Ensaio clínico randomizado com o uso de laser de CO2 fracionado e estrogênio vaginal no tratamento da síndrome genito urinária em mulheres pós menopausa

• Autor(a) principal: Dutra, Paula Fernanda Santos Pallone [UNIFESP]
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9989771; https://hdl.handle.net/11600/64819
• topic: CO2 Laser; Genitourinary Syndrome; Vulvovaginal Atrophy; Dyspareunia; Estriol; Laser Fracionado De CO2; Dispareunia; Síndrome Genitourinária; Estriol

Introduction: Genitourinary syndrome (SGU) is a chronic and progressive disease common in postmenopausal women and defines a set of symptoms and signs associated with estrogen deficit in Organs genitourinary organs. It is estimated that SGU affects about 50% of post-menopausal women, negatively impacting quality of life. Among the most common symptoms we can mention vaginal dryness, pain on intercourse, vulvovaginal itching and urinary infections. Topical estrogen therapy is the treatment of choice and the most effective for SGU. However, some women have specific contraindications for hormonal therapy or, even, do not respond to the topical dose used for treatment. In this context, the evaluation of new alternative non- hormonal treatments will allow a peculiar group of women to have access to the treatment of symptoms resulting from vulvovaginal atrophy. Objectives: To compare the effectiveness of using fractional CO2 laser and vaginal topical estriol in genitourinary syndrome. Subjects and Methods: A randomized clinical trial was carried out, involving 25 postmenopausal women, selected, between February 2017 and February 2018. It included women, between 50 and 65 years old, with at least 1 year of amenorrhea and FSH above 40 IU / L, being followed up at the Ambulatory of Pathology of the Lower Genital Tract and Colposcopy - UNIFESP and that met the inclusion criteria of the work. The women were randomly randomized into two groups, with 13 women in the laser group and 12 women in the group that would use vaginal estrogen therapy. Subjective evaluation was performed through physical examination and colposcopy, analysis of the cell maturation index and sexual function before and after the treatments proposed for each group and histomorphometric analysis of the vaginal epithelium. Statistical analysis was performed using: Shapiro-Wilk to verify the assumption of Normality of the numerical information; t-Student for independent samples when comparing groups (estrogen, laser), according to numerical information with Normal distribution; Chi-square or Fisher's exact test when comparing groups (estrogen, laser), according to marital status and education; Mann- Whitney in the comparison of groups (estrogen, laser), according to age at the beginning of menopause and analysis of variance (ANOVA) with repeated measures in the comparison of epithelial thickness, Female Sexual Quotient (QSF), number of deep, intermediate and superficial (FROST) and maturation index between groups (estrogen, laser) and times (initial, final); in addition to multiple Bonferroni 12 comparisons when needed. In all conclusions obtained through inferential analyzes, an alpha significance level of 5% was used and statistical analyzes were performed using the statistical programs IBM-SPSS Statistics version 24 and R version 3.6.3. Results: The evaluation through physical examination showed an important improvement in trophic aspects in both groups. Regarding cell maturation, there was a tendency for the estrogen group to increase when compared to laser. Sexual function, assessed using the Female Sexual Quotient (QSF), showed a significant increase over time, both in the estrogen group (p <0.001) and in the laser group (p <0.001). In histological analysis, both fractional CO2 laser (p <0.001) and estrogen therapy (p = 0.001), showed a significant increase in the thickness of the vaginal epithelium at the end of treatment. Conclusion: CO2 fractional laser can be considered an effective method for the treatment of vulvovaginal atrophy similarity to standard estrogen treatment.