Zerzan Nicholas L, Greer Nancy, Ullman Kristen E, Sowerby Catherine, Diem Susan, Ensrud Kristine, Forte Mary L, Anthony Maylen C, Landsteiner Adrienne, Butler Mary, Wilt Timothy J, Danan Elisheva R
From the Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN.
Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN.
Menopause. 2025 Feb 1;32(2):176-183. doi: 10.1097/GME.0000000000002465. Epub 2025 Jan 7.
Hormone treatments for genitourinary syndrome of menopause (GSM) symptoms have limitations. There is interest in nonhormone therapies, including energy-based interventions. Benefits and harms of energy-based interventions are not currently well known.
The aim of this study was to assess the benefits and harms of energy-based therapies (eg, CO 2 laser, Er:YAG laser, and radiofrequency) for GSM. Outcomes of interest are the eight "Core Outcomes in Menopause" and include the following: dyspareunia, vulvovaginal dryness, vulvovaginal discomfort/irritation, dysuria, change in most bothersome symptom, quality of life, treatment satisfaction, and treatment adverse effects.
Eligible studies included English language randomized controlled trials (RCT) or prospective observational studies of energy-based treatments with ≥8 weeks follow-up in postmenopausal women with ≥1 GSM symptom and studies of any design reporting adverse effects ≥12 months postintervention. Ovid/MEDLINE, Embase, and CINAHL were searched from inception to December 11, 2023 using vocabulary and natural language terms, along with free-text words. Two authors extracted data and assessed the quality of included studies.
We identified 32 unique studies (16 RCT; 1 quasi-RCT; 15 nonrandomized). Ten RCT and the quasi-RCT were rated low to moderate risk of bias (RoB) and underwent data extraction. Included studies evaluated CO 2 laser (k = 7), Er:YAG laser (k = 3), or radiofrequency and CO 2 laser (k = 1). CO 2 laser compared with sham (k = 4) may result in little to no difference in dysuria, dyspareunia, or quality of life (low certainty of evidence [COE]). CO 2 laser compared with vaginal conjugated estrogens cream (k = 2) may result in little to no difference in dyspareunia, dryness, discomfort/irritation, dysuria, or quality of life (low COE). Treatment effects on all other outcomes and effects of Er:YAG laser or radiofrequency on any outcome are very uncertain (very low COE). Studies noted few adverse events and no serious adverse events.
CO 2 laser resulted in little to no difference in outcomes compared with sham or vaginal estrogen; the evidence is very uncertain on the effect of energy-based interventions versus all other comparators for all other outcomes. Adverse event reporting was limited. There is a need for further evidence assessing energy-based interventions.
用于治疗绝经后泌尿生殖综合征（GSM）症状的激素疗法存在局限性。人们对非激素疗法很感兴趣，包括基于能量的干预措施。目前尚不清楚基于能量的干预措施的益处和危害。
本研究的目的是评估基于能量的疗法（如二氧化碳激光、铒：钇铝石榴石激光和射频）治疗GSM的益处和危害。感兴趣的结果是“绝经的八项核心结果”，包括以下内容：性交困难、外阴阴道干燥、外阴阴道不适/刺激、排尿困难、最困扰症状的变化、生活质量、治疗满意度和治疗不良反应。
符合条件的研究包括英文随机对照试验（RCT）或对有≥1种GSM症状的绝经后女性进行的≥8周随访的基于能量治疗的前瞻性观察性研究，以及报告干预后≥12个月不良反应的任何设计的研究。从数据库建立到2023年12月11日，使用词汇、自然语言术语以及自由文本词在Ovid/MEDLINE、Embase和CINAHL中进行检索。两位作者提取数据并评估纳入研究的质量。
我们确定了32项独特的研究（16项RCT；1项准RCT；15项非随机研究）。10项RCT和准RCT被评为低至中度偏倚风险（RoB），并进行了数据提取。纳入研究评估了二氧化碳激光（k = 7）、铒：钇铝石榴石激光（k = 3）或射频和二氧化碳激光（k = 1）。与假手术（k = 4）相比，二氧化碳激光在排尿困难、性交困难或生活质量方面可能几乎没有差异（证据确定性低[COE]）。与阴道结合雌激素乳膏（k = 2）相比，二氧化碳激光在性交困难、干燥、不适/刺激、排尿困难或生活质量方面可能几乎没有差异（COE低）。对所有其他结果的治疗效果以及铒：钇铝石榴石激光或射频对任何结果的影响非常不确定（COE极低）。研究指出不良事件很少，没有严重不良事件。
与假手术或阴道雌激素相比，二氧化碳激光在结果方面几乎没有差异；关于基于能量的干预措施与所有其他对照在所有其他结果上的效果，证据非常不确定。不良事件报告有限。需要进一步的证据来评估基于能量的干预措施。
