Intravaginal radiofrequency versus local estrogen and prasterone for genitourinary syndrome of menopause: a comparative study of clinical outcomes

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BACKGROUND: Genitourinary syndrome of menopause (GSM) causes vulvovaginal and urinary symptoms due to estrogen deficiency. While local estrogen therapy is a standard treatment, non-hormonal alternatives such as intravaginal radiofrequency (RF) are under investigation. OBJECTIVE: To compare the effectiveness of intravaginal RF with local estriol and prasterone in postmenopausal women with clinically significant GSM. METHODS: Prospective, multicenter, quasi-experimental, non-randomized study with sequential allocation (2:2:1) to estriol, prasterone, or RF (three monthly sessions). Primary outcome was defined as favorable response in vaginal dryness, while secondary outcomes included patient satisfaction and favorable response in: pruritus/pain, dyspareunia, vaginal cytology, pH, Bladder Control Self-Assessment Questionnaire (B-SAQ) score, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score and urinary symptoms. RESULTS: Of 146 women allocated, 131 completed follow-up (estriol n = 54; prasterone n = 52; RF n = 25). RF showed comparable outcomes in selected urinary endpoints, including recurrent urinary tract infections, nocturia, urinary incontinence, and patient satisfaction compared with estriol. In adjusted analyses controlling for baseline pollakiuria, prasterone was associated with higher odds of favorable response in vaginal dryness compared with RF (OR 7.50; 95% CI 2.22-25.32; p = 0.001). RF showed lower favorable-response proportions for vaginal dryness and vaginal cytology, although only the comparison with prasterone for vaginal dryness reached statistical significance in adjusted analyses. CONCLUSIONS: RF showed partial clinical effectiveness and may be considered a non-hormonal option for selected women, particularly when urinary symptoms are prominent or hormonal therapy is not suitable. However, local estriol and prasterone showed greater benefit for vaginal dryness, dyspareunia, and epithelial outcomes.

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