Physical energies for the management of genitourinary syndrome of menopause: An overview of a systematic review and network meta‐analysis

Abstract Background Energy‐based devices (laser and radiofrequency) have been used to treat genitourinary syndrome of menopause (GSM). Objectives To evaluate the efficacy and safety of physical energy use in managing GSM symptoms. Search Strategy Five databases were searched from inception to December 2022. Language restrictions were not imposed. Selection Criteria We included all Cochrane and non‐Cochrane systematic reviews with or without meta‐analyses that described postmenopausal women with symptoms of GSM treated with physical energy. Data Collection and Analysis We performed a network meta‐analysis using frequentist methods to calculate standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs). Methodological and reporting quality were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2). Main Results Nine reviews were included in the overview, six of which were meta‐analyses. Four randomized controlled trials, representing 218 participants and nine different study arms, met the criteria for inclusion in our component network meta‐analysis. Confidence in review findings was low in six reviews and critically low in three. Our network meta‐analysis results showed that premarin (SMD 2.60, 95% CI 7.76–3.43), conjugated estrogens (SMD 2.13, 95% CI 1.34–2.91), carbon dioxide laser (SMD 1.71, 95% CI 1.10–2.31), promestriene (SMD 1.41, 95% CI 0.59–2.24), and vaginal lubricant (SMD 1.37, 95% CI 0.54–2.20) were more effective than sham for reducing sexual dysfunction, with a consequent increase in Female Sexual Function Index (FSFI). Two studies showed a high risk of bias, owing to a lack of blinding. Conclusion Several gaps in the use of physical energy for managing GSM still need to be addressed. The small number of blind clinical trials made the results fragile.