The evidence for vaginal laser treatments for post-menopausal symptoms

Dr Jason Abbott

University of New South Wales

There is an increasing body of evidence regarding vulvo-vaginal laser treatments for menopausal symptoms and for treating a variety of other female genital issues such as prolapse. In our recent systematic review we identified 3 randomised studies, 16 prospective studies, and 7 retrospective studies with a combined total of 2678 participants. Pooled data from 3 randomised controlled trials show no difference between vaginal laser and topical hormonal treatments for change in vaginal symptoms (−0.14, 95% confidence interval −1.07 to 0.80) or sexual function scores (2.22, 95% confidence interval −0.56 to 5.00). Sexual function was not significantly improved in any of these studies. We have added to this data with the world’s first double-blind randomised trial with 78 women completing 12 months follow-up. There was no significant difference found in the change in the most bothersome symptom from baseline to 12 months, between laser and sham groups (VAS score: laser 79 [95%CI 73,85] to 55 [95%CI 44,65]; and sham 77 [95%CI 70,84] to 59 [95%CI 48,70]). For at least one woman to achieve greater than 50% improvement in the most bothersome symptom, the number needed to treat (NNT) is 85. There were no significant differences in quality of life, VHI or histological comparisons between laser and sham treatment. The highest quality evidence to date reports that laser treatment offers little to no change in symptoms when compared with placebo or topical treatments.


Biography:

Dr Jason Abbott is Professor of Gynaecological Surgery at the University of New South Wales. He is Associate Editor of the Journal of Minimally Invasive Gynaecology and ANZJOG and has more than 135 publications including text-books, book chapters and large-scale RCTs in gynaecological surgery. Jason has an active role in undergraduate, post-graduate and doctoral supervision and is the former Chairman of the Practice Committee of the AAGL charged with delivering evidence-based guidelines for surgical gynaecology.

Jason has chaired the MBS review committee for benign gynaecology and helped shape Australia’s National Action Plan for Endometriosis launched July 2018 – the first for any disease in Australia and a blueprint for all other national action plans. He is a Principle Investigator and Chair for the Australian Government funded National Endometriosis and Clinical Trial (NECST) network in endometriosis in Australia. Jason is a member of The Federal Government’s Endometriosis Advisory Group and he Chairs the Australian and New Zealand College of Obstetricians and Gynaecologists Expert Advisory Group on Endometriosis.