Histological Changes Related to Fractional CO2 Laser in Genitourinary Syndrome of Menopause

Abstract

Introduction: The genitourinary syndrome of menopause is a hypoestrogenic condition with genital, urological and sexual implications that affects more than 50% of postmenopausal women. Fractionated CO2 laser therapy has gained interest as a
feasible, safe and effective non-hormonal option to reduce symptoms and improve quality of life and sexual function.
Objective: To discuss the histological changes associated with fractional CO2 laser treatment in the genitourinary syndrome of menopause.
Methods: A review was carried out of 255 articles published in scientific journals indexed in PubMed, Cochrane and Scopus from January 1, 2011 to November 30, 2020, written in English and related to the area of gynecology. The study excepted
those that did not include histological studies, with therapeutic modalities other than fractionated CO2 laser, pathologies other than the genitourinary syndrome of menopause, and survivors of breast cancer. Only ten publications met the inclusion
criteria. The papers with level of evidence IIB and III, were the most frequent.
Conclusions: Histological changes associated with fractional CO2 laser treatment in genitourinary syndrome of menopause were restoration of the flat stratified epithelium with significant degree of maturation and desquamation of glycogen-rich cells,
remodeling of the lamina propria with new and larger papillae and abundant blood vessels, and the restoration of the vaginal microenvironment with increase in Lactobacillus concentrations and concomitant Ph decrease.