From the Guidelines
Vaginal estrogen therapy is the most effective treatment for vaginal atrophy, with more robust clinical evidence supporting its effectiveness compared to the MonaLisa Touch procedure. The MonaLisa Touch procedure and vaginal estrogen therapy are both used to treat vaginal atrophy, but they have different mechanisms of action and advantages. Vaginal estrogen therapy, as noted in the NCCN guidelines 1, is considered the gold standard treatment for vaginal dryness leading to sexual dysfunction and has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals.
The MonaLisa Touch is a non-hormonal laser procedure that may be beneficial for women who cannot use estrogen therapy, such as those with hormone-sensitive cancers. However, the evidence for its effectiveness is not as strong as that for vaginal estrogen therapy. According to the NCCN guidelines 1, vaginal estrogen has been shown to improve vaginal atrophy and sexual function in postmenopausal survivors of hormone receptor-positive breast cancer receiving aromatase inhibitor therapy.
Key points to consider when choosing between the MonaLisa Touch procedure and vaginal estrogen therapy include:
- Individual health history
- Cancer risk
- Preference for hormonal versus non-hormonal options
- Cost considerations, as laser therapy is often not covered by insurance while estrogen therapy typically is
- The need for ongoing maintenance sessions with the MonaLisa Touch procedure, typically annually, compared to the daily or weekly use of vaginal estrogen therapy.
Overall, while both treatments can improve vaginal tissue health, moisture, and sexual function, vaginal estrogen therapy is generally considered the more effective option, with a larger body of evidence supporting its use 1.
From the Research
Effectiveness of Mona Lisa Touch Procedure
- The Mona Lisa Touch procedure is a form of energy-based treatment for vaginal atrophy, but there is limited research directly comparing its effectiveness to vaginal estrogen therapy 2, 3.
- Vaginal estrogen therapy has been shown to be effective in treating vaginal atrophy, with low-dose, local vaginal estrogen delivery being well-tolerated and effective 2.
- The choice of therapy should be guided by clinical experience and patient preference, with progestogen generally not indicated when low-dose estrogen is administered locally for vaginal atrophy 2.
Comparison to Vaginal Estrogen Therapy
- There is no direct comparison between the Mona Lisa Touch procedure and vaginal estrogen therapy in the provided studies, making it difficult to determine the relative effectiveness of the two treatments.
- However, studies have shown that women may prefer certain characteristics of local estrogen therapy, such as disposable applicators with small tablets and therapy that does not cause smudges/leakage 4.
- Barriers to treatment with local estrogen therapy, such as patient reluctance to discuss the condition and misinformation, can result in its underuse, and healthcare providers can help overcome these barriers by facilitating discussion and education 5, 6.
Treatment Options for Vaginal Atrophy
- Local estrogen therapy is the first-line pharmacologic treatment recommended by the North American Menopause and International Menopause Societies for vaginal atrophy 5.
- Other treatment options, such as ospemifene, are available for women who are not candidates for local estrogen therapy, and healthcare providers should consider individual patient preferences and needs when making treatment decisions 3.