Microablative and non-ablative laser and radiofrequency treatment of genitourinary syndrome of menopause: A randomised controlled trial with four different energies.

Abstract

Objective: This study compared the effects of four different types of energy treatments on women with genitourinary syndrome of menopause.

Material and methods: Four-arm single-blind randomised clinical trial, with 48 postmenopausal women with genitourinary syndrome of menopause. Participants were randomised into four groups: Group 1 received sessions of non-ablative Er:YAG laser; Group 2 received sessions of microablative CO2 laser; Group 3 underwent sessions of non-ablative radiofrequency; and Group 4 received sessions of fractional microablative radiofrequency. The primary outcome was the assessment of symptoms of genitourinary syndrome of menopause correlated with vaginal histological analysis at baseline and 1 month after the end of treatment. Secondary outcomes included sexual function and urinary symptoms, treatment satisfaction and major adverse events.

Results: All treatment modalities demonstrated significant improvement in dryness (p < 0.001) and dyspareunia (p < 0.001) measured by visual analogue scales and in vaginal symptoms assessed with the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (p < 0.001), with no significant differences between groups. All treatment energies resulted in significant increases in tissue thickness (p < 0.001), layer number (p < 0.001), and collagen quantity and depth (p < 0.001), with no significant difference among the groups.

Conclusions: Both microablative and non-ablative energies, whether utilizing laser or radiofrequency, are effective treatments for the symptoms of genitourinary syndrome of menopause, with histological correlations observed and no notable differences in efficacy between modalities.

Clinical trial registration: Registered in REBEC (Registro Brasileiro de Ensaios Clínicos; Brazilian Registry of Clinical Trials). Trial registration number RBR-5vw3vpg. The protocol can be accessed at https://ensaiosclinicos.gov.br/rg/RBR-5vw3vpg.