9 November 2018: 

Earlier this week, Professor Chris Maher a urogynaecologist from the University of Queensland and Dr Melissa Buttini, a gynaecologist at the Wesley Hospital in Brisbane raised some serious questions about vaginal laser treatment of genitourinary syndrome of the menopause (GSM).

The Therapeutics Goods Administration (TGA) approved CO₂ laser therapy for a number of body soft tissues, however was not listed specifically for treatment of GSM. There is no Medicare Benefits Schedule item number for CO₂ laser therapy and so the extent of its use cannot be measured. We do know however that advertisements for CO₂ laser therapy treatment for symptoms of GSM are extensive.

In July this year, the Food and Drug Administration (FDA) in the US issued a warning about the use of CO₂ laser therapy for ‘vaginal rejuvenation’ and stated “These products have serious risks and don’t have adequate evidence to support their use for these purposes. We are deeply concerned women are being harmed.”

AMS President Clinical Associate Professor Amanda Vincent was interviewed for the Australian Doctor in response to the MJA article and noted “There are safety concerns and significant costs involved - the recommendation is for 3 treatments in a 12-month period with each treatment costing $500-$1000.”

Maher and Buttini question the abstract and conclusion of the first randomised control trial undertaken by Cruz et al reported in January this year. While Cruz et al suggest that vaginal laser therapy has a place in the treatment of GSM, further investigation of the methods and results paint a different story. Patients in the vaginal oestrogen intervention reported better outcomes compared with patients in the laser/sham cream arm who reported a significant worsening of pain.

In MJA InSight, Maher warns “What really causes some anxiety for me is we have been through all this within the past 10 years with transvaginal meshes, we’re still going through it.” Clearly further evidence is required from rigorous clinical trials before we can recommend vaginal laser as a therapy for GSM. In the interim, vaginal/topical oestrogen is the gold standard treatment for GSM as it is safe and efficacious. The only group of women who can’t use that are those with breast cancer or breast cancer survivors.

The AMS looks forward to hearing the results of a double-blinded, randomised, placebo-controlled trial of the efficacy of the MonaLisa Touch procedure for the treatment of postmenopausal vulvovaginal symptoms currently being undertaken by Professor Jason Abbott at the Royal Hospital for Women in Randwick.

Vitamin D is already well known for its benefits in building healthy bones. A new study supports the idea that it also may reduce cancer risk as well as breast cancer mortality, especially in women with a lower body mass index. 

Breast cancer remains the most common cancer in women worldwide and is the leading cause of death from cancer in women. Reproductive risk factors such as early onset of puberty, late menopause, later age at first pregnancy, never having been pregnant, obesity, and a family history have all been shown to be associated with breast cancer development. The role of vitamin D concentration in the development of breast cancer, however, continues to be debated.

This study involving more than 600 Brazilian women suggests that vitamin D may reduce cancer risk by inhibiting cell proliferation. Study results appear in the article "Low pretreatment serum concentration of vitamin D at breast cancer diagnosis in postmenopausal women."

Researchers involved in the study concluded that postmenopausal women had an increased risk of vitamin D deficiency at the time of their breast cancer diagnoses, associated with higher rates of obesity, than women of the same age group without cancer. Similar studies also have previously demonstrated a relationship between vitamin D and breast cancer mortality. Women in the highest quartile of vitamin D concentrations, in fact, had a 50% lower death rate from breast cancer than those in the lower quartile, suggesting that vitamin D levels should be restored to a normal range in all women with breast cancer.

"Although published literature is inconsistent about the benefits of vitamin D levels and breast cancer, this study and others suggest that higher levels of vitamin D in the body are associated with lowered breast cancer risk," says Dr. JoAnn Pinkerton, executive director of NAMS. "Vitamin D may play a role in controlling breast cancer cells or stopping them from growing. Vitamin D comes from direct sunlight exposure, vitamin D3 supplements, or foods rich in vitamin D."