Fractional CO₂ laser monotherapy versus combination therapy with vaginal oestrogen for genitourinary syndrome of menopause: A prospective observational cohort study conducted over two years.

OBJECTIVE

To prospectively evaluate symptom outcomes following micro-ablative fractional carbon dioxide laser therapy for genitourinary syndrome of menopause, and to explore whether concomitant use of topical vaginal oestrogen is associated with additional improvement.

DESIGN

Postmenopausal women presenting with symptoms consistent with genitourinary syndrome of menopause were enrolled in a prospective observational cohort study undertaken in routine clinical practice over a two-year period. Participants received fractional carbon dioxide laser therapy either alone or alongside topical vaginal oestrogen. Symptom severity was recorded at baseline and reassessed four weeks after completion of the treatment course using a ten-point visual analogue scale across six symptom domains.

RESULTS

Seventy-two participants were included (mean age 61 years). Significant improvements were observed across all symptom domains following laser therapy. Painful sexual intercourse demonstrated the greatest reduction, with scores improving from 5.67 to 2.33 (p < 0.001). Vaginal dryness, burning, itching, pain, and dysuria also improved significantly (p < 0.001). Participants using concomitant topical vaginal oestrogen showed slightly greater improvements in dryness and dyspareunia, although these differences were not statistically significant.

CONCLUSION

Fractional carbon dioxide laser therapy was associated with significant symptom improvement at short-term follow-up after treatment completion in this clinical cohort. No statistically significant additional benefit was observed with concomitant topical vaginal oestrogen, although confounding by indication cannot be excluded and the study had limited power. Larger randomised sham-controlled trials with longer follow-up are required to determine comparative efficacy and durability of response.