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Vaginal AtrophyEPMLARFNCT04081805

LASER and Radiofrequency for Treatment of Vaginal Vulvar Atrophy (VVA) in Women Treated for Breast Cancer (EPMLARF-arm2)

A study testing LASER, Micro Ablative Radiofrequency and Promestriene in people with Vaginal Atrophy and Vulva; Atrophy, run by Federal University of São Paulo at 1 site in Brazil.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

This is a randomized controlled trial to evaluate the use of LASER, Micro Ablative radiofrequency and topic promestriene to treat symptoms of vulvovaginal atrophy of women treated for breast cancer. Read more about this study

Who is it for?
Ages 30 to 75 years, women only
Conditions the study is for
Vaginal Atrophy, Vulva; Atrophy, Breast Cancer
What is being tested?
LASER, Micro Ablative Radiofrequency and Promestriene
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
195 participants
Where
1 siteBrazil
Study dates
30 Sep 2019to Sep 2025
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 30 to 75 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Women with breast cancer treated with surgery and / or chemotherapy and / or radiotherapy, that has been concluded at least 6 months before inclusion, whether or not using aromatase inhibitor and complaining of vulvovaginal atrophy
  • To present, at least moderate, or severe intensity (score 4 or more of visual analog scale ( 0-10)) of one of the signs or symptoms of vulvovaginal atrophy:
  • Burning
  • Discomfort
  • Dryness
  • Cracks
Show all 13Show fewer
  • Pruritus
  • Lack of vaginal lubrication
  • Penetration dyspareunia that began at the menopausal or postmenopausal transition
  • Decreased vaginal epithelium turgor and trophism
  • Deletion of mucous and skin folds.
  • Absence of vaginal surgical procedure in the last year
  • Genital prolapse stage no greater than stage II of Pelvic Organs Prolapse Quantitation (POP-Q) with Ba, Bp or C points less than or equal to 0

Who cannot join

  • Active genital infection
  • Active infection of HPV (human papillomavirus) or Herpes
  • users of medications with estrogenic effect (digoxin and other chemicals)
  • Postmenopausal genital bleeding
  • uncontrolled diabetes
  • use of multivitamins with zinc
  • use of copper or hormonal IUDs (intrauterine device) at the time of inclusion
  • presence of genitourinary or rectovaginal fistulas

Trial locations and contacts

1 site in 1 country.

Brazil1 site
  • Federal University of Sao Paulo - Unifesp

    São Paulo, São Paulo, 0-4023- 062

Other trials in Brazil

About this study

Official title: LASER and Radiofrequency as Alternative Treatment of Vaginal Vulvar Atrophy in Women Treated for Breast Cancer

This is a randomized controlled trial to evaluate the use of LASER, Micro Ablative radiofrequency and topic promestriene to treat symptoms of vulvovaginal atrophy of women treated for breast cancer.

Read the detailed description

Women treated for breast cancer with moderate or severe signs or symptoms of vulvovaginal atrophy will be eligible for the study.

The patients will be randomized to receive one of the three intravaginal therapies: LASER, Micro Ablative radiofrequency or Promestriene. The applications will occur in the interval of 30 days for 3 times, for LASER and Radiofrequency groups. For the promestriene group, the application will be done by the patient, daily for 2 weeks and then twice a week for 3 months, and each 30 days, the patients will have an appointment when will be checked the weight of the promestriene tube, to verify the correct use.

The follow-up visits will occur 30, 90, 180 and 360 days after the conclusion of the third month of treatment.

Will be evaluated: vulvar and vaginal histology before and after the use of LASER, radiofrequency or estriol; microbiota and vaginal pH before and after the use of LASER, radiofrequency or promestriene; extracellular matrix and metalloproteinases in the remodeling of vulvovaginal collagen induced by promestriene, LASER and radiofrequency; quality of life, sexual dysfunctions and complains before and after the use of LASER, radiofrequency or hormones; metabolomics and vaginal microbiome.

