Vaginal CO2 laser use for the management of genitourinary syndrome of menopause in gynecological cancer survivors

Abstract

Genitourinary syndrome of menopause (GSM) may arise from the destruction of ovarian function resulting in hypoestrogenism caused by various forms of gynecological cancer treatment including surgery, chemotherapy, radiation, and anti-estrogen therapy. Historically, patients with a hormone dependent gynecological cancer and physicians have been less comfortable introducing vaginal estrogen due to risk of recurrence. Published data indicate that low-dose vaginal estrogens cause a minimal, if any significant, time limited, increase in plasma estradiol and do not rise significantly enough to cause recurrence. Often physicians and patients are reluctant to treat GSM with local estrogen. CO2 vaginal laser therapies have demonstrated efficacy as an effective, nonhormonal alternative for the treatment of GSM in healthy menopausal patients. Our objective is to evaluate the published data on the effect of CO2 vaginal laser for the management of GSM in gynecological cancer patients. Well-controlled clinical trials in gynecological cancer patients are needed to further elucidate both the safety and efficacy of this nonhormone therapy. More data is needed about the longevity of effect and cost-effectiveness of the CO2 vaginal lasers use in gynecological cancer survivors before this can be implemented in clinical practice