Impact of Microablative Fractional CO2 Laser Applied in Menopausal Period on Vulvovaginal Atrophy and Dyspareunia: A Systematic Review and Meta-analysis Study

Aim: This study aimed to synthesize current evidence on the clinical effectiveness of microablative fractional CO₂ laser (MFCO₂) therapy for the management of menopausal vulvovaginal atrophy and dyspareunia.
Materials and Methods: A meta-analysis was conducted to identify relevant studies published within the last ten years. Electronic database searches were performed between March and June 2024 using PubMed, EBSCOhost, Web of Science, Google Scholar, and the YÖK National Thesis Center. Following the screening process and eligibility evaluation according to established inclusion criteria, eight studies were ultimately retained for analysis. The methodological rigor of the selected studies was evaluated using design-specific critical appraisal instruments developed by the Joanna Briggs Institute (JBI). Quantitative data synthesis was performed using CMA Version 2 software, and findings were interpreted using both statistical meta-analytic techniques and descriptive synthesis.
Results: The pooled analysis demonstrated that MFCO₂ laser therapy produced a statistically significant improvement in vulvovaginal atrophy among menopausal women (SMD: 1.437, 95% CI: 0.646–2.228; Z = 3.559, p < 0.001; I² = 94.93%). Similarly, treatment was associated with a significant reduction in dyspareunia severity (SMD: −1.820, 95% CI: −3.063 to −0.577; Z = −2.871, p = 0.004; I² = 96.17%). These findings indicate that MFCO₂ laser therapy may contribute to meaningful symptom improvement in menopausal genitourinary disorders. However, considerable heterogeneity among included studies suggests variability in intervention protocols, patient characteristics, and outcome assessment methods.
Conclusion: Microablative fractional CO₂ laser therapy may serve as a beneficial non-hormonal intervention for improving menopausal genitourinary symptoms, especially dyspareunia among sexually active women. Nevertheless, large-scale clinical trials with uniform treatment protocols and longer follow-up are needed to confirm long-term therapeutic efficacy and safety.