Modern problems and opportunities in the treatment of genitourinary syndrome of menopause in the context of medical science and technology development

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Abstract

Genitourinary syndrome of menopause (GSM) is one of the most common complications of female reproductive aging which influences the quality of life and sexual health of most women during menopause. However, no more than 25% of women receive adequate therapy for GSM, even in developed countries. GSM is obviously a serious medical and social problem affecting a wide range of generally healthy women. The issue of finding and studying new, effective and safe, as well as patient-friendly and highly compliant methods for treating symptoms of vulvovaginal atrophy (VVA)/GSM remains extremely relevant, and its importance will only increase in the coming years, taking into account existing demographic and social trends. In addition to the objective risks associated with hormone therapy, which is the gold standard of VVA/GSM treatment, some patients do not want to use hormone-containing drugs, and some patients have contraindications for such therapy, therefore, alternative options for the treatment of GSM symptoms are necessary for them. Laser treatment may be such an option, and according to available data, laser treatment is comparable to local hormone therapy in effectiveness, and may exceed it in terms of safety.

Conclusion: Among the available laser devices used in gynecological practice, ablative and non-ablative lasers can currently be applied for correcting the symptoms of VVA/GSM, and the latter devices are rated as the safest ones. The Nd:YAG laser appears to be a very promising device that has not been sufficiently studied in terms of capabilities, limitations and methods of use in patients with symptoms of VVA/GSM; large-scale studies and observational programs are necessary to assess the effectiveness and safety of its use.

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About the authors

Marina O. Ramazanova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: mar1naramazanova@yandex.ru
ORCID iD: 0000-0003-2508-7109

Obstetrician-gynecologist, PhD student

Russian Federation, Moscow

Inna A. Apolikhina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: i_apolikhina@oparina4.ru
ORCID iD: 0000-0002-4581-6295

Dr. Med. Sci., Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor of the Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia

Russian Federation, Moscow; Moscow

Ekaterina I. Shershakova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: dr.cathynioca@gmail.com
ORCID iD: 0009-0008-9866-4185

clinical resident of the 2nd year of the direction «obstetrics and gynecology»

Russian Federation, Moscow

References

  1. Koothirezhi R., Ranganathan S. Postmenopausal syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
  2. Федеральная служба государственной статистики. Женщины и мужчины России 2020. Статистический сборник. М.; 2020. 239с. [Federal State Statistics Service. Women and men of Russia 2020. Statistical compilation. Moscow; 2020. 239p. (in Russian)]. Available at: https://rosstat.gov.ru/storage/mediabank/yhNtbedG/Wom-Man%202020.pdf
  3. Тихомирова Е.В., Балан В.Е., Фомина-Нилова О.С. Методы лечения генитоуринарного синдрома на современном этапе. Медицинский Совет. 2020; 13: 91-6. [Tikhomirova E.V., Balan V.E., Fomina-Nilova O.S. Current treatment options for genitourinary syndrome. Medical Council. 2020; (13): 91-6. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2020-13-91-96.
  4. Palacios S., Nappi R.E., Bruyniks N., Particco M., Panay N.: EVES Study Investigators. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric. 2018; 21(3): 286-91. https://dx.doi.org/10.1080/13697137.2018.1446930.
  5. Turcan N., Grădinaru-Fometescu D., Baros A., Coravu V., Turcan G., Cirstoiu M.M. Vulvovaginal atrophy - the impact on the quality of life and self-regard. Review of literature. RJMM Rom. J. Mil. Med. 2022;125(1):50-5. https://dx.doi.org/10.55453/rjmm.2022.125.1.7
  6. Portman D.J., Gass M.L.; Vulvovaginal Atrophy Terminology Consensus Conference Panel. 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. Menopause. 2014; 21(10): 1063-8. https://dx.doi.org/10.1097/GME.0000000000000329.
  7. Angelou K., Grigoriadis T., Diakosavvas M., Zacharakis D., Athanasiou S. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020; 12(4): e7586. https://dx.doi.org/10.7759/cureus.7586.
  8. Дикке Г.Б., Гурская Т.Ю., Прокофьева С.В., Стольникова И.И., Андреева А.С., Репина Н.Б., Яговкина Н.В., Теплых С.В., Федорова Е.П. Эффективность и безопасность вагинального эстриола в ультранизкой дозе в терапии генитоуринарного менопаузального синдрома: многоцентровое рандомизированное контролируемое испытание III фазы. Акушерство и гинекология. 2022; 12: 146-56. [Dikke G.B., Gurskaya T.Yu., Prokof’evа S.V., Stol’nikova I.I., Andreeva A.S., Repina N.B., Yagovkina N.V., Teplykh S.V., Fedorova E.P. Efficacy and safety of ultra-low dose vaginal estriol in the therapy of genitourinary syndrome of menopause: a phase III multicenter randomized controlled trial. Obstetrics and Gynecology. 2022; (12): 146-56. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.303.
  9. Briggs P. Genitourinary syndrome of menopause. Post Reprod. Health. 2019; 26(2): 111-4. https://dx.doi.org/10.1177/2053369119884144.
  10. Goldstein I. Recognizing and treating urogenital atrophy in postmenopausal women. J. Womens Health (Larchmt). 2010; 19(3): 425-32. https://dx.doi.org/10.1089/jwh.2009.1384.
  11. Harris B.S., Bishop K.C., Kuller J.A., Ford A.C., Muasher L.C., Cantrell S.E., Price T.M. Hormonal management of menopausal symptoms in women with a history of gynecologic malignancy. Menopause. 2020; 27(2): 243-8. https://dx.doi.org/10.1097/GME.0000000000001447.
  12. Paszkowski T., Bińkowska M., Dębski R., Krzyczkowska-Sendrakowska M., Skrzypulec-Plinta V., Zgliczyński W. Menopausal hormone therapy in questions and answers - a manual for physicians of various specialties. Prz. Menopauzalny. 2019; 18(1): 1-8. https://dx.doi.org/10.5114/pm.2019.84150.
  13. Beauchamp P.J., Held B. Estrogen replacement therapy. Universal remedy for the postmenopausal woman? Postgrad. Med. 1984; 75(7): 42-9, 52-3. https://dx.doi.org/10.1080/00325481.1984.11698613.
  14. Rossouw J.E., Anderson G.L., Prentice R.L., LaCroix A.Z., Kooperberg C., Stefanick M.L. et al.; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002; 288(3): 321-33. https://dx.doi.org/10.1001/jama.288.3.321.
  15. Доброхотова Ю.Э., Хлынова С.А. Использование лубрикантов при вульвовагинальной атрофии. РМЖ. Мать и дитя. 2018; 1(2): 163-7. [Dobrokhotova Yu.E., Khlynova S.A. Lubricants application in vulvovaginal atrophy. Russian Journal of Woman and Child Health. 2018; 1(2): 163-7. (in Russian)]. https://dx.doi.org/10.32364/2618-8430-2018-1-2-163-167.
  16. Pinkerton J.V. Hormone therapy for postmenopausal women. N. Engl. J. Med. 2020; 382(5): 446-55. https://dx.doi.org/10.1056/NEJMcp1714787.
