Genitourinary symptoms of menopause (GSM) affect ~50% of women after menopause. Recently, CO laser therapy has been used for managing GSM but without high quality evidence. The present review assessed the effectiveness of CO laser therapy in the management of GSM. PubMed, Embase, Web of Science, CENTRAL and Scopus databases were searched for randomized controlled trials (RCTs), published up to June 30, 2023, comparing CO laser and sham laser treatments for GSM management. The outcomes of interest included Female Sexual Function Index (FSFI), Vaginal Health Index (VHI) and visual analog scale (VAS) for dyspareunia, dryness, burning, itching and dysuria. A total of seven RCTs were included in the review and meta-analysis, with 6/7 studies using three sessions of laser therapy, 4-8 weeks apart. Meta-analysis demonstrated no statistically significant difference in FSFI [mean difference (MD), -1.48; 95% CI, -5.85, 2.89; I=45%] and VHI scores (MD, -0.18; 95% CI, -1.66, 1.31; I =72%) between laser and control groups. Meta-analysis also demonstrated no statistically significant difference in VAS scores for dyspareunia (MD, -1.63; 95% CI; -4.06, 0.80; I=91%), dryness (MD, -1.30; 95% CI, -3.14, 0.53; I=75%), burning (MD, -0.76; 95% CI, -2.03; 0.51 I=56%), itching (MD, -0.28; 95% CI, -0.95, 0.38; I=0%) and dysuria (MD, 0.15; 95% CI, -0.37, 0.67; I=23%) between the groups. The included RCTs had low risk of bias. In conclusion, meta-analyses of high-quality sham-controlled RCTs indicated that CO may not have any beneficial effect on GSM. Limited data and high heterogeneity in meta-analyses in this area of research are important limitations that need to be addressed by future RCTs.