Intravaginal laser therapy, hyaluronic acid suppositories help counter urogenital atrophy

Breast cancer patients with urogenital atrophy may benefit from intravaginal laser therapy and hyaluronic acid suppositories, with a recent study showing that both help resolve related symptoms equally.

In a randomized controlled trial involving 43 breast cancer survivors (mean age 54 years) with urogenital atrophy, the degree of atrophy was attenuated in those who received two courses of intravaginal laser therapy within a month and those who used hyaluronic acid suppositories three times weekly for 3 months.

Specifically, the primary endpoint of score on the Vaginal Health Index (VHI) at 3 months improved substantially in both the laser and suppository arms (p=0.001) without a significant between-group difference (p=0.232). [Maturitas 2022;doi:10.1016/j.maturitas.2022.08.013]

Comparable improvements were also noted in subjective bother of urogenital atrophy, quality of life, and sexual health among the participants who received intravaginal laser therapy and those who received hyaluronic acid suppositories.

“Vaginal dryness and dyspareunia were found to be the most bothersome symptoms, which is in accordance with a recent systematic review… We found significant improvements of presence and bother of these urogenital atrophy symptoms after 3 months of treatment. However, women still experienced bothersome problems after study completion, [that is] 50 percent of women from the suppository group opted for a succeeding laser therapy due to ongoing urogenital atrophy problems,” according to the investigators. [Ecancermedicalscience 2019;13:988]

Furthermore, women with primary subjective stress urinary incontinence (SUI) showed a large reduction in the subjective bother of SUI, suggesting that laser therapy might be favourable in those with urogenital atrophy and concomitant urinary incontinence.

“In conclusion, both intravaginal laser and suppository treatment appear safe and efficient for treatment of urogenital atrophy short-term in women with a history of breast cancer,” the investigators said.

The findings are said to have important clinical implications since common concerns during menopause—such as vaginal dryness, burning, discharge, itching, sexual discomfort or pain, and/or urinary symptoms of urgency and dysuria—occur in up to 50 percent in postmenopausal women, with the symptoms even worse in breast cancer patients who have completed treatment like chemotherapy or antihormonal therapy. [Int J Women Health 2013;5:437-447; Oncologist 2008;13:222-231]

“Due to the radical decrease of circulating oestrogen [in breast cancer patients], biologic and clinical changes in the urogenital tissues … further aggravate clinical bother. Oestrogen therapy is the most effective treatment for urogenital atrophy. However, many providers and patients are reluctant to use estrogen in this setting,” the investigators said. [Ther Adv Med Oncol 2017;9:269-285]

While several gynaecological and similar societies have recommended vaginal laser therapy for urogenital atrophy only in the course of clinical studies due to unknown side effects, none of the patients who received laser therapy in the current study experienced adverse effects. They specifically received an Erbium:Yag laser with a microablative mode instead of a CO2 laser due to the recent FDA warning about certain vaginal ablative laser therapy, the investigators pointed out. [Ecancermedicalscience 2019;13;988; Int Urogynecol J 2019;30:371-376; Neurourol Urodyn 2019;38:1009-1023]

On the other hand, there are almost no contraindications for the therapy with hyaluronic acid suppositories, they added. However, some patients apply for laser therapy, so this needs to be taken into account when counselling patients,” they added.

The investigators called for additional studies to assess the long-term efficacy and safety of both treatment modalities.