  17. Weidlinger S., Schmutz C., Janka H., Gruetter C., Stute P. Sustainability of vaginal estrogens for genitourinary syndrome of menopause - a systematic review. Climacteric. 2021; 24(6): 551-9. https://dx.doi.org/10.1080/13697137.2021.1891218.
  18. Hirschberg A.L., Bitzer J., Cano A., Ceausu I., Chedraui P., Durmusoglu F. et al. Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: an EMAS clinical guide. Maturitas. 2021; 148: 55-61. https://dx.doi.org/10.1016/j.maturitas.2021.04.005.
  19. Nappi R.E., Martella S., Tiranini L., Cucinella L., Palacios S. Efficacy and safety of a device that combines multipolar radiofrequency with pulsed electromagnetic field for the treatment of vulvovaginal atrophy: a randomized, sham-controlled trial. J. Sex. Med. 2024; 21(3): 203-10. https://dx.doi.org/10.1093/jsxmed/qdad166.
  20. Fernandes M.F.R., Bianchi-Ferraro A.M.H.M., Sartori M.G.F., Jármy Di Bella Z.I.K., Cantarelli G.C., Dedonatto C. et al.; LARF Study Group. CO 2 laser, radiofrequency, and promestriene in the treatment of genitourinary syndrome of menopause in breast cancer survivors: a histomorphometric evaluation of the vulvar vestibule. Menopause. 2023; 30(12): 1213-20. https://dx.doi.org/10.1097/GME.0000000000002274.
  21. D'Oria O., Giannini A., Buzzaccarini G., Tinelli A., Corrado G., Frega A. et al. Fractional Co2 laser for vulvo-vaginal atrophy in gynecologic cancer patients: a valid therapeutic choice? A systematic review. Eur. J. Obstet. Gynecol. Reprod. Biol. 2022; 277: 84-9. https://dx.doi.org/10.1016/j.ejogrb.2022.08.012.
  22. Оразов М.Р., Силантьева Е.С., Радзинский В.Е., Михалева Л.М., Хрипач Е.А., Долгов Е.Д. Эффективность лазерной ремоделирующей терапии при генитоуринарном менопаузальном синдроме. Гинекология. 2022; 24(6): 465-70. [Orazov M.R., Silant’eva E.S., Radzinskii V.E., Mikhaleva L.M., Khripach E.A., Dolgov E.D. Efficacy of laser remodeling in the genitourinary syndrome of menopause. Gynecology. 2022; 24(6): 465-70. (in Russian)]. https://dx.doi.org/10.26442/20795696.2022.6.201897.
  23. Горбунова Е.А., Аполихина И.А., Рамазанова М.О. Применение фракционного фототермолиза CO2-лазером в гинекологической практике. Акушерство и гинекология. 2023; 7: 155-61. [Gorbunova E.A., Apolikhina I.A., Ramazanova M.O. Application of CO2-fraction laser photothermolysis in gynecological practice. Obstetrics and Gynecology. 2023; (7): 155-61. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.176. Salvatore S., Nappi R.E., Zerbinati N., Calligaro A., Ferrero S., Origoni M. et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014; 17(4): 363-9. https://dx.doi.org/10.3109/13697137.2014.899347.
  24. Paraiso M.F.R., Ferrando C.A., Sokol E.R., Rardin C.R., Matthews C.A., Karram M.M. et al. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: the VeLVET trial. Menopause. 2020; 27(1): 50-6. https://dx.doi.org/10.1097/GME.0000000000001416.
  25. Siliquini G.P., Tuninetti V., Bounous V.E., Bert F., Biglia N. Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women. Climacteric. 2017; 20(4): 379-84. https://dx.doi.org/10.1080/13697137.2017.1319815.
  26. Weaver S., Rosen L. Changes in vaginal pH after treatment for atrophic vaginitis with a CO2 laser [4A]. Obstet. Gynecol. 2016; 127(Suppl. 1): 12S-13S. https://dx.doi.org/10.1097/01.AOG.0000483299.84198.e4.
  27. Оразов М.Р., Демяшкин Г.А., Токтар Л.Р. Ремоделирующая лазерная терапия влагалища при генитоуринарном менопаузальном синдроме. Хирургическая практика. 2018; 1: 22-37. [Orazov M.R., Demyashkin G.A., Toktar L.R. Remodeling laser therapy of the vagina in genitourinary menopausal syndrome. Surgical Practice (Russia). 2018; (1): 22-37. (in Russian)]. https://doi.org/10.17238/issn2223-2427.2018.1.22-37.
  28. Preti M., Vieira-Baptista P., Digesu G.A., Bretschneider C.E., Damaser M., Demirkesen O. et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: an ICS/ISSVD best practice consensus document. Neurourol. Urodyn. 2019; 38(3): 1009-23. https://dx.doi.org/10.1002/nau.23931.
  29. Salvatore S., Athanasious S., Yuen H.T.H., Karram M. LASER users' expert opinion in response to "The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: an ICS/ISSVD best practice consensus document". Neurourol. Urodyn. 2019; 38(8): 2383-4. https://dx.doi.org/doi: 10.1002/nau.24140.
  30. Mortensen O.E., Christensen S.E., Løkkegaard E. The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: a state-of-the-art review. Acta Obstet. Gynecol. Scand. 2022; 101(6): 657-92. https://dx.doi.org/10.1111/aogs.14353.
