The level of evidence was downgraded due to risk of bias in original trials (lack of blinding and heterogeneity in outcomes and comparison interventions). Long term effects and harms are unknown. There is a lack of high-quality placebo-controlled trials.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Jang YC, Leung CY, Huang HL. Comparison of Severit...»1 | SR/MA | 270 women (Brazil, Iran, US) with genitourinary symptoms of menopause (GSM), mean age ranged from 54.6 to 61.0 years).135 were randomized to laser therapy and 135 to estrogen therapy. | Intervention: Fractional micro ablative carbon dioxide laser or fractional carbon dioxide laser
(2-3 sessions, 1000 μs, 30W or 40W, 28-35 days apart) Comparison: Local estriol 1mg: daily for 30d, followed by twice weekly for 2 months or 3 times weekly for 20 weeks; localconjugated estrogen 0,5 g daily for 14d, followed by twice weekly for 24w or 0.625mg 3 times weekly for 3mo; promestriene 10mg 3 times weekly for 3months. |
FSFI, VAS, VHI, VMI |
Moderate |
SR=systematic review; MA=meta-analysis; FSFI=Female Sexual Function Index; VAS=Vaginal Analog Scale; VHI=Vaginal Health Index; VMI=Vaginal Maturation Index
| Outcomes | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| The quality of evidence is downgraded due to study limitations and suspected publication bias. | |||||
| 1. FSFI | 3 (79/81) | 3,5 – 6 months | 1.7 - 6 | 2.0 - 4.9 | –0.04 (–0.45 to 0.36) |
| 2. VAS | 2 (45/47) | 5 – 6 months | -4.7 - -3.0 | -3.2 - -3.0 | –0.16 (–0.67 to 0.36) |
| 3. VHI | 3 (79/81) | 3,5 – 6 months | 0.9 - 9.4 | 1.2 - 5.9 | 0.20 (–0.56 to 0.97) |
| 4. VMI | 2 (41/41) | 5 – 6 months | 3.9 - 16.1 | 21.3 - 25.0 | –0.56 (–1.14 to 0.02) |
I= intervention; C=comparison; CI=confidence interval; FSFI=Female Sexual Function Index; VAS=Vaginal Analog Scale; VHI=Vaginal Health Index; VMI=Vaginal Maturation Index.