Genitourinary syndrome of menopause (GSM), also known as vaginal atrophy, urogenital atrophy, and vulvovaginal atrophy, affects many menopausal, and particularly postmenopausal women. It is due to hormonal deficiency affecting the urogenital area, including vagina, vulva and urinary tract. It can cause significant discomfort, troublesome symptoms and distress. GSM is a long term condition, and so long term treatments are required. Treatments include vaginal estrogen, HRT (although some women benefit from addition of vaginal estrogen even if taking HRT), vaginal moisturisers and lubricants. New treatment options have developed over recent years, including laser treatments applied into the vagina. So far, a lack of scientific evidence on the effect, particularly from randomised controlled trials, have led to uncertainty about the role of energy-based devices.

A recently published trial from Italy assessed 58 postmenopausal women who had been diagnosed with GSM. 28 women had 3 monthly sessions of active CO2-laser sessions, while 30 women had 3 monthly sessions of sham treatments, where the same procedure was applied but no laser energy was released.

The group concluded that the CO2 laser is effective for dryness, pain during sex, and sexual dysfunction symptoms of GSM symptoms. For these symptoms, the improvement from the active laser treatments were found superior to the sham treatments and so was not due to a placebo effect. However, the limitations of the study include relatively small numbers of patients and a short-term follow-up. More research is required to confirm the role of CO2 laser in other GSM symptoms such as Lower Urinary Tract Symptoms, as well as the mechanism of its mode of action.

Reference CO2 laser and the genitourinary syndrome of menopause: a randomized sham-controlled trial. S. Salvatore,E. Pitsouni,T. Grigoriadis et al Climacteric Volume 24, 2021 – https://doi.org/10.1080/13697137.2020.1829584

See more about GSM at Vaginal problems during menopause: Symptoms: Menopause Matters and treatments at Vaginal dryness during menopause: Treatments: Menopause Matters