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.
Korzeniewska et al. (Mon,) studied this question.