Journal of Molecular Biology Research; Vol. 9, No. 1; 2019 ISSN 1925-430X E-ISSN 1925-4318 Published by Canadian Center of Science and Education 67 Evaluation of Fractional CO 2 Laser Treatment Efficacy and Comparison to Vaginal Conjugated Estrogen Cream in Postmenopausal Women with Vulvovaginal Atrophy: A Randomized Clinical Trial Mahin Najafian 1 , Kobra Shojaei 1 & Saadat Hajatzadeh 1 1 Department of Obstetric & Gynecology, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, Iran Correspondence: Saadat Hajatzadeh, Department of Obstetric & Gynecology, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, Iran. E-mail: dr.hajatzadeh.saadat84@gmail.com Received: June 1, 2019 Accepted: June 21, 2019 Online Published: July 11, 2019 doi:10.5539/jmbr.v9n1p67 URL: https://doi.org/10.5539/jmbr.v9n1p67 Abstract Background: Vulvovaginal atrophy is common and bothersome among postmenopausal women. Hence in this study, the fractional CO 2 laser treatment efficacy was compared with vaginal conjugated estrogen cream in postmenopausal women with vulvovaginal atrophy was assessed. Materials and Methods: In this randomized clinical trial, 130 consecutive postmenopausal women with vulvovaginal atrophy attending to urogynecologic clinic in Imam-Khomeini hospital in Ahvaz in 2015 were enrolled and were randomly assigned to receive either fractional CO 2 laser treatment or vaginal conjugated estrogen cream. The improvement of vulvovaginal atrophy symptoms, sexual satisfaction and function were compared across the groups after 12 weeks. Results: There improvement of vulvovaginal atrophy symptoms, sexual satisfaction, and function were 86.2%, 87.7%, and 87.7%, respectively in laser group and 53.8%, 52.3%, and 52.3%, respectively in primarin group showing statistically significant differences (P=0.0001). There were no side effects. Conclusion: Totally, according to obtained results, it may be concluded that efficacy of fractional CO 2 laser was higher than vaginal conjugated estrogen cream in postmenopausal women with vulvovaginal atrophy. Keywords: Laser, Vaginal Conjugated Estrogen, Menopause, Vulvovaginal Atrophy 1. Introduction Menopause is a natural stage in women’s life accompanied with decreased estrogen secretion (Minkin, Maamari, & Reiter, 2013; Sparavigna, Tenconi, De Ponti, Bulgheroni, & Scarci, 2013). This reduction is accompanied with multiple alterations in vaginal mucus that may result in vaginal atrophy with symptoms such as dryness, redness, burning sensation, and post-coital bleeding (Mac Bride, Rhodes, & Shuster, 2010; Santoro & Komi, 2009). These symptoms would result in decreased quality of life, self-esteem, sexual satisfaction, etc. (Simon & Komi, 2007). The prevalence rate of vaginal atrophy in women older than sixty years is fifty percent leading to some health concerns in subjects (Suckling, Kennedy, Lethaby, & Roberts, 2006). When the estrogen level is normal, the vaginal epithelium is wet and thick but estrogen deficiency would develop thin dry layer and for this matter estrogen products are essential to improve such symptoms. However, some studies have shown that hormone therapy in post-menopausal women is accompanied with increased risk of breast cancer, endometrial hyperplasia, thrombosis, and cardiac and cerebral ischemia (Prentice, 2014; Amanlou & Mostafavi, 2017; Salehi, Hadadi, & Tavallaei, 2019; Kilitci, Kaya, Acar, & Elmas, 2018). Hence use of non-estrogen modalities is grown currently. In recent years, need to safe long-acting therapeutic modalities with some effects on deeper vaginal mucosal layers is increased significantly. Hence use of regenerative tissue methods and anti-aging approaches for vaginal problems is entered to clinical trial phases leading to treatment of vaginal atrophy by fractional CO 2 laser (Tierney & Hanke, 2011). This method is accompanied by superficial and even deeper tissue alterations with small size leading to elastic and neo-collagen production resulting in improvement in pH and wetness that finally would lead to improvement in vaginal atrophy symptoms (Stefano,