Treatment of Vaginal Atrophy With Low Intensity Nanosecond Neodymium Laser

Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexFemale
Age40-75
SponsorMeLSyTech, Ltd

About this trial

The aim of study is characteristic of changes in the vaginal wall after treatment of neodymium laser radiation with a wavelength of 1064 nm. To assess the condition of the vaginal walls before and after laser treatment, the following methods will be used: vaginal health index, perineometry, measurement of the vaginal wall thickness by ultrasound, Doppler sonography of the vaginal walls vessels, optical coherence tomography, biopsy, cytological and immunocytochemical methods. The King's Health Questionnaire will be used to collect feedback on changes in the participants life quality. Total up to 100 participants with and 20 participants without postmenopausal atrophy will be involved in the study. Participants will be divided into three groups: laser treatment (study group), topical hormones treatment (control group 1) and no treatment (control group 2) by 70, 30 and 20 participants in each group respectively. The time intervals between special tests and the tests themselves will be the same for all groups. Thus, a direct comparison between conventional treatment (topical hormones), laser treatment of the vaginal atrophy and normal condition without treatment will be made. The main hypothesis of the study is improvement in condition of the vaginal walls after laser treatment compared with the initial state of not less than thirty percent of participants, and improvement in condition on average compared with the control group.

Eligibility criteria

This trial accepts healthy volunteers

Qualifiers

Age of 40-75 years, inclusive;

Vaginal atrophy or 1st grade vaginal prolapse with atrophy, or lack of vaginal atrophy in case of control group 2;

All participants have informed consent to conduct a course of procedures according to protocol, carry out follow-up visits, and conduct studies.

Disqualifiers

Age of under 40 and over 75 years old;

History of oncological diseases;

Active tuberculosis;

Inflammatory diseases of the vulva and vagina including genital herpes in the acute stage;

Trial design

Design model

Parallel

Treatments tested in this trial

  • Laser Treatment

    Device

    Laser radiation is emitted by a series of pulses following each other through a pause. The duration of one pulse is 20-200 ns, the pause between pulses is 30 us. The energy of one pulse is about 1 mJ. General laser radiation parameters for 1st and 2nd stages are: beam with diameter of 4 millimeters (mm) scans treatment area by 4 circles with step of 2 mm (50% overlap), average power of 10-25 Watt (W), treatment time in one point of 1-10 seconds (s), treatment step of 5 mm (total handpiece length of 10 centimeter (cm), 20 treatment points along vagina), from 1 to 5 repetitions of total vagina treatment. General laser radiation parameters for 3d stage are: beam diameter of 6 mm, average power of 15-30 W, duration of ns-pulses packet of 100 milliseconds (ms), pause between packets of 50 ms, treatment duration up to 65 s, treatment in permanent motion with speed of 10-50 mm/s. The procedure is performed without anesthesia. The doctor always focuses on the participant's feeling of warmth.

  • Topical hormone estriol

    Drug

    Estriol suppository ((17 beta)-estra-1,3,5 (10)-trien-3,17-diol). Active ingredient of 0.5 milligram in 1 suppository. Daily dose will be 1 suppository.

  • Сlinical blood analysis

    Diagnostic test

    Taking blood from a vein for Clinical blood analysis (to include the participant in the study).

  • Сlinical urine test

    Diagnostic test

    Urine sampling for Clinical urine test (to include the participant in the study).

  • Vaginal smear

    Diagnostic test

    Vaginal smear for flora investigation (to include the participant in the study), immunocytochemical examination and cytology (to evaluate procedure efficiency).

  • Cervical oncocytology test.

    Diagnostic test

    Cervical smear for oncocytology test (to include the participant in the study).

  • Extended colposcopy

    Diagnostic test

    Extended colposcopy is performed under a microscope using a Lugol to determine external changes in the epithelium in order to determine atrophy and pathologies of the cervix and vaginal vault (dysplasia, erosion, cancer, etc.) (to include the participant in the study).

  • Pelvic ultrasound

    Diagnostic test

    Pelvic ultrasound investigation to determine pathologies of the pelvic through a gynecological probe (to include the participant in the study).

  • King's Health Questionnaire

    Other intervention

    The King's Health Questionnaire will be used to collect feedback on changes in the participants life quality (to evaluate procedure efficiency).

  • Vaginal Health Index

    Diagnostic test

    Vaginal Health Index will be investigated by clinical examination for vaginal elasticity, vaginal secretions, epithelial mucous membrane, vaginal hydration. pH (potential of hydrogen) will be investigated by test-lines paper (to evaluate procedure efficiency).

  • Ultrasound investigation

    Diagnostic test

    Ultrasound investigation with General Electric Voluson E8 Expert for assessing blood vessels (Doppler sonography) and vaginal wall thickness measurement (to evaluate procedure efficiency).

  • Perineometry

    Diagnostic test

    Pressure force of vaginal walls measurement with IEASE device (to evaluate procedure efficiency).

  • Optical coherence tomography

    Diagnostic test

    Optical non-invasive method of investigation vaginal mucus morphological and functional condition.

  • Biopsy

    Diagnostic test

    Biopsy of the vaginal wall to assess the condition of the vaginal wall and compare the obtained data with the data of optical coherence tomography.

