Efficacy of CO2 laser vs vaginal estrogen in perimenopausal women with genitourinary syndrome of menopause: systematic review and meta-analysis.

IF 3.3 3区医学 Q1 UROLOGY & NEPHROLOGY

Journal of Sexual Medicine Pub Date : 2025-07-07 DOI:10.1093/jsxmed/qdaf153

Aya Mohamed Nasr, Mohab Alsaid Saad, Amer Salah Mohamed, Yousif Ahmad Hanafi, Bilal Walid Bazbaz, Sarra Salah Amer Mohamed, Sayed Mahmoud Selim, Zaid Fatehi Altawallbeh

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引用次数: 0

Abstract

Background: Genitourinary syndrome of menopause (GSM) is characterized by vaginal dryness, itching, burning, pain during intercourse, and urinary symptoms. Traditionally, hormone replacement therapy (HRT), specifically estrogen therapy, has been the first-line treatment for GSM, due to its side effects, fractional CO2 laser therapy has emerged as an alternative for managing GSM symptoms.

Aim: The primary focus is to compare CO2 fractional laser therapy and estrogen therapy on postmenopausal women with GSM through systemically reviewing all the randomized controlled trials.Methods: A comprehensive search of electronic databases, including PubMed, Scopus, Web of Science, Medline, Cochrane, Scielo, UC Berkeley library, and Google Scholar, was performed in October 2024. The inclusion criteria targeted randomized controlled trials comparing CO2 fractional laser therapy and estrogen therapy on postmenopausal women with GSM, which used at least 1 of these outcomes: Female Sexual Function Index (FSFI), Vaginal Health Index, Visual Analog Score, and Urinary Distress Inventory 6.

Results: Out of 688 studies, 7 studies were included for final analysis with a total of 302 participants: 154 had CO2 fractional laser therapy with a mean age of 55.9 years, and 148 had estrogen therapy with a mean age of 57.2 years. The analysis revealed no statistically significant difference between CO2 laser and estrogen in Vaginal Health Index (mean difference [MD], 1.60; 95% CI, -0.36 to 3.56; P = .09), FSFI-total (MD, 0.10; 95% CI, -2.03 to 2.23; P = .93), and Urinary Distress Inventory 6 (MD, -3.18; 95% CI, -6.77 to 0.42; P = .08). We used a sensitivity analysis on the FSFI-arousal subscale due to high heterogeneity, excluding 1 study. It showed that the CO2 laser group had a statistically significant difference when compared with the estrogen group (MD, 0.47; 95% CI, 0.15-0.79; P = .01).

Conclusion: CO2 laser therapy is an effective line of treatment for GSM. However, its comparison with estrogen therapy did not reach a statistically significant difference favoring one line over the other.

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CO2激光与阴道雌激素对围绝经期妇女伴绝经期泌尿生殖系统综合征的疗效：系统评价和meta分析。

背景：绝经期泌尿生殖系统综合征（GSM）的特征是阴道干燥、瘙痒、灼烧、性交疼痛和泌尿系统症状。传统上，激素替代疗法（HRT），特别是雌激素治疗，一直是GSM的一线治疗，由于其副作用，分数CO2激光治疗已成为管理GSM症状的替代方法。目的：通过系统回顾所有随机对照试验，比较CO2分次激光治疗和雌激素治疗绝经后GSM妇女的疗效。方法：于2024年10月对PubMed、Scopus、Web of Science、Medline、Cochrane、Scielo、UC Berkeley library、谷歌Scholar等电子数据库进行全面检索。纳入标准针对的是比较CO2分次激光治疗和雌激素治疗绝经后GSM妇女的随机对照试验，这些试验至少使用以下1项结果：女性性功能指数（FSFI）、阴道健康指数、视觉模拟评分和尿窘迫量表6。结果：在688项研究中，7项研究被纳入最终分析，共有302名参与者：154名接受CO2分次激光治疗，平均年龄为55.9岁，148名接受雌激素治疗，平均年龄为57.2岁。分析显示，CO2激光与雌激素在阴道健康指数上的差异无统计学意义(mean difference [MD], 1.60；95% CI, -0.36 ~ 3.56；P = .09), FSFI-total (MD, 0.10；95% CI, -2.03 ~ 2.23；P = 0.93)，尿窘迫量表6 (MD, -3.18；95% CI, -6.77 ~ 0.42；p = .08)。由于高异质性，我们对fsfi -觉醒分量表进行了敏感性分析，排除了1项研究。结果显示，CO2激光组与雌激素组比较，差异有统计学意义(MD, 0.47；95% ci, 0.15-0.79；p = 0.01)。结论：CO2激光治疗是治疗GSM的有效方法。然而，它与雌激素治疗的比较并没有达到统计学上显著的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Sexual Medicine 医学-泌尿学与肾脏学

CiteScore

6.20

自引率

5.70%

发文量

826

审稿时长

2-4 weeks

期刊介绍： The Journal of Sexual Medicine publishes multidisciplinary basic science and clinical research to define and understand the scientific basis of male, female, and couples sexual function and dysfunction. As an official journal of the International Society for Sexual Medicine and the International Society for the Study of Women''s Sexual Health, it provides healthcare professionals in sexual medicine with essential educational content and promotes the exchange of scientific information generated from experimental and clinical research. The Journal of Sexual Medicine includes basic science and clinical research studies in the psychologic and biologic aspects of male, female, and couples sexual function and dysfunction, and highlights new observations and research, results with innovative treatments and all other topics relevant to clinical sexual medicine. The objective of The Journal of Sexual Medicine is to serve as an interdisciplinary forum to integrate the exchange among disciplines concerned with the whole field of human sexuality. The journal accomplishes this objective by publishing original articles, as well as other scientific and educational documents that support the mission of the International Society for Sexual Medicine.