Different effects of CO₂ laser and estrogen treatment on vaginal mucosa microbiota and function in genitourinary syndrome of menopause patients

Abstract

AimTo characterize the effects of CO2 laser treatment and estrogen treatment on vaginal microbiota in patients with genitourinary syndrome of menopause (GSM).MethodsSixty‐four patients with genitourinary syndrome were divided into the estrogen group, the CO2 laser group, and the control group. The control group did not receive any treatment. Vaginal mucosa was collected after 3 and 12 months of treatment. The former was used for 16S rRNA sequencing, and the latter was used for pathological evaluation. Vaginal health and voiding function were assessed using the vaginal health index (VHI) scale and the UDI‐6 scale at 3 and 12 months after treatment.ResultsThe results showed that both treatments reduced alpha diversity in the vaginal flora. Additionally, the abundance of 65 genera differed significantly between the treatment and control groups, with an increase in potentially beneficial bacteria such as Lactobacillus, IheB3_7, Mycoplasma urealyticum, and Streptococcus. In addition, the VHI and UDI‐6 scores improved in both treatment groups compared to the control group after 3 months. Whereas VHI and UDI‐6 scores were close to baseline in the estrogen group, and remained significantly improved in the CO2 laser group after 12 months. Pathological results showed that both methods improved the vaginal health status of patients with GSM after 12 months of treatment. However, the CO2 group exhibited a more significant increase in type III collagen.ConclusionsBoth CO2 laser and estrogen therapies can regulate the vaginal flora imbalance of GSM and improve the corresponding symptoms. However, the long‐term efficacy of CO2 laser therapy is superior compared to estrogen therapy.

The Efficacy of CO2 Vaginal Laser in the Treatment of Recurrent, Post-Coital and Interstitial Cystitis: A Multicentric Prospective Study

“…All these demonstrate that the laser induces a restoration of the vaginal epithelium [ 37 ]. Another retrospective study conducted in 2024 by Yueming et al investigated the effects of CO 2 laser therapy in modifying vaginal bacterial flora in women suffering from urogenital menopausal syndrome, showing that both the CO 2 micro-ablative vaginal laser and estrogen therapies can regulate the vaginal microbiota imbalance of GSM and improve the corresponding symptoms [ 38 ].…”