Vaginal laser therapy for genitourinary syndrome of menopause – systematic review

•Genitourinary syndrome of menopause affects between 53.8% and 90% of postmenopausal women.•The efficacy and safety of laser therapy have not been yet established and international societies do not endorse its use.•Treatment with carbon dioxide laser seems to improve scores on the Visual Analogue Scale, Female Sexual Function Index and Vaginal Health Index in genitourinary syndrome of menopause and its safety appears to be proved.•Further well-designed clinical trials with sham-laser control groups and evaluating objective variables are needed to provide the best evidence. Genitourinary syndrome of menopause (GSM) can have a great impact on the quality of life (QOL), and affects between 53.8% and 90% of postmenopausal women. The literature suggests that vaginal laser therapy could be an effective treatment for GSM symptoms, but its efficacy and safety have not been established and international societies do not endorse its use. Despite that, there has been an increase in the use of vaginal laser therapy globally over the last decade. The objective of this review is to evaluate the literature which assesses the efficacy and safety of the vaginal laser therapy in the treatment of GSM. A comprehensive literature search was conducted electronically using Embase and PubMed to retrieve studies assessing evidence for the efficacy and safety of vaginal laser therapy for GSM or vulvovaginal atrophy up to June 2021. A total of 64 studies were finally included in the review. There were 10 controlled intervention studies, 7 observational cohort and cross-sectional studies and 47 before-after studies without a control group. Vaginal laser seems to improve scores on the Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI) in GSM over the short term. Safety outcomes are underreported and short-term. Further well-designed clinical trials with sham-laser control groups and evaluating objective variables are needed to provide the best evidence on efficacy.