MonaLisa Touch – An Alternative Treatment for the Symptoms of Menopause

Lesson 3

Welcome back to the third video in our series. In this particular video, I'm going to talk to you in detail about the MonaLisa Touch, what it is, what it does, how it works. And by the end of this video, I think that you'll be feeling really informed about this non-hormonal, non-surgical option to the treatment of the genitourinary symptoms of menopause.

What is MonaLisa Touch, and how does it work?

The MonaLisa Touch is a Health Canada approved medical device. It's a carbon dioxide based laser and we take light that's produced by the laser at a particular wavelength and we focus that light to be able to treat the tissues at a very, very small depth, about one 1000th of a millimeter. The intent of the treatment is to cause multiple tiny little micro-injuries such that your body in response brings in those normal healing tissues, healing cells that will rebuild and reform the structure around the vagina and in the skin of the vulva. And those are bringing in cells like collagen, elastin, the cells that create normal vaginal lubrication. And with just three treatments of the MonaLisa Touch, we can turn the clock back, if you will, by rebuilding the structure that supports both the vagina and the bladder. The advantage of that is we can then generate normal lubrication for intercourse without having to use gels or lubricants, and we can improve bladder health such that you no longer have to wear a pad, or you don't have to be worried about being embarrassed in social situations if you cough or sneeze.

How does laser light help alleviate the genitourinary symptoms of menopause?

The easiest way for me to explain how the MonaLisa Touch works is if I was to cut my finger with a knife, for example, once we got the bleeding stopped, there's a healing process that happens over the next several days. And what's happening there is your body is bleeding, bringing in blood flow to the area, not only to stop the bleeding that's there through