Management of Genitourinary Syndrome of Menopause in Korean Breast Cancer Survivors by Fractional CO2 Laser Treatment

Q: Why is local estrogen therapy often limited in breast cancer survivors with GSM?

Clinicians hesitate due to concerns about systemic absorption after using local estrogen therapy, especially in women with a history of estrogen-dependent cancers like breast cancer.

Q: How was fractional CO2 laser treatment administered in this study?

Each participant received three fractional CO2 laser treatments at 4-week intervals, with assessments at baseline (V1), 4 weeks (V2), 8 weeks (V3), and a final follow-up at 12 weeks (V4).

Q: What outcomes improved after the laser treatment?

Symptom severity measured by VAS largely improved, and VHIS increased significantly after completion of laser therapy; nearly all symptoms improved except frequency.

Sep 23, 2026

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Genitourinary syndrome of menopause (GSM) commonly affects breast cancer survivors, yet clinicians hesitate to use low-dose local estrogen because of concerns about systemic absorption. This prospective study assessed the safety and effectiveness of fractional CO2 laser treatment for GSM in Korean breast cancer survivors, using patient-reported symptom severity by VAS, objective genital health by VHIS, and post-treatment satisfaction. Three laser sessions were delivered at 4-week intervals with follow-up through 12 weeks.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Purpose

Materials and Methods

Participants and Treatments

Outcome Measures

Results

Conclusion

Original Article Yonsei Med J 2026 Jan;67(1):42-47 [https://doi.org/10.3349/ymj.2025.0161](https://doi.org/10.3349/ymj.2025.0161) pISSN: 0513-5796 · eISSN: 1976-2437 | Management of Genitourinary Syndrome of Menopause in Korean Breast Cancer Survivors by Fractional CO2 Laser Treatment
Youn-Jee Chung1, Minji Ko2, Jung Yoon Park1, Mee-Ran Kim1, and Jae-Yen Song1
1Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul; 2Department of Obstetrics and Gynecology, Grace Women’s Hospital, Goyang, Korea. | | --- | | Purpose: Many breast cancer patients experience genitourinary syndrome of menopause (GSM) symptoms. Concerns about systemic absorption limit the use of local estrogen therapy, and clinicians are often hesitant to prescribe it to breast cancer survivors. Therefore, other treatment options are essential. The aim of this study was to examine the safety and effectiveness of fractional CO2 laser treatment in breast cancer survivors experiencing GSM.
Materials and Methods: Each woman received three fractional CO2 treatments at 4-week intervals between sessions: baseline (V1), 4-week follow-up (V2), 8-week follow-up (V3), and a final follow-up at 12 weeks (V4). Breast cancer survivors who had one or more symptoms related to GSM qualified for inclusion in this study. Severity of symptoms was assessed with a visual analog scale (VAS) at baseline and every follow-up visit. We also measured GSM objectively using the vaginal health index score (VHIS) at every visit. AtV4, patients evaluated their satisfaction with laser therapy using a 5-point Likert scale.
Results: Twenty-four women were included in the study. Almost all symptoms showed improvement based on mean VAS score after treatment. Vaginal dryness and urgency improved after the second treatment. After completion of all treatments, all symptoms except frequency showed improvement. VHIS increased significantly after completion of laser treatment (8.5±3.1 at baseline vs. 16.2±2.9 atV4; p<0.001).
Conclusion: Fractional CO2 laser treatment appears to be an effective and safe method in breast cancer survivors with GSM. KeyWords: CO2 laser; breast cancer; menopause; genitourinary syndrome of menopause; vulvo-vaginal atrophy | INTRODUCTION Genitourinary syndrome of menopause (GSM) is a collection of symptoms and signs resulting from changes to the vulva, vagina, and lower urinary tract due to decreased estrogen and other sex steroids during menopause. According to the Inter- Received: June 10, 2025 Revised: July 3, 2025 Accepted: July 4, 2025 Published online: October 21, 2025 Corresponding author: Jae-Yen Song, MD, PhD, Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. [E-mail: jaeyen77@nate.com](E-mail: jaeyen77@nate.com) •The authors have no potential conflicts of interest to disclose.© Copyright: Yonsei University College of Medicine 2026 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/](https://creativecommons.org/licenses/)[ ](https://creativecommons.org/licenses/)[by-nc/4.0](by-nc/4.0)) [which](which) permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. national Society for the Study of Women’s Sexual Health (ISSWSH) and the North American Menopause Society (NAMS), GSM includes genital symptoms (such as dryness, burning, and irritation), sexual symptoms (including lack of lubrication and discomfort or pain), and urinary symptoms (such as urgency, dysuria, and recurrent urinary tract infections).1 These changes are primarily caused by estrogen deficiency, which leads to reduced levels of hyaluronic acid, collagen, and elastin, thinning of the epithelium, denser conne

FAQs

Why is local estrogen therapy often limited in breast cancer survivors with GSM?

Clinicians hesitate due to concerns about systemic absorption after using local estrogen therapy, especially in women with a history of estrogen-dependent cancers like breast cancer.

How was fractional CO2 laser treatment administered in this study?

Each participant received three fractional CO2 laser treatments at 4-week intervals, with assessments at baseline (V1), 4 weeks (V2), 8 weeks (V3), and a final follow-up at 12 weeks (V4).

What outcomes improved after the laser treatment?

Symptom severity measured by VAS largely improved, and VHIS increased significantly after completion of laser therapy; nearly all symptoms improved except frequency.

Sep 23, 2026

Uploaded by Jiven