Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause

Adrian Gaspar, Hugo Brandi, Valentin Gomez, Daniel Luque, Adrian Gaspar, Hugo Brandi, Valentin Gomez, Daniel Luque

Abstract

Objectives: The objective of this prospective comparative cohort study was to establish the effectiveness and safety of Erbium:YAG (Er:YAG) laser treatment for genitourinary syndrome of menopause and to compare it with an established topical estriol treatment.

Methods: Fifty patients with genitourinary syndrome of menopause were divided into two groups. The estriol group received a treatment of 0.5 mg estriol ovules for 8 weeks and the laser group was first treated for 2 weeks with 0.5 mg estriol ovules 3 times per week to hydrate the mucosa and then received three sessions with 2,940 nm Er:YAG laser in non-ablative mode. Biopsies were taken before and at 1, 3, 6, and 12 months post-treatment. Maturation index, maturation value and pH where recorded up to 12-months post-treatment, while the VAS analysis of symptoms was recorded up to 18 months post-treatment.

Results: Statistically significant (P < 0.05), reduction of all assessed symptoms was observed in the laser group at all follow-ups up to 18 months post-treatment. Significant improvement in maturation value and a decrease of pH in the laser group was detected up to 12 months after treatment. The improvement in all endpoints was more pronounced and longer lasting in the laser group. Histological examination showed changes in the tropism of the vaginal mucosa and also angiogenesis, congestion, and restructuring of the lamina propria in the laser group. Side effects were minimal and of transient nature in both groups, affecting 4% of patients in the laser group and 12% of patients in the estriol group.

Conclusions: Our results show that Er:YAG laser treatment successfully relieves symptoms of genitourinary syndrome of menopause and that the results are more pronounced and longer lasting compared to topical estriol treatment. Lasers Surg. Med. 49:160-168, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Keywords: Erbium:YAG laser; genitourinary syndrome of menopause; topical estriol; vaginal atrophy.

© 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Assessment of the following symptoms of GSM: (a) dyspareunia, (b) irritation, (c) dryness, (d) chronic leukorrhea—on a 0–3 VAS scale in the laser group and in the estriol group before the treatment and after 1, 3, 6,12, and 18 months. *Indicates level of statistically significant improvement—***P < 0.001; **P < 0.01; *P < 0.05; x denotes statistically significant worsening ‐xx ‐ P < 0.01; x ‐ P < 0.05.
Figure 2
Figure 2
(a) Maturation value before and at 1, 3, 6, and 12 months post treatment, and (b) pH before and at 3 and 12 months follow‐up. *Indicates level of statistical significance—***P < 0.001; **P < 0.01; *P < 0.05.
Figure 3
Figure 3
Histological examination (hematoxylin‐eosin staining) of the vaginal mucosa of patients with GSM symptoms before and after Er:YAG laser treatment. Panel I shows images before treatment (a) and 1 month after laser treatment (b). New vessel formation can be observed (2). Panel II shows images before treatment (c) and 3, 6, and 12 months after laser treatment (d–f, respectively). Increased cellularity and neo‐angiogenesis can be observed (2) after Er:YAG laser treatment, increase in papillomatosis (1), basal cells hyperplasia, and a complete restorative reaction at the level of the lamina propria. Panel III shows images at 6 months after laser treatment, displaying increased angiogenesis (g) and restorative reaction at the level of the extracellular matrix (h and i). Photomicrographs at 4× (a–g) and 10× (h and i) magnification are presented.

