Women who have been treated for breast cancer may experience vulvo-vaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM). This is a progressive condition and will not improve without treatment. Whilst vaginal oestrogen is the most effective treatment for GSM, many breast cancer survivors and clinicians remain reluctant to use it. Laser therapy is emerging as an alternative treatment for this condition but there is little evidence available as to its value in this setting.We undertook a systematic literature review to identify available evidence for the use of laser therapy for VVA in women with breast cancer. There are a number of small studies which suggest an improvement in vaginal health in this group. However, these are all small, non-randomised studies and there are a number of key questions which need to be answered before this treatment can be implemented into practice. BackgroundVulvovaginal atrophy (VVA), which is now known as genitourinary syndrome of menopause (GSM), results due to the natural hypo-oestrogenic state that occurs during and following menopause. Approximately 50% of post-menopausal women will suffer from GSM (reported incidence is between 39% and 62%) [20]. However, up to 75% of women surviving breast cancer are expected to experience GSM [27], because they are either post-menopausal at diagnosis or they have become menopausal as a result of endocrine or chemotherapy. Achieving very low oestrogen levels is the goal of endocrine sensitive breast cancer treatment, which will exacerbate menopausal problems. It is estimated that there are over 500,000 breast cancer survivors living in the UK, with the majority of women surviving for over 20 years. GSM is progressive in nature; hence, it will only deteriorate with time and will not improve without intervention. This can have a significant effect on the quality of life (QoL) [7].The vaginal mucosa prior to menopause is composed of a thick stratified squamous epithelium [8] which is hormone-responsive, relying primarily on oestrogen to maintain Research ecancer 2019, 13:988; www.ecancer.org; DOI: https://doi.