GynecologyGynecologyГинекология2079-56962079-5831Consilium Medicum12845510.26442/20795696.2022.6.201897REVIEWОБЗОРReview ArticleEfficacy of laser remodeling in the genitourinary syndrome of menopause: A reviewЭффективность лазерной ремоделирующей терапии при генитоуринарном менопаузальном синдромеhttps://orcid.org/0000-0002-1767-5536OrazovMekan R.ОразовМекан Рахимбердыевич
Russian Federation

D. Sci. (Med.), Prof., People’s Friendship University of Russia (RUDN University)

д-р мед. наук, проф., проф. каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН

omekan@mail.ruhttps://orcid.org/0000-0002-7667-3231SilantyevaElena S.СилантьеваЕлена Сергеевна
Russian Federation

D. Sci. (Med.), GC "Mother and Child"

д-р мед. наук, врач – акушер-гинеколог, врач-физиотерапевт Клинического госпиталя «Лапино-1» ГК «Мать и дитя»

omekan@mail.ruhttps://orcid.org/0000-0003-4956-0466RadzinskyViktor E.РадзинскийВиктор Евсеевич
Russian Federation

D. Sci. (Med.), Prof., Corr. Memb. RAS, People’s Friendship University of Russia (RUDN University)

чл.-кор. РАН, д-р мед. наук, проф., зав. каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН, засл. деят. науки РФ

radzinsky@mail.ruhttps://orcid.org/0000-0003-2052-914XMikhalevaLiudmila M.МихалеваЛюдмила Михайловна
Russian Federation

D. Sci. (Med.), Prof., Petrovsky National Research Centre of Surgery

д-р мед. наук, проф., дир. Научно-исследовательского института морфологии человека им. акад. А.П. Авцына ФГБНУ «РНЦХ им. акад. Б.В. Петровского»

omekan@mail.ruhttps://orcid.org/0000-0003-2895-1193KhripachElizaveta A.ХрипачЕлизавета Аркадьевна
Russian Federation

Obstetrician-Gynecologist, “DEKA Medical”

врач – акушер-гинеколог Многопрофильного медицинского центра «DEKA MEDICAL»

elizaveta.ark@mail.ruhttps://orcid.org/0000-0001-6709-5209DolgovEvgeny D.ДолговЕвгений Денисович
Russian Federation

Clinical Resident, People’s Friendship University of Russia (RUDN University)

клин. ординатор каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН

1586dolgde@gmail.comPeople’s Friendship University of Russia (RUDN University)ФГАОУ ВО «Российский университет дружбы народов»GC "Mother and Child"ГК «Мать и дитя»Petrovsky National Research Centre of SurgeryФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского»Multidisciplinary Medical Center "DEKA Medical"Многопрофильный медицинский центр «DEKA Medical»211220222464654701901202319012023Copyright ©; 2022, Consilium MedicumCopyright ©; 2022, ООО "Консилиум Медикум"2022Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://gynecology.orscience.ru/2079-5831/article/view/128455

The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the "gold standard" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 2012–2022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice.

Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause.

Лечение генитоуринарного менопаузального синдрома в реальной клинической практике имеет ряд ограничений: наличие противопоказаний к местной гормональной терапии препаратами эстрогена, которая в настоящее время признана «золотым стандартом» лечения вульвовагинальной атрофии (ВВА), страх перед системным действием эстрогенов при их топическом применении или/и канцерофобия, а также недостаточная приверженность пациенток использованию интравагинальных средств. В этой связи актуален поиск альтернативных неинвазивных или минимально инвазивных методов терапии, преимущественно негормональных. Выполнен поиск научной литературы в базах данных PubMed, CochraneLibrary, Science Direct, ELibrary по ключевым словам CO2-laser/СО2-лазер, Er:YAG-laser/эрбиевый лазер, vulvovaginal atrophy/вульвовагинальная атрофия, genitourinary syndrome of menopause/генитоуринарный менопаузальный синдром, treatment/лечение, postmenopausal age/постменопаузальный возраст за 2012–2022 гг. Ремоделирующая микроаблятивная лазерная терапия с использованием углекислого газа (СО2) – перспективный метод для лечения ВВА, действующий патогенетически и симптоматически. Использование СО2-лазера при ВВА позволяет не просто купировать симптомы, но и улучшить состояние слизистой оболочки влагалища путем усиления регенерации, восстановления вагинального рН. Однако перед введением метода в широкую клиническую практику необходимы доказательства эффективности и долгосрочной безопасности метода, полученные в исследованиях высокого качества.

Цель. Выполнить анализ и обобщить полученные к настоящему времени доказательные и экспериментальные данные об эффективности и безопасности лазерной терапии ВВА и генитоуринарного менопаузального синдрома.

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