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Laser therapy ‘insignificant’ for post-menopausal issues


Morgan Liotta


26/10/2021 4:13:29 PM

The efficacy of laser treatment for post-menopausal genitourinary symptoms versus placebo and topical therapies has been revealed.

Woman talking to GP
GPs are well placed to provide appropriate treatment assessment for women experiencing post-menopausal genitourinary symptoms.

Genitourinary symptoms are estimated to effect around half of all post-menopausal women and can have adverse impacts on a woman’s quality of life.
 
Despite concerns surrounding safety, efficacy and cost, fractional carbon dioxide vaginal laser treatment has been increasingly offered as a potential treatment.
 
However, a recently published study has further strengthened uncertainty regarding its benefits, finding its efficacy remains unproven and that there is little difference between laser and placebo or sham treatment.
 
The sham-controlled, double-blinded, randomised clinical trial of 85 Australian post-menopausal women with vaginal symptoms ‘substantive enough to seek medical treatment’ comprised 43 women in a laser-receiving group and 42 in a group receiving sham treatment. Three treatments using a fractional micro-ablative carbon dioxide laser system were performed 4−8 weeks apart.
 
After 12 months, treatment with fractional carbon dioxide laser versus sham treatment did not significantly improve vaginal symptoms in the participants, the study found.
 
‘No matter which way you look at it, there wasn’t any difference between whether you had the actual laser or whether you had this placebo treatment,’ study author UNSW Sydney Professor Jason Abbott said.
 
‘The treatment of laser for post-menopausal vaginal symptoms just wasn’t effective.’
 
The Therapeutic Goods Administration (TGA) approved the use of fractional carbon dioxide vaginal laser in 2018 for a number of body soft tissues, but it is not specifically approved for treatment of genitourinary syndrome of menopause or vaginal atrophy. The US Food and Drug Administration has also previously warned about the risks of the ‘vaginal rejuvenation’ therapy, and there is currently no MBS item number for the laser therapy.
 
GP and Australasian Menopause Society (AMS) President-elect Dr Karen Magraith agrees with the laser therapy’s current regulation, believing it is no longer justified and ‘probably never was’ for this indication in Australia.

‘The laser treatment is recommended quite a bit in Australia, and various practitioners, including some GPs and gynaecologists, have expensive machines that they claim help this condition,’ Dr Magraith told newsGP.
 
‘There is no MBS item for vaginal laser treatment, it requires multiple treatments and can be a very expensive option for women. For the majority of women, cheaper, effective treatments are available.
 
‘Topical vaginal oestrogen treatment is cheap and effective and safe for the majority of women, but is very much underused.
 
‘Women can sometimes get it confused with systemic menopausal hormone therapy and have concerns about potential long-term side effects.
 
‘In fact, the vast majority of women can use vaginal oestrogen treatment for as long as they wish to.’
 
In the study, outcomes for symptom severity were assessed using a visual analogue scale (VAS) and the Vulvovaginal Symptom Questionnaire (VSQ).
 
The VAS and VSQ scores for ‘overall’ and ‘most severe’ symptoms showed minor differences between the two groups, with no significant differences between either group in the mean quality of life score. There were 16 adverse events in the laser group and 17 in the sham group, including vaginal pain/discomfort (44% versus 68%), spotting, discharge, and lower urinary tract symptoms.
 
No severe adverse events were reported in either group.
 
With the study validating that treatment with fractional carbon dioxide laser versus sham treatment does not improve symptom severity or quality of life for women with post-menopausal genitourinary symptoms, Dr Magraith said GPs have a role in making an appropriate assessment.
 
‘The assessment needs to take into account factors such as whether the patient is menopausal, whether she is receiving treatment for breast cancer, and any other relevant medical history,’ she said.
 
‘If the issue is vaginal dryness causing discomfort with sex, a sexual and relationship history is helpful to see if there are any other factors that might be contributing. The GP should offer examination, which can help to exclude conditions such as lichen sclerosus, and make an assessment.  
 
‘If a woman has vaginal dryness requiring treatment, the first options are lubricants or vaginal moisturisers. Vaginal oestrogen treatment is an effective treatment and is safe for the majority of women.’
 
For patients with a history of breast cancer, Dr Magraith recommends GPs discuss treatment with the patient’s oncologist and using a shared decision-making progress if vaginal oestrogen is being considered.

While the study found there was no difference between laser treatment and sham treatment at 12 months, there were also no significant adverse effects of laser treatment in the trial.
 
However, this could change should the treatment be administered by ‘less well-trained hands in the community’, according to Dr Magraith, who said that cost is currently the biggest concern.
 
‘At the moment the most common adverse effect is likely to be the cost − and the opportunity cost when many of these women could have cheaper effective treatment,’ she said.
 
Professor Abbott hopes the study findings will help to discourage women from seeking this form of treatment.
 
‘Based on our study, we hope that women don’t go for commercial laser treatment for post-menopausal symptoms,’ he said.
 
‘It’s really important for women to be made aware when it’s quite an expensive treatment that it isn’t different to having no treatment at all.’
 
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Dr Serguei Kisselev   27/10/2021 10:51:13 AM

Laser therapy is a great method , which gives a lot of advantages and benefits if applied correctly - as any other method. If laser light is applied incorrectly as in the mentioned study, absolutely ignoring the physical, biological and other effects of the laser light on the illuminated tissues and whole body - why should we expect a good result? ? Why is the conclusion based on the poorly designed study? Could it be better to ask people who have been studying laser light for many years and successfully applying these methods to help their patients? Could it be better to start with exploring the nature of the laser light and its effect on the body? By the way - how many other medical technologies have 3 Nobel prizes? The first one - 1903. Were these doctors and scientists wrong?