Use of Fractional CO2 Laser Versus Erbium:YAG Laser for the Treatment of GSM in Patients Using Aromatase Inhibitors

Inclusion Criteria:

Recruited participants will meet all of these criteria:

• a history of breast cancer

• premenopausal at diagnosis of breast cancer

• using AI as an adjuvant treatment

• moderate to severe symptoms of GSM (VAS ≥ 4/10)

• currently menopausal, which can be either biochemical menopause as confirmed afterchemotherapy, surgical or medicinally induced (GnRH analogues for the duration ofthe trial)

Exclusion Criteria:

• Not willing to abstain from vaginal intercourse for 1 week following laser therapy

• Use of non-hormonal vaginal preparations within the last 6 weeks before inclusion

• Use of hormonal therapy within 6 months prior to inclusion (systemic or local)

• Acute urinary or genital tract infections

• A history of genital fistula, a thin rectovaginal septum as determined by theinvestigator, or history of fourth degree laceration

• Prolapse ≥ grade 2 according to the Pelvic Organ Prolapse Quantification System

• Previous vaginal mesh implantation

• Abnormal result in the last cervical smear (maximum 36 month before enrollment)

• Active cancer treatment (radiotherapy or chemotherapy) ongoing or planned prior tothe measurement of the primary outcome (6 months after inclusion, 3 months afterlast laser)

• Vaginal stenosis that does not allow the placement of the laser probe

• Any condition that could interfere with study compliance