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URMC / Obstetrics & Gynecology / UR Medicine Menopause and Women's Health / menoPAUSE Blog / June 2020 / I have heard that there are new non‐hormonal treatments for vaginal dryness during menopause. Are th

I have heard that there are new non‐hormonal treatments for vaginal dryness during menopause. Are these treatments safe?

Your Question: I have heard that there are new non‐hormonal treatments for vaginal dryness during menopause. Are
these treatments safe? 

Our Response: Genitourinary syndrome of menopause is the term now used to encompass vaginal dryness, vaginal atrophy, as well as pain on intercourse and lower bladder urgency.

New non‐hormonal, energy‐based treatments for genitourinary symptoms of menopause include laser‐based devices and radiofrequency‐based devices initially utilized in dermatology and aesthetic medicine. While several devices are on the market, they function in a somewhat similar way. Through a vaginal probe, heat shock proteins and tissue growth factors are activated in the vaginal tissue during a brief treatment exposure. Vaginal healing over time leads to production of new collagen and elastic fibers and thickening of the mucosa. Depending on the protocol used, several treatments are then carried out over a few weeks or months (Pagano 2017).

Of the various energy‐based vaginal units on the market, there are, however, differences. For example, radiofrequency‐based devices like Protégé IntimaTM, (BTL Aesthetics, Farmingham MA) emit focused electromagnetic waves generating heat when encountering tissue impedance. Minimally ablative factional laser devices such as MonaLisa Touch® (Holistic Company, Westford, MA) produce only CO2 induced microscopic areas of thermal necrosis. By comparison, diVa® CO2 laser unit (Hybrid fractional laser technology, Grand Rapids, MI) has two distinct wavelengths delivered simultaneously, one is fractionally ablative, 2940 nm, treating the epithelium, and one that is non‐ablative, 1470 nm, for deeper treatment benefiting collagen remodeling.

At present, costs for the procedures, averaging $1,000 to $3,000, are not covered by insurance companies, primarily due to insufficient data on safety and long‐term consequences. The U.S. Food and Drug administration (FDA) in 2018 stated, “The safety and effectiveness of energy‐based devices for treatment of these conditions have not been established.” The American College of Obstetricians and Gynecologists (2016) and North American Menopause Society (2018) also await confirmation of safety and longterm outcomes for these new vaginal treatments.

Despite these cautionary opinions, when safety and outcome data are available, these newer, minimally invasive, energy‐based treatments may prove an important option for women suffering from genitourinary syndrome of menopause who cannot take hormone treatments.

James Woods | 6/12/2020

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