# Vaginal pixel CO2 laser versus topical use of promestriene for genitourinary syndrome of menopause

## TL;DR

A study compared CO2 laser and promestriene for treating menopause-related genital symptoms, finding the laser more effective for certain outcomes.

## Contribution

This study provides a head-to-head comparison of two non-hormonal treatments for genitourinary syndrome of menopause.

## Key findings

- Both CO2 laser and promestriene significantly reduced symptoms of genitourinary syndrome of menopause.
- CO2 laser showed greater improvements in lubrication, orgasm, and satisfaction compared to promestriene.
- Vaginal biopsies showed histological improvements in both treatment groups.

## Abstract

To compare the effectiveness of pixel CO2 laser and vaginal promestriene in treating genitourinary syndrome of menopause (GSM).

A quasi-randomized controlled trial was conducted with 48 patients. CO2 Laser Group (24 patients) received 3 sessions of vaginal pixel CO2 laser, and promestriene group (24 patients) used vaginal promestriene daily for 14 days, then twice weekly for 3 months and 3 weeks. Patients were evaluated before and after treatment using a visual analog scale (VAS), FSFI-6, ICIQ-SF, Vaginal Health Index (VHI), and vaginal wall biopsy.

Of the 48 patients, 22 in CO2 Laser Group and 21 in promestriene group completed the study. Both groups showed significant symptom reduction by VAS, with improvements in desire, lubrication, and total FSFI-6 scores. CO2 Laser Group had greater improvements in lubrication, orgasm, and satisfaction (p<0.001). Urinary incontinence improved in both groups (p<0.01). VHI scores increased significantly in both groups (p<0.001). Biopsies revealed improvements in collagen, glycogen, vascularity, epithelial thickness, and reduced neutrophil count (p<0.01).

CO2 laser appears to be a viable non-hormonal alternative for treating GSM, particularly for women unable or unwilling to use hormonal therapies.