  31. Arunkalaivanan A., Kaur H., Onuma O. Laser therapy as a treatment modality for genitourinary syndrome of menopause: a critical appraisal of evidence. Int. Urogynecol. J. 2017; 28(5): 681-5. https://dx.doi.org/10.1007/s00192-017-3282-y.
  32. Mension E., Alonso I., Tortajada M., Matas I., Gómez S., Ribera L. et al. Vaginal laser therapy for genitourinary syndrome of menopause - systematic review. Maturitas. 2022; 156: 37-59. https://dx.doi.org/10.1016/j.maturitas.2021.06.005.
  33. Gordon C., Gonzales S., Krychman M.L. Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy. Menopause. 2019; 26(4): 423-7. https://dx.doi.org/10.1097/GME.0000000000001293.
  34. Wallace S.L., St Martin B., Lee K., Sokol E.R. A cost-effectiveness analysis of vaginal carbon dioxide laser therapy compared with standard medical therapies for genitourinary syndrome of menopause-associated dyspareunia. Am. J. Obstet. Gynecol. 2020; 223(6): 890.e1-890.e12. https://dx.doi.org/10.1016/j.ajog.2020.06.032.
  35. Lang P., Dell J.R., Rosen L., Weiss P., Karram M. Fractional CO2 laser of the vagina for genitourinary syndrome of menopause: is the out-of-pocket cost worth the outcome of treatment? Lasers Surg. Med. 2017; 49(10): 882-5. https://dx.doi.org/10.1002/lsm.22713.
  36. Geusic J.E., Marcos H.M., Van Uitert L.G. Laser oscillations in Nd-doped yttrium aluminum, yttrium gallium and gadolinium garnets. APL. 1964; 4(10): 182-4. https://dx.doi.org/10.1063/1.1753928.
  37. Dalgic H., Kuscu N.K. Laser therapy in chronic cervicitis. Arch. Gynecol. Obstet. 2001; 265(2): 64-6. https://dx.doi.org/10.1007/s004040000135.
  38. Leclair C.M., Goetsch M.F., Lee K.K., Jensen J.T. KTP-nd: YAG laser therapy for the treatment of vestibulodynia: a follow-up study. J. Reprod. Med. 2007; 52(1): 53-8.
  39. Bizjak Ogrinc U., Senčar S., Luzar B., Lukanović A. Efficacy of non-ablative laser therapy for Lichen sclerosus: a randomized controlled trial. J. Obstet. Gynaecol. Can. 2019; 41(12): 1717-25. https://dx.doi.org/10.1016/j.jogc.2019.01.023.
  40. Gubarkova E., Potapov A., Krupinova D., Shatilova K., Karabut M., Khlopkov A. et al. Compression optical coherence elastography for assessing elasticity of the vaginal wall under prolapse after neodymium laser treatment. Photonics. 2022; 10(1); 6. https://dx.doi.org/10.3390/photonics10010006.
  41. Паузина О.А., Аполихина И.А., Малышкина Д.А. Возможности применения неодимового лазера (Nd:YAG) у пациенток c сопутствующими заболеваниями, сопровождающимися патологическими выделениями из половых путей. Гинекология. 2020; 22(4): 75-81. [Pauzina O.A., Apolikhina I.A., Malyshkina D.A. Possibilities of using neodymium laser (Nd:YAG) in patients with concomitant diseases which are accompanied by pathological discharge from the genital tract. Gynecology. 2020; 22(4): 75-81. (in Russian)]. https://dx.doi.org/10.26442/20795696.2020.4.200277.
  42. Okui N., Okui M., Gambacciani M. Is erbium/neodymium laser combination therapy an effective treatment option for interstitial cystitis/bladder pain syndrome with vulvodynia? Cureus. 2022; 14(11): e31228. https://dx.doi.org/10.7759/cureus.31228.
  43. Gambacciani M., Fidecicchi T. Short-term effects of an erbium/neodymium laser combination in superficial dyspareunia: a pilot study. Climacteric. 2022; 25(2): 208-11. https://dx.doi.org/10.1080/13697137.2021.2014809.
  44. Аполихина И.А., Рамазанова М.О. Первый российский опыт применения ND:YAG-лазера (неодимового лазера) для лечения симптомов генитоуринарного менопаузального синдрома. Акушерство и гинекология: новости, мнения, обучение. 2021; 10(1): 6-10. [Apolikhina I.A., Ramazanova M.O. The first Russian experience of using ND:YAG laser (neodymium laser) for the treatment of genitourinary syndrome of menopause symptoms. Obstetrics and Gynecology: News, Opinions, Training. 2021; 10(1): 6-10. (in Russian)]. https://dx.doi.org/10.33029/2303-9698-2022-10-1-6-10.
  45. Аполихина И.А., Малышкина Д.А., Бычкова А.Е., Паузина О.А. Применение неодимового лазера в практике акушера-гинеколога. Акушерство и гинекология. 2021; 1: 194-9. [Apolikhina I.A., Malyshkina D.A., Bychkova A.E., Pauzina O.A. Use of neodymium laser in the practice of an obstetrician/gynecologist. Obstetrics and Gynecology. 2021; (1): 194-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.1.194-199.

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