CO₂ AND Er:YAG LASERS AND PLATELET-RICH PLASMA FOR VAGINAL ATROPHY IN MENOPAUSAL WOMEN: CLINICAL EVIDENCE, SAFETY, AND GUIDELINE PERSPECTIVES

Agnieszka Maria Korzeniewska; Julia Agnieszka Dębczak; Magdalena Korba; Adrianna Kowalik; Agnieszka Krajewska; Karolina Łuczak; Natalia Malicka; Wiktoria Polkowska; Katarzyna  Tłustochowicz

doi:10.31435/ijitss.1(49).2026.5239

Authors

Agnieszka Maria Korzeniewska Military Medical Institute – National Research Institute, Warsaw, Poland https://orcid.org/0009-0006-0337-961X
Julia Agnieszka Dębczak Military Medical Institute – National Research Institute, Warsaw, Poland https://orcid.org/0009-0004-4574-8466
Magdalena Korba St. Anne’s Hospital in Miechów, Miechów, Poland https://orcid.org/0009-0002-5577-9923
Adrianna Kowalik Independent Public Healthcare Complex in Płońsk, Płońsk, Poland https://orcid.org/0009-0001-4092-5839
Agnieszka Krajewska Maria Skłodowska-Curie Voivodeship Specialist Hospital in Zgierz, Zgierz, Poland https://orcid.org/0009-0003-2961-7565
Karolina Łuczak Międzyleski Specialist Hospital in Warsaw, Warsaw, Poland https://orcid.org/0009-0000-5952-8457
Natalia Malicka Independent Public Healthcare Centre of the Ministry of the Interior and Administration, Kielce, Poland https://orcid.org/0009-0002-3045-2908
Wiktoria Polkowska Central Clinical Hospital of the Medical University of Łódź, Łódź, Poland https://orcid.org/0009-0006-3812-9573
Katarzyna Tłustochowicz Independent Public Healthcare Centre of the Ministry of the Interior and Administration, Kielce, Poland https://orcid.org/0009-0006-4209-2558

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.5239

Keywords:

Genitourinary Syndrome Of Menopause, CO₂ Laser, Er:YAG Laser, Platelet-Rich Plasma, Non-Hormonal Therapy

Abstract

Background: Genitourinary syndrome of menopause (GSM) affects approximately 50% of postmenopausal women and arises from estrogen deficiency, causing vaginal epithelial thinning, Lactobacillus depletion, and increased vaginal pH, which collectively elevate infection risk. Local estrogen therapy (LET) is standard but may be limited. Interest is growing in non-hormonal regenerative therapies, including CO₂ and Er:YAG lasers and PRP.

Aim: This narrative review aims to evaluate the current evidence on the efficacy and safety of CO₂ and Er:YAG laser therapies, as well as platelet-rich plasma (PRP), in the management of GSM with a focus on clinical guidelines and expert recommendations.

Methods: A narrative review of the literature was conducted, including clinical trials, systematic reviews, expert opinions, and international society guidelines. Outcomes of interest included symptom severity (VAS), Vaginal Health Index (VHI), Female Sexual Function Index (FSFI), vaginal pH, patient satisfaction, and reported adverse events.

Results: CO₂ and Er:YAG laser therapies, as well as PRP, demonstrate promising efficacy in reducing symptoms of genitourinary syndrome of menopause, with improvements observed in clinical parameters (VHI, FSFI, VAS) and high patient satisfaction. The safety profile reported in available studies is favorable, with adverse events generally mild and transient.

Conclusions: CO₂ and Er:YAG laser therapies and PRP represent promising non-hormonal approaches for GSM, particularly in women with contraindications to estrogen. Due to limited high-quality evidence, these modalities remain experimental, and their efficacy and protocols require confirmation in long-term, sham-controlled studies.

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