Being tested
LASER, Micro Ablative Radiofrequency, Promestriene
Keywords
LASER, Radiofrequency, Vulvovaginal atrophy, breast cancer, treatment
Medical subject headings
Atrophy, Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • LASERProcedure or surgery

    Also called Fractional Co2 (carbon dioxide)Laser, MonaLisa Touch® treatment, SmartXide Touch V²LR® Deka

    The patient will use intravaginal estriol, daily for 2 weeks and them twice a week for 3 months . Each 30 days, the patients will have an appointment when will be checked the weight of the estriol tube to verify the correct use.vulvar application of LASER, to postmenopausal genitourinary syndrome. The patient will be in gynecological position, after remove of vaginal secretion, with gauze and under topic anesthesia, the LASER will be applied, according to the protocol of the manufactured.

  • Micro Ablative RadiofrequencyProcedure or surgery

    Also called FRAAX, Linly™ Loktal Medical Electronics

    Use of Linly™ equipment to perform ambulatory intravaginal and vulvar application of fractionated microablative radiofrequency, to postmenopausal genitourinary syndrome. The patient will be in gynecological position, after remove of vaginal secretion, with gauze and under topic anesthesia, the radiofrequency will be applied, according to the protocol of the manufactured

  • PromestrieneDrug

    Also called Vaginal Promestriene

    The patient will perform self application of this vaginal promestriene daily for 2 weeks and after that the applications will occur twice a week.

Study groups in NCT04081805
Study groupRoleWhat they receive
LASERActive comparatorThe patients will receive 3 consecutive applications of intravaginal and vulvar CO2 LASER, according to the manufacturer protocol for vaginal atrophy. The applications will be separated by the interval of 30 days
Receives: Procedure: LASER
Micro Ablative RadiofrequencyActive comparatorThe patients will receive 3 consecutive applications of intravaginal and vulvar MIcroablative radiofrequency, according to the manufacturer protocol for vaginal atrophy. The applications will be separated by the interval of 30 days
Receives: Procedure: Micro Ablative Radiofrequency
PromestrieneActive comparatorThe patient will use intravaginal promestriene, daily for 2 weeks and them twice a week for 3 months . Each 30 days, the patients will have an appointment when will be checked the weight of the promestriene tube to verify the correct use.
Receives: Drug: Promestriene

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical Improvement of signs and symptoms of vulvovaginal atrophy with intravaginal LASER, Micro Ablative Radiofrequency, and topic promestriene

    Will be applied a Visual Analogic Scale (0-10) to access the improvement of genitourinary signs and symptoms, the results of the three groups will be compared

    Measured: The evaluation will be done 90 days after treatment]

  2. Satisfaction with treatment by intravaginal LASER, Micro ablative Radiofrequency, and topic promestriene for women treated for breast cancer, with genitourinary atrophy syndrome

    Will be applied a LIKERT Satisfaction Scale (1-5) to access the satisfaction with the treatment, the results of the three groups will be compared

    Measured: The evaluation will be done 90 days after treatment

Secondary outcomes (8)
  1. Evaluation of Microbiota before and after the use of intravaginal LASER, Micro Ablative radiofrequency or topic promestriene

    The vaginal flora will be evaluated by vaginal smear. The results of the three groups will be compared

    Measured: The evaluation will occur pre-treatment 30, 90 , 180 and 360 days after treatment]

  2. Evaluation of vaginal pH before and after the use of intravaginal LASER, Micro ablative radiofrequency or topic promestriene

    The vaginal pH will be verified by the use of pH tape's. The results of the three groups will be compared

    Measured: The evaluation will occur pre-treatment and 30, 90, 180 and 360 days after treatment

  3. Histologic evaluation of vagina and vulva before and after the use of intravaginal and vulvar LASER, Micro Ablative radiofrequency or topic promestriene.

    Thickness of epithelium (mm and number of layers), and evaluation of expression of Ki-67 and VEGF (vascular endothelial growth factor) will be done on vaginal and vulvar biopsies, in order to evaluate the tissue regeneration ( a greater the number of layers associated with the expression of VEGF and ki67 indicate a tissue regeneration, the combination of this measures, and not evaluation each one isolated, are important to evaluate histological improvement). The results of the three groups will be compared

    Measured: The evaluation will occur pre-treatment and 30 and 180 days after treatment

  4. Evaluation of impact in Quality of life after treatment with intravaginal and vulvar LASER, Micro Ablative radiofrequency or topic promestriene.

