Use of Erbium Laser in vaginal atrophy after menopause 

Objectives:  

Vaginal atrophy after menopause can be a frustrating symptom for women and has imaginable impact on quality of life . Most women do not find much relief in using merely lubricants. A lot of myths and fears are prevalent for hormone replacement therapy (HRT) use in the country. There is a need for a non-invasive option for these women for this under-reported and often stigmatized condition. This study aims to evaluate the efficacy of erbium vaginal laser in the management of symptoms of vaginal atrophy (vaginal dryness and dyspareunia) over some time. 

Design: Prospective Analysis 

Methods:  

The study was performed on women suffering from vaginal atrophy symptoms due to natural or surgical menopause using Erbium laser (Fotona). The results were assessed using the vaginal health index score (VHS) and visual analogue score (VAS) at 3 months, one year and again at 18 months and then at 24 months. 50 patients were selected after ruling out all contraindications (use of estrogen cream lubricants three months before the start of the study). Post-menopausal women were considered if they had an FSH of more than 40 or no periods for a year.  

Interventions:  

• Erbium vaginal laser (3 sessions 4-6 weeks apart) using Fotona machine on factory settings (wavelength of 2940 msec to treat these patients.  
• The procedure was performed in OPD settings without anaesthesia  
• RenovolaseTM mode was used with a laser spot size of 7mm with a pulse at a frequency of 1.6 Hz and fluence of 6 J/cm2. R11 probe is used with angular probe and inserted in speculum in vagina, and three rounds are done followed by treatment of the vestibule using PSO3.  

Main Outcome Measure(s): improvement in VHIS and VAS score at 3 months, 12 months, and 18-24 months any side effects faced immediate and long-term 

Results: There was a significant decrease in the VAS score (p< 0.01) and an increase in the VHIS score (p< 0.01) at one year; however, the effects seemed to deteriorate after 18-24 months of follow-up. One patient took only one session and dropped out due to relocation to another country, and two patients did not continue beyond one session due to intolerance to heat and fear of burns. One patient was lost to follow-up.  

Conclusions:  

• The results suggest a significant improvement in the improvement of symptoms of vaginal dryness and dyspareunia. However, the results did not last beyond 24 months.