Fractional carbon dioxide laser fails to improve vaginal symptoms after menopause: JAMA study

Australia: An estimated 40% to 60% of postmenopausal women shows vaginal symptoms. Vaginal symptoms can cause physical discomfort and may negatively affect sexual function, relationships, and quality of life however fractional carbon dioxide vaginal laser is increasingly offered as a treatment.

A new study by Dr. Fiona G. Li, MD, and team has reported that women with postmenopausal vaginal symptoms, who underwent treatment with fractional carbon dioxide laser vaginal symptoms didn't significantly improve after a year.

This study is published in the Journal of the American Medical Association (JAMA). 

The objective of the study was to evaluate the efficacy of fractional carbon dioxide laser for the treatment of vaginal symptoms associated with menopause.

The study was a double-blind, randomized, sham-controlled trial with a 12-month follow-up was undertaken at a single tertiary referral hospital in Sydney, Australia. Enrollment commenced on September 19, 2016, with a final follow-up on June 30, 2020. Participants were postmenopausal women with vaginal symptoms substantive enough to seek medical treatment.

A total of 232 participants were approached, and 85 were randomized. Three treatments using a fractional microablative carbon dioxide laser system were performed 4 to 8 weeks apart, with 43 women randomized to the laser group and 42 to the sham group. 85 randomized participants (mean age, 57 years), 78 (91.7%) completed the 12-month follow-up. From baseline to 12 months, there was no significant difference between the carbon dioxide laser group and the sham group.

The results of the study were

• symptom severity was VAS score for overall vaginal symptoms: –17.2 vs –26.6; difference, 9.4; VAS score for the most severe symptom: –24.5 vs –20.4; difference –4.1; VSQ score: –3.1 vs –1.6; difference, –1.5)

• There were no significant differences between the laser and sham group in the mean quality of life score i.e 6.3 vs 1.4; difference, 4.8 and Vaginal Health Index Score (0.9 vs 1.3; difference, –0.4)

• There were 16 adverse events in the laser group and 17 in the sham group, including vaginal pain/discomfort (44% vs 68%), spotting, discharge, and lower urinary tract symptoms. No severe adverse events were reported in either group.

Dr. Li and team concluded that "Among women with postmenopausal vaginal symptoms, treatment with fractional carbon dioxide laser vs sham treatment did not significantly improve vaginal symptoms after 12 months."

Reference:

Li FG, Maheux-Lacroix S, Deans R, et al. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021;326(14):1381–1389.

doi:10.1001/jama.2021.14892