    The IQol (incontinence quality of life questionnaire, validated to portuguese language - score 0-100) will be used to evaluate quality of life .The results of the three groups will be compared

    Measured: The evaluation will occur pre-treatment and 30 and 180 and 360 days after treatment]

  5. Evaluation of impact in Sexual function after treatment with intravaginal and vulvar LASER, Micro Ablative radiofrequency or topic promestriene.

    The FSF-I (Female Sexual Function Index , validated to portuguese language- score range from 2 - 36) will be used to evaluate sexual function . The results of the three groups will be compared

    Measured: The evaluation will occur pre-treatment and 30 180 and 360 days after treatment

  6. Evaluation of extracellular matrix before and after the use of intravaginal and vulvar LASER, Micro Ablative radiofrequency or topic promestriene.

    Evaluation of the composition and concentration of the glycosaminoglycans of extracellular matrix in the vaginal and vulvar biopsies by specific markers. The results of the three groups will be compared

    Measured: The evaluation will occur pre-treatment and 30 and 180 days after treatment]

  7. Evaluation of matrix metalloproteinases(MMP) in remodeling of vulvovaginal collagen induced by intravaginal and vulvar LASER, Micro Ablative radiofrequency or topic promestriene.

    Evaluation of the tissue distribution of the MMP-1, MMP-2, MMP-3, MMP-7, MMP-9 metalloproteinases of collagen I, II, IV and elastin proteins by specific markers on vaginal and vulvar biopsies. The results of the three groups will be compared

    Measured: The evaluation will occur pre-treatment and 30 and 180 days after treatment

  8. Evaluation of visual aspect of vulva after the use of intravaginal and vulvar LASER, Micro Ablative radiofrequency or topic promestriene.

    Pictures of vulva will be taken before and after treatment. The images will be evaluated by a blind gynecologist and dermatologist regarding the type of treatment and the chronological order of the photos, which will classify the images as: better; equal or worse, in relation to tropism and number of vulvar skin grooves, The results of the three groups will be compared

    Measured: The pictures will be taken before and 30 days and 180 days after treatment.]

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Sep 2019
  2. Study start30 Sep 2019
  3. Primary completionSep 2025 (estimated)
  4. Study completionSep 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
The patient will be randomized in block to receive one of the three intravaginal therapies: LASER, Radiofrequency and promestriene
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
195 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04081805
Sponsor's protocol ID
CEP0431/2018 arm 2
Acronym
EPMLARF
Status last verified
Apr 2025
First submitted
8 Aug 2019
Last updated
24 Apr 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Cantarelli GC, Bianchi-Ferraro AMHM, Dedonatto C, Fernandes MFR, Vanzin RB, Dardes RCM, Logullo AF, de Almeida JS, Facina G, de Jarmy-Di Bella ZIK, Sartori MGF, Patriarca MT; LARF-Study Group. Clinical and histomorphometric evaluation of the vagina following treatment with CO2 laser, radiofrequency, and promestriene for genitourinary syndrome of menopause in breast cancer survivors on adjuvant therapy. Maturitas. 2025 Jan;191:108155. doi: 10.1016/j.maturitas.2024.108155. Epub 2024 Nov 14.

    PubMed 39566128
  • Fernandes MFR, Bianchi-Ferraro AMHM, Sartori MGF, Jarmy Di Bella ZIK, Cantarelli GC, Dedonatto C, Vanzin RB, Dardes RCM, Logullo AF, Patriarca MT; LARF Study Group. CO 2 laser, radiofrequency, and promestriene in the treatment of genitourinary syndrome of menopause in breast cancer survivors: a histomorphometric evaluation of the vulvar vestibule. Menopause. 2023 Dec 1;30(12):1213-1220. doi: 10.1097/GME.0000000000002274. Epub 2023 Nov 14.

    PubMed 37963315

Questions about this trial

What is this clinical trial studying?

A study testing LASER, Micro Ablative Radiofrequency and Promestriene in people with Vaginal Atrophy and Vulva; Atrophy, run by Federal University of São Paulo at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 24 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical Improvement of signs and symptoms of vulvovaginal atrophy with intravaginal LASER, Micro Ablative Radiofrequency, and topic promestriene (time frame: The evaluation will be done 90 days after treatment]). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04081805, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Apr 2025.

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