Revista Brasileira de Ginecologia E Obstetricia · Feb 20, 2026

Vaginal pixel CO2 laser versus topical use of promestriene for genitourinary syndrome of menopause

By Beckhauser K, Bernardi MG, Capp E et al.

OBJECTIVE: To compare the effectiveness of pixel CO₂ laser and vaginal promestriene in treating genitourinary syndrome of menopause (GSM). METHODS: A quasi-randomized controlled trial was conducted with 48 patients. CO₂ Laser Group (24 patients) received 3 sessions of vaginal pixel CO₂ laser, and promestriene group (24 patients) used vaginal promestriene daily for 14 days, then twice weekly for 3 months and 3 weeks. Patients were evaluated before and after treatment using a visual analog scale (VAS), FSFI-6, ICIQ-SF, Vaginal Health Index (VHI), and vaginal wall biopsy. RESULTS: Of the 48 patients, 22 in CO₂ Laser Group and 21 in promestriene group completed the study. Both groups showed significant symptom reduction by VAS, with improvements in desire, lubrication, and total FSFI-6 scores. CO₂ Laser Group had greater improvements in lubrication, orgasm, and satisfaction (p<0.001). Urinary incontinence improved in both groups (p<0.01). VHI scores increased significantly in both groups (p<0.001). Biopsies revealed improvements in collagen, glycogen, vascularity, epithelial thickness, and reduced neutrophil count (p<0.01). CONCLUSION: CO₂ laser appears to be a viable non-hormonal alternative for treating GSM, particularly for women unable or unwilling to use hormonal therapies.

doi.org/10.61622/rbgo/2026rbgo13 Open access PubMed 41815932 Interventions