Laser therapy for genitourinary syndrome of menopause: systematic review and meta- analysis of randomized controlled trial

Objective: This meta-analysis of randomized controlled trials [RCTs] aimed to update evidence on the effectiveness and safety of laser therapy for treating genitourinary syndrome of menopause [GSM]. Data sources: Manuscripts published until May 2023 were systematically searched in PubMed; Embase; Scopus; Web of Science; CENTRAL; CINAHL; and clinical trial databases [www.trialscentral. org, www.controlled-trials.com, and clinicaltrials.gov], with no language and year of publication restriction. Studies selection: RCTs with women diagnosed with GSM, and the intervention was vaginal laser therapy [CO2-laser or Er: YAG-laser] comparing with placebo [sham therapy], no treatment or vaginal estrogen therapy. Data collection: Two authors evaluated the publications for inclusion based on the title and abstract, followed by reviewing the relevant full-text articles. Disagreements during the review process were addressed by consensus, with the involvement of a third author. Data synthesis: Twelve RCTs, representing a total of 5147 participants, were included in this review. Vaginal health index [VHI] significantly improved in the carbon dioxide laser [CO2-laser] therapy group [MD=2.21; 95% CI=1.25 to 3.16], while dyspareunia [MD=-0.85; 95% CI=-1.59 to -0.10], dryness [MD=-0.62; 95% CI=-1.12 to -0.12] and burning [MD= -0.64; 95% CI=-1.28 to -0.01] decreased. No serious adverse effects were reported. Conclusion: CO2-laser increases VHI score and decreases dyspareunia, dryness and burning, especially when compared to sham-laser. However, the certainty of the evidence is low, thus preventing the recommendation of laser therapy for GSM management.