Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil.
Department of Pathology, Federal University of São Paulo - Paulista Medical School, UNIFESP/EPM, Sao Paulo, Brazil.
Menopause. 2021 May 17;28(7):756-763. doi: 10.1097/GME.0000000000001797.
To compare the efficacy of fractional CO2 laser therapy with topical estrogen therapy for the treatment of postmenopausal genitourinary syndrome of menopause.
We conducted a randomized controlled clinical trial involving 25 postmenopausal women. Participants were aged between 50 and 65 years with at least 1 year of amenorrhea and follicle-stimulating hormone levels of >40 IU/L. The women were randomized into two groups: the laser therapy group (n = 13) and the vaginal topical estrogen therapy group (n = 12). Changes in the vaginal epithelium thickness, Frost index, and cell maturation were analyzed in both the groups. The female sexual quotient of each woman was also evaluated. Subjective evaluation was performed through a physical examination.
Histological analysis showed a significant increase in the vaginal epithelium thickness at the end of treatment in females in both the laser therapy (P < 0.001) and topical estrogen therapy (P = 0.001) groups. The topical estrogen therapy group tended to present a higher maturation index at the end of treatment when compared with that of the other group. Sexual function increased significantly over time in both the topical estrogen therapy (P < 0.001) and laser therapy (P < 0.001) groups. Subjective evaluation through physical examination showed a significant improvement in atrophy in both the groups.
Despite the nonequivalence with topical estrogen therapy, our data suggest that laser therapy is an effective method for the treatment of vulvovaginal atrophy.
比较 CO2 激光治疗与局部雌激素治疗绝经后女性泌尿生殖系统综合征的疗效。
我们进行了一项随机对照临床试验，纳入了 25 名绝经后女性。参与者年龄在 50 至 65 岁之间，至少有 1 年的闭经和卵泡刺激素水平>40IU/L。将这些女性随机分为两组：激光治疗组（n=13）和阴道局部雌激素治疗组（n=12）。分析两组的阴道上皮厚度、Frost 指数和细胞成熟度变化。每位女性的女性性商数也进行了评估。通过体格检查进行主观评估。
组织学分析显示，激光治疗组（P<0.001）和局部雌激素治疗组（P=0.001）女性在治疗结束时阴道上皮厚度均显著增加。与另一组相比，局部雌激素治疗组在治疗结束时趋向于表现出更高的成熟指数。局部雌激素治疗组（P<0.001）和激光治疗组（P<0.001）的性功能随时间推移均显著增加。体格检查的主观评估显示两组萎缩均有显著改善。
尽管与局部雌激素治疗不等效，但我们的数据表明，激光治疗是治疗外阴阴道萎缩的有效方法。
