group in the sample underwent treatment with fractional CO2 laser; 3) the control group received simulated fractional CO2 laser therapy, topical hormonal treatment, or a topical gel lubricant; 4) the studies evaluated outcomes related to sexual function, urinary symptoms, or the quality of the vaginal epithelium; and 5) the study design was a randomized controlled trial. The exclusion criterion specified that participants should not have a history of any type of cancer or prior treatment with a different type of laser.

Tabulation, integration, and results: Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled SD. The I2 statistic was used to determine the degree of heterogeneity. The 11 articles included in the review had a group receiving fractional CO2 laser therapy and a control group receiving simulated fractional CO2 laser, topical hormonal treatment, or topical gel lubricant. The meta-analyses indicated that fractional CO2 laser is effective for improving sexual function through increased sexual desire, arousal, lubrication, orgasms, and sexual satisfaction; reducing pain during sexual activity (standardized mean difference 0.51, P=.021); and improving urinary function by reducing the frequency and magnitude of urinary leakage and frequency of urination (standardized mean difference 0.51, P<.001).

Conclusion: Fractional CO2 laser is associated with statistically significant improvements in the short-term treatment of sexual and urinary symptoms but not vaginal epithelium quality. The clinical significance of these changes is unclear.

Systematic review registration: PROSPERO, CRD42023435636.