17 April 2023 – Vaginal laser “rejuvenation” doesn't relieve certain symptoms of menopause or improve sexual function in breast cancer survivors, recent research shows. But will this be enough to stop some health care providers from peddling the false guarantees of laser therapy and being profitable off it?
Probably not, “because history teaches us that facts do not always get in the way of ego and profit,” wrote Dr. Jen Gunter of Kaiser Permanente Northern California in a editorial published parallel to the study in JAMA network opened.
According to Gunter, it is very unlikely that the clinical practice of laser therapy for the so-called genitourinary syndrome of menopause shall be discontinued within the United States.p. without FDA intervention.
This implies that “many doctors here and around the world will likely continue to use the offensive phrase 'vaginal rejuvenation' to get patients to pay thousands of dollars for GSM treatment, even though the most compelling evidence to date tells us it is an ineffective procedure,” she said. “There is simply too much money to be made in this.”
Many people experience GSM symptoms during menopause and if left untreated, these symptoms can last for a long time.
Vaginal laser therapy has been shown to be a approach to improve sexual function in addition to vaginal lubrication and moisture while avoiding the long-term use of pills and creams, Gunter explained.
The hype surrounding vaginal laser therapy suggests that it is actually a well-researched “spa treatment.” Treatment without downsides,” she said. But the “reality of laser treatment for GSM and so-called vaginal rejuvenation could be very different from the guarantees.”
The FDA has not approved these laser devices, and there are limited evidence to demonstrate that they are safe and effective.
For example, a 2021 randomized controlled trial of postmenopausal women with vaginal symptoms found that fractional carbon dioxide vaginal laser therapy does not improve symptoms or quality of life, or lead to Changes in vaginal histology compared to sham vaginal laser therapy, in which a physician pretends to perform the treatment but in reality does not.
The study “must have been enough to stop laser therapy outside of clinical trials. Unfortunately, this was not the case,” said Gunter.
The new study finds similar results – this time in breast cancer survivors with GSM who are receiving aromatase inhibitors. These drugs are given to patients who have already gone through menopause. This “group is of particular importance for the study because they typically have worse symptoms and can have safety concerns about hormone therapies,” says Gunter.
All 72 women were told to use a first-line treatment for their genitourinary syndrome of menopause based on non-hormonal moisturizers and stimulation by a vaginal vibrator; 35 were randomly assigned to five monthly sessions of vaginal laser therapy with fractionated carbon dioxide and 37 to sham laser therapy.
At six-month follow-up, all women showed significant improvement in outcomes related to these menopausal symptoms, regardless of whether they received real or sham laser therapy, according to the authors, led by Dr. Eduard Mension of the Hospital Clinic of Barcelona in Spain.
The team also found no significant differences between real and sham laser therapy in key secondary outcomes; both groups showed significant improvements in all key areas.
Kristin Rojas, MD, a breast surgeon and gynecologist based in Miami, Was not surprised by the brand new data, tweet: “I'll say it again, folks: These money-based 'rejuvenation therapies' are not any higher than placebos.”
The idea that laser therapy could stimulate blood flow and collagen formation, thereby relieving symptoms of menopausal genital and urinary incontinence syndrome, is a “valid hypothesis,” Gunter said. But “some doctors promoting vaginal laser therapy appear to have moved from proof-of-concept studies to a secure and effective therapy.”