  • Femoflor screen

    Diagnostic test

    Femoflor screen for the study of vaginal microbiocenosis, specifically for the detection of the pathogens, opportunistic flora and normal flora and their qualitative and quantitative evaluation (to include the participant in the study).

Treatment groups

120 Participants
are divided into 3 treatment groups
Group A: Laser TreatmentExperimental treatment 14 interventions
Group B: Topical hormoneActive comparator 12 interventions
Group C: No treatmentOther 3 interventions

Trial outcomes

Primary outcomes

1

Mean Change from Baseline of Vaginal Health Index Score

Vaginal Health Index will be investigated by clinical examination for vagina: A. Vaginal elasticity (Characteristic=Points: Non=1, Poor=2, Fair=3, Good=4, Excellent=5), B. Vaginal secretions (None=1; Sсant, thin yellow=2; Superficial, thin white=3; Moderate, thin white=4; Normal (white)=5), C. Epithelial mucous membrane (Petechiae noted before contact=1, Bleeding with light contact=2, Bleeds with scraping, Not friable thin epithelium=4, Normal=5), D. Vaginal hydration (None, surface inflamed=1, None, surface nod inflamed=2, Minimal=3, Moderate=4, Normal=5), E. pH (potential of hydrogen) will be investigated by test-lines paper (≥6.1=1, 5.6-6.0=2, 5.1-5.5=3, 4.7-5.0=4, ≤4.6=5). Score=A+B+C+D+E

Time frame
2nd visit (before any treatment); 3d visit (4-6 weeks after 2nd visit); 4th visit (4-6 weeks after 3d visit) - the end of any treatment; 1 month after 4th visit, 3 months after 4th visit, and 6 months after 4th visit
2

Mean Change from Baseline of Periodic Acid Schiff Reaction Percentage in Vaginal Smear

Part of a cytological test. Histological preparation prepared by liquid-based cytology and stained according to the instructions of the Periodic Acid Schiff kit. The investigator counts 100 cells in field of view with 400x magnification and records the proportion of cells with diffuse and granular staining. Parameter will be measured in percentages (%).

Time frame
2nd visit (before any treatment); 3d visit (4-6 weeks after 2nd visit); 1 month after 4th visit (after the end of any treatment), 3 months after 4th visit
3

Mean Change from Baseline of Resistive Index by Doppler Sonography

Measurement is a part of ultrasonography. Resistive Index will be measured with US-device. The Resistive Index (RI) is calculated by the following equation: RI = (PSV - EDV) / PSV, where PSV is peak systolic velocity and EDV is end-diastolic velocity, in relative units.

Time frame
2nd visit (before any treatment);1 month after 4th visit (after the end of any treatment), 3 months after 4th visit, and 6 months after 4th visit

Secondary outcomes

Other outcomes

1

Mean Change from Baseline of "General Health Perceptions" Score on the King's Health Questionnaire

Participants answer question: Q1. How would participant describe her health at the present? Answers = Points: Very good=1, Good=2, Fair=3, Poor=4, Very poor=5. Score = ((Score to Q1 - 1)/4) x 100

Time frame
2nd visit (before any treatment); 3d visit (4-6 weeks after 2nd visit); 4th visit (4-6 weeks after 3d visit) - the end of any treatment; 1 month after 4th visit, 3 months after 4th visit, and 6 months after 4th visit
2

Mean Change from Baseline of "Incontinence Impact" Score on the King's Health Questionnaire

Participants answer question: Q2. How much do participant think her bladder problem affects her life? Answers = Points: Not at all=1, A little=2, Moderately=3, A lot=4. Score =((Score to Q2 - 1)/3) x 100

Time frame
2nd visit (before any treatment); 3d visit (4-6 weeks after 2nd visit); 4th visit (4-6 weeks after 3d visit) - the end of any treatment; 1 month after 4th visit, 3 months after 4th visit, and 6 months after 4th visit
3

Mean Change from Baseline of "Role Limitations" Score on the King's Health Questionnaire

Participants answer questions: A. Does participant's bladder problem affect her household tasks? (cleaning, shopping etc) B. Does participant's bladder problem affect her job, or her normal daily activities outside the home? Answers = Points: Not at all=1, Slightly=2, Moderately=3, A lot=4. Score =(((Scores to Q 3A + 3B) - 2)/6) x 100

Time frame
2nd visit (before any treatment); 3d visit (4-6 weeks after 2nd visit); 4th visit (4-6 weeks after 3d visit) - the end of any treatment; 1 month after 4th visit, 3 months after 4th visit, and 6 months after 4th visit
4

Mean Change from Baseline of "Physical Limitations" Score on the King's Health Questionnaire

Participants answer questions: A Does participant's bladder problem affect her physical activities (e.g. going for a walk, running, sport, gym etc)? B. Does participant's bladder problem affect her ability to travel? C. Does participant's bladder problem limit her social life? D. Does participant's bladder problem limit her ability to see and visit friends? Answers = Points: Not at all=1, Slightly=2, Moderately=3, A lot=4. Score =(((Scores to Q 4A + 4B) - 2)/6) x 100

Time frame
2nd visit (before any treatment); 3d visit (4-6 weeks after 2nd visit); 4th visit (4-6 weeks after 3d visit) - the end of any treatment; 1 month after 4th visit, 3 months after 4th visit, and 6 months after 4th visit

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