Why does menopause cause vaginal dryness ?
Declining oestrogen levels after menopause gradually change the tissues of the vulva and vagina.
The vaginal mucosa may become thinner, drier and less elastic. Lubrication decreases in some women. Burning, irritation and pain during intercourse may then appear. Urinary symptoms may also occur.
This group of symptoms is called the genitourinary syndrome of menopause (GSM).
Not all postmenopausal women have these symptoms. An absence of symptoms does not justify preventive vaginal treatment.
Dryness, burning and pain : what are the indications for vaginal laser treatment at menopause ?
Vaginal laser treatment is mainly studied for vulvovaginal symptoms of the genitourinary syndrome of menopause.
It may be discussed particularly in the presence of :
- Vaginal dryness.
- Reduced lubrication.
- Vaginal burning or irritation.
- Vaginal discomfort.
- Pain during intercourse associated with dryness and mucosal changes.
These symptoms must first be attributed to menopause. Pain, irritation or vaginal discharge can have other causes and do not automatically constitute an indication for laser treatment.
How does vaginal laser treatment work after menopause ?
The laser delivers energy to the vaginal mucosa to induce a controlled tissue reaction.
The vaginal lasers studied, mainly fractional CO₂ and Erbium, use different mechanisms and settings. Their aim is to change vaginal tissues locally, particularly their structure and quality.
However, laser treatment does not compensate for the decline in oestrogen responsible for the genitourinary syndrome of menopause. Its mechanism therefore differs from that of vaginal hormonal treatment.
Vaginal laser treatment or local oestrogens : which treatment is more effective ?
Comparative studies have not demonstrated superiority of CO₂ laser treatment over vaginal oestrogens for the main symptoms of the genitourinary syndrome of menopause.
A meta-analysis published in 2025, involving 7 randomised trials and 302 women, found no significant difference between CO₂ laser treatment and vaginal oestrogens for several outcomes, including the vaginal health index and overall sexual function.
A systematic review from 2025 also concludes that CO₂ laser treatment may make little or no difference compared with vaginal oestrogens for dryness, discomfort, pain during intercourse and certain other symptoms, with a low level of evidence.
Laser treatment should therefore not be presented as superior to available local treatments.
Is vaginal laser treatment recommended as first-line treatment at menopause ?
No. Vaginal laser treatment is not currently recommended as routine first-line treatment for the genitourinary syndrome of menopause.
Available treatments depend on symptoms and their intensity. They include vaginal moisturisers, lubricants and, when indicated, local hormonal treatments.
Laser treatment may therefore be an option to discuss in certain situations rather than a necessary treatment for every postmenopausal woman.
Can vaginal dryness be treated with a laser without using oestrogens ?
Yes, the absence of oestrogen administration is one reason why some women are interested in vaginal laser treatment.
A patient may not wish to use local hormonal treatment or may have a medical situation requiring specific discussion about its use.
This does not mean that laser treatment automatically becomes the best treatment. The choice depends on the symptom, its cause, treatments already tried and available evidence on the different options.
In a woman with a history of hormone-dependent cancer, the choice of treatment for genitourinary symptoms must be discussed in the context of her oncological history. Evidence concerning laser treatment in this population remains limited.
Which menopausal symptoms cannot be treated with vaginal laser treatment ?
No. Vaginal laser treatment does not treat every cause of intimate discomfort occurring after menopause.
Pain may be caused by a vulval condition, infection, a scar or a pelvic floor disorder. A sensation of heaviness may reveal prolapse. Urinary leakage may correspond to different types of incontinence.
In these situations, treating the vaginal mucosa does not necessarily correct the cause of the symptom.
The appearance of vaginal bleeding after menopause also requires medical assessment and must not simply be attributed to vaginal dryness.
Who can benefit from vaginal laser treatment during menopause ?
The first step is to identify the symptom and its cause precisely before choosing treatment.
In a woman with dryness, irritation or pain during intercourse, examination looks for changes consistent with the genitourinary syndrome of menopause and rules out another cause.
The different therapeutic options must then be compared, taking into account treatments already used, their results, possible contraindications and the patient's preferences.
In Geneva, vaginal laser treatment may therefore be considered in certain symptomatic postmenopausal women, but menopause itself is not an indication for treatment.
Article written by Dr Valeria Romano
Dr Valeria Romano supports each patient with a comprehensive approach to the aesthetics of the face, body and intimate areas, and to skin and hair quality. Every treatment is based on a personalised medical assessment.
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