Comparison of Severity of Genitourinary Syndrome of Menopause Symptoms After Carbon Dioxide Laser vs Vaginal Estrogen Therapy

Key Points Question Are there differences in outcomes after carbon dioxide laser vs vaginal estrogen therapy in patients with genitourinary syndrome of menopause? Findings This systematic review and meta-analysis of 270 women from 6 randomized clinical trials found that vaginal laser therapy, compared with vaginal estrogen, was associated with similar improvement in genitourinary syndrome of menopause. Meaning Future noninferiority trials are needed to test whether vaginal laser therapy could be a potential treatment option for women with contraindications to vaginal estrogen.

Selection process 8 Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.

Methods, paragraph 3
Data collection process 9 Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.
Methods, paragraph 5 Data items 10a List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which results to collect.
Methods, paragraph 4 10b List and define all other variables for which data were sought (e.g. participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information.
Methods, paragraph 5 Study risk of bias assessment 11 Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.

Methods, paragraph 5
Effect measures 12 Specify for each outcome the effect measure(s) (e.g. risk ratio, mean difference) used in the synthesis or presentation of results.
Methods, paragraph 6 Synthesis methods 13a Describe the processes used to decide which studies were eligible for each synthesis (e.g. tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).
Methods, paragraph 5 13b Describe any methods required to prepare the data for Methods,

Section and Topic
Item # Checklist item Location where item is reported presentation or synthesis, such as handling of missing summary statistics, or data conversions. paragraph 6 13c Describe any methods used to tabulate or visually display results of individual studies and syntheses.
Methods, paragraph 6 13d Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.
Methods, paragraph 6 13e Describe any methods used to explore possible causes of heterogeneity among study results (e.g. subgroup analysis, meta-regression).
Methods, paragraph 6 13f Describe any sensitivity analyses conducted to assess robustness of the synthesized results.

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Reporting bias assessment 14 Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).

Methods, paragraph 5
Certainty assessment 15 Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.
Methods, paragraph 6 RESULTS Study selection 16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.
Results, paragraph 1. Figure 1 16b Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.

Supplement, eTable 5
Study characteristics 17 Cite each included study and present its characteristics. Results, paragraph 2. Table 1 Risk of bias in studies 18 Present assessments of risk of bias for each included study. Results, paragraph 2. Figure 2 Results of individual studies 19 For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g. confidence/credible interval), ideally using structured tables or plots. Results, paragraph 3.
20b Present results of all statistical syntheses conducted. If metaanalysis was done, present for each the summary estimate and its precision (e.g. confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect.