Novel Treatment for Genitourinary Symptoms of Menopause Restores Vaginal Health

Q&A with Duke obstetrician and gynecologist

older woman sitting in field

Duke now offers a nonhormonal, nonpharmaceutical treatment option for patients with genitourinary symptoms of menopause—a novel laser system that restores vaginal health to premenopausal levels by generating new collagen and elastin, and increasing vascularization to the vaginal tissue.

Susann L. Clifford, MD, is currently the only Duke obstetrician and gynecologist offering treatment with the MonaLisa Touch laser system (DEKA M.E.L.A. Srl, Calenzano, Italy). She answers common questions that physicians and their patients may have about the treatment and how it can improve the troublesome symptoms of menopause.

Question: How does the system work?

Clifford: It is a CO2 laser that uses fractional technology, meaning that only a small amount of vaginal tissue is lasered. It works as ablative as well as thermal technology. The laser causes microtraumas in a portion of the vagina to stimulate the body’s natural healing reaction. During that process the body remodels the vaginal epithelium with improved collagen and elastin, resulting in the vaginal tissues being restored to tissues similar to  a premenopausal state. It’s a five-minute, office-based procedure performed three times, six weeks apart. Patients return six and 12 months later for follow-up, and some will need a booster treatment after 12 to 18 months to continue the effects.

Question: Why is it important for Duke to be able to offer this treatment?

Clifford: The genitourinary symptoms of menopause affect up to 50% of all women going through menopause, whether it’s induced physiologically, surgically, or medically. The symptoms usually get worse over time, so many women have years of painful, bothersome symptoms—such as dryness and pain during intercourse—that they often don’t even want to discuss. Topical estrogen applied to the vagina and vulva is the gold standard treatment, but there are women for whom estrogen is either contraindicated or they’re unwilling to use it. Patients with estrogen-receptor-positive breast cancer, for example, are very leery of, and often discouraged from use of the traditional hormone treatment. Additionally, some breast cancer treatments can cause severe atrophy and vaginal discomfort. Now we can give patients another option to relieve their symptoms that doesn’t involve hormones, medications, or exposure to chemicals.

Question: Are all women good candidates for the treatment?

Clifford: There are very few contraindications for this treatment, such as active pelvic infections, undiagnosed vaginal bleeding, or a history of radiation therapy. With the exception of those conditions, any patient who has failed conventional therapy with estrogen or is unable or unwilling to use it for any reason are good candidates.

Question: Some women seek similar laser treatments solely for vaginal rejuvenation and improved sexual function. What should physicians tell their patients about this trend?

Clifford: At Duke, the MonaLisa Touch system is offered exclusively as a clinical procedure to restore vaginal tissue to premenopausal levels. This is not used to treat an aesthetic complaint, but rather a functional medical problem. Patients will likely experience an improvement in their sexual function due to a decrease in pain and dryness as their condition is treated.   

Question: What is the typical success rate for the procedure?

Clifford: Most women are able to resume their normal activities the day of the procedure, and   intimacy may resume within a few days after treatment. Side effects are rare, and mild if they occur. Studies have shown up to an 84% success rate up to 12 to 18 months following treatment; “success” is defined as patients being satisfied with the improvement in their symptoms.