Physical methods for the treatment of genitourinary syndrome of menopause: A systematic review

Abstract

Background Genitourinary syndrome of menopause (GSM) negatively affects sexual function and quality of life. Techniques like laser and radiofrequency are being used to manage GSM, particularly in women with contraindications for hormone therapy. Objectives To verify whether the physical methods of laser and radiofrequency can be recommended as safe and effective options for the treatment of GSM/urinary urgency or incontinence in pre‐ and postmenopausal women. Search strategy Databases were comprehensively searched using combinations of the following keywords in any language: “postmenopause”; “genitourinary syndrome of menopause”; “vaginal atrophy”; “radiofrequency”; and “laser.” Selection criteria Full articles of case‐control, cross‐sectional, cohort, randomized clinical trials, and quasi‐randomized or controlled clinical trials were included. Data collection and analysis All authors independently evaluated the design of the studies for quality of reporting, risk of bias, and quality of evidence. Main results Of the included 49 studies, 37 were on the CO2 laser, 10 on the Erbium laser, and two on radiofrequency. Conclusions Laser and radiofrequency therapy could be promising and safe therapeutic options for GSM/urinary incontinence. However, the study findings cannot be generalized until new randomized clinical trials are performed that confirm the strength of the evidence. This review has been registered with PROSPERO: CRD42020141913.

Microablative fractional radiofrequency for the genitourinary syndrome of menopause: protocol of randomised controlled trial

“…The CO 2 laser has been demonstrated to be an efficacious therapy for managing all GSM symptoms up to 12 months after treatment. 32 The VHI score improved concerning elasticity, fluid volume, pH, epithelial integrity and vaginal moisture, and VAS scores improved considerably for sensitivity, vaginal dryness, itching/stinging, dyspareunia and dysuria. The studies about the Er:YAG treatment showed that this method is effective, practical and safe too, and the effects are rapid and sustained for at least 12 months.…”

“…21 28 Some systematic reviews have already been published on the subject. [29][30][31][32] A recent study assessing the physical methods for the treatment of GSM showed that, among physical methods, the CO 2 laser continues to be one of the most commonly used methods, as it has the largest body of scientific evidence. The CO 2 laser has been demonstrated to be an efficacious therapy for managing all GSM symptoms up to 12 months after treatment.…”

“…Application of Er:YAG laser is associated with an improvement in vaginal atrophy, and such treatment induced a significant decrease in VAS, an increase of VHI and a substantial improvement in the UI. 32 Additionally, the RF method could be a safe and effective non-surgical option for treating mild-to-moderate UI and other symptoms related to GSM. Significant improvements were observed in the mean VAS score and for complaints of VVA.…”

“…For this reason, new research about this topic is necessary. 32 We can also quote a prospective study 28 conducted at a public university hospital to evaluate the effectiveness of MAFRF in the non-hormonal treatment of GSM. In this research, 55 postmenopausal women were examined Open access before and after the treatment for VHI, vaginal microbiota, vaginal pH and cell maturation.…”

What We Know about the Long-Term Risks of Hysterectomy for Benign Indication—A Systematic Review

“…These studies were not included in the literature review because they do not include women with UF, but they further highlight the need for patient counselling prior to hysterectomy [65]. Finally, the risk of stress UI may increase with hormone deprivation and postmenopausal status [66,67]. The impact of hysterectomy on hormonal status is discussed in the next section.…”