International urogynecology journal · 2026
Two-Year Real-World Outcomes in Women with Genitourinary Syndrome of Menopause Following Fractional CO2 Laser Treatment.
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Dogruel Telal, Kadirogullari Pinar, Dogruel Hikmet Can, Dogan Umran Karabulut, Comert Erhan Huseyin, Dogan Ozan
Аннотация
INTRODUCTION AND HYPOTHESIS: To evaluate the short- and long-term clinical outcomes of fractional CO2 laser therapy in postmenopausal women with genitourinary syndrome of menopause (GSM), including durability of symptom control and the need for booster sessions.
METHODS: This retrospective single-center study included 126 postmenopausal women with GSM who underwent a standardized three-session fractional CO2 laser protocol. Booster sessions were applied in cases of symptom recurrence. Outcomes were assessed at baseline, 4-6 weeks, 1 year, and 2 years using validated instruments: Patient Satisfaction Score, Michigan Incontinence Severity Index (MISI), Female Sexual Function Index (FSFI) and its subdomains, Vulvovaginal Symptoms Questionnaire (VSQ), and Female Genital Self-Image Scale (FGSIS).
RESULTS: Significant improvement was observed in all outcome measures at 4-6 weeks, including GSM-related symptoms, sexual function, and genital self-image (all p < 0.0001). These benefits were largely sustained at 1 year. Although a slight decline was noted at 2 years, scores remained significantly improved compared to baseline. For example, FSFI lubrication scores improved from 2.97 ± 0.55 at baseline to 4.54 ± 0.49 at 1 year, and both VSQ and FGSIS demonstrated persistent gains at 2 years. Satisfaction scores continued to increase over time. Post hoc analyses confirmed significant differences across all evaluation time points.
CONCLUSION: Fractional CO2 laser therapy provides clinically meaningful and durable improvement in GSM-related symptoms in postmenopausal women. While some decline may occur over time, benefits remain superior to baseline, and booster sessions may support long-term maintenance. Fractional CO2 laser may represent a nonhormonal, symptom-oriented option for carefully selected patients with GSM; however, it should not be considered first-line therapy, and prospective controlled studies are needed to further define long-term efficacy and patient selection.
METHODS: This retrospective single-center study included 126 postmenopausal women with GSM who underwent a standardized three-session fractional CO2 laser protocol. Booster sessions were applied in cases of symptom recurrence. Outcomes were assessed at baseline, 4-6 weeks, 1 year, and 2 years using validated instruments: Patient Satisfaction Score, Michigan Incontinence Severity Index (MISI), Female Sexual Function Index (FSFI) and its subdomains, Vulvovaginal Symptoms Questionnaire (VSQ), and Female Genital Self-Image Scale (FGSIS).
RESULTS: Significant improvement was observed in all outcome measures at 4-6 weeks, including GSM-related symptoms, sexual function, and genital self-image (all p < 0.0001). These benefits were largely sustained at 1 year. Although a slight decline was noted at 2 years, scores remained significantly improved compared to baseline. For example, FSFI lubrication scores improved from 2.97 ± 0.55 at baseline to 4.54 ± 0.49 at 1 year, and both VSQ and FGSIS demonstrated persistent gains at 2 years. Satisfaction scores continued to increase over time. Post hoc analyses confirmed significant differences across all evaluation time points.
CONCLUSION: Fractional CO2 laser therapy provides clinically meaningful and durable improvement in GSM-related symptoms in postmenopausal women. While some decline may occur over time, benefits remain superior to baseline, and booster sessions may support long-term maintenance. Fractional CO2 laser may represent a nonhormonal, symptom-oriented option for carefully selected patients with GSM; however, it should not be considered first-line therapy, and prospective controlled studies are needed to further define long-term efficacy and patient selection.