References

    1. Management of symptomatic vulvovaginal atrophy: 2013 position statement of the north american menopause society. Menopause 2013; 20(9):888–902; quiz 903–904.
    1. Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med 2009; 6(8):2133–2142.
    1. Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician 2000; 61(10):3090–3096.
    1. Portman DJ, Gass ML. Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Vulvovaginal Atrophy Terminology Consensus Conference Panel. Menopause 2014; 21(10):1063–1068.
    1. Iosif CS, Bekassy Z. Prevalence of genito‐urinary symptoms in the late menopause. Acta Obstet Gynecol Scand 1984; 63(3):257–260.
    1. Johnston SL, Farrell SA, Bouchard C, Farrell SA, Beckerson LA, Comeau M, Johnston SL, Lefebvre G, Papaioannou A; SOGC Joint Committee‐Clinical Practice Gynaecology and Urogynaecology . The detection and management of vaginal atrophy. J Obstet Gynaecol Can 2004; 26(5):503–508.
    1. Von Schoultz E, Rutqvist LE. Menopausal hormone therapy after breast cancer: The Stockholm randomized trial. J Natl Cancer Inst 2005; 97(7):533–535.
    1. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane database Syst Rev 2006;(4):CD001500.
    1. Cardozo L, Bachmann G, McClish D, Fonda D, Birgerson L. Meta‐analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: Second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 1998; 92(4 Pt 2):722–727.
    1. Drnovsek‐Olup B, Beltram M, Pizem J. Repetitive Er:YAG laser irradiation of human skin: A histological evaluation. Lasers Surg Med 2004; 35(2):146–151.
    1. Kunzi‐Rapp K, Dierickx CC, Cambier B, Drosner M. Minimally invasive skin rejuvenation with erbium: YAG laser used in thermal mode. Lasers Surg Med 2006; 38:899–907.
    1. Bodendorf MO, Willenberg A, Anderegg U, Grunewald S, Simon JC, Paasch U. Connective tissue response to fractionated thermo‐ablative Erbium: YAG skin laser treatment. Int J Cosmet Sci 2010; 32(6):435–445.
    1. Salvatore S, Leone Roberti Maggiore U, Athanasiou S, Origoni M, Candiani M, Calligaro A, Zerbinati N. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: An ex vivo study. Menopause 2015; 22(8):845–849.
    1. Berlin AL, Hussain M, Phelps R, Goldberg DJ. A prospective study of fractional scanned nonsequential carbon dioxide laser resurfacing: A clinical and histopathologic evaluation. Dermatol Surg 2009; 35(2):222–228.
    1. Ogrinc UB, Senčar S, Lenasi H. Novel minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med 2015; 47:689–697.
    1. Gambacciani M, Levancini M, Cervigni M. Vaginal erbium laser: The second‐generation thermotherapy for the genitourinary syndrome of menopause. Climacteric 2015; 18:757–763.
    1. Meisels A. The maturation value. Acta Cytol 1967; 11(4):249.
    1. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc 2010; 85(1):87–94.
    1. Rahn DD, Good MM, Roshanravan SM, Shi H, Schaffer JI, Singh RJ, Word RA. Effects of preoperative local estrogen in postmenopausal women with prolapse: A randomized trial. J Clin Endocrinol Metab 2014; 99(10):3728–3736.
    1. Montoya TI, Maldonado PA, Acevedo JF, Word RA. Effect of vaginal or systemic estrogen on dynamics of collagen assembly in the rat vaginal wall. Biol Reprod Feb 2015; 92(2):43.
    1. Cano A, Estévez J, Usandizaga R, Gallo JL, Guinot M, Delgado JL, Castellanos E, Moral E, Nieto C, del Prado JM, Ferrer J. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: Results from a pivotal phase III study. Menopause 2012; 19(10):1130–1139.
    1. Dams SD, de Liefde‐van Beest M, Nuijs AM, Oomens CWJ, Baaijens FPT. Heat shocks enhance procollagen type I and III expression in fibroblasts in ex vivo human skin. Skin Res Technol 2011; 17(2):167–180.
    1. Romanos GE, Gladkova ND, Feldchtein FI, Karabut MM, Kiseleva EB, Snopova LB, Fomina YV. Oral mucosa response to laser patterned microcoagulation (LPM) treatment. An animal study. Lasers Med Sci 2013; 28(1):25–31.
    1. Sturdee DW, Panay N. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 2010; 13(6):509–522.
    1. Gaspar A, Addamo G, Brandi H. Vaginal fractional CO 2 laser: A minimally invasive option for vaginal rejuvenation. Am J Cosmet Surg 2011; 28(3):156–162.
    1. Salvatore S, Nappi RE, Zerbinati N, et al. A 12‐week treatment with fractional CO2 laser for vulvovaginal atrophy: A pilot study. Climacteric 2014; 17(4):363–369.
    1. Zerbinati N, Serati M, Origoni M, Candiani M, Iannitti T, Salvatore S, Marotta F, Calligaro A. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci 2015; 30(1):429–436.
    1. Vizintin Z, Rivera M, Fistonić I, Saracoglu F, Guimares P, Gaviria J, Garcia V, Lukac M, Perhavec T, Marini L. Novel minimally invasive VSP Er:YAG laser treatments in gynecology. J Laser Health Acad 2012; 1:46–58.
    1. Thomsen S. Pathologic analysis of photothermal and photomechanical effects of laser‐tissue interactions. Photochem Photobiol 1991; 53(6):825–835.
    1. Melo de VA, Anjos dos DCS, Albuquerque Júnior R, Melo DB, Carvalho FUR. Effect of low level laser on sutured wound healing in rats. Acta Cir Bras 2011; 26(2):129–134.
    1. Kao B, Kelly KM, Majaron B, Nelson JS. Novel model for evaluation of epidermal preservation and dermal collagen remodeling following photorejuvenation of human skin. Lasers Surg Med 2003; 32(2):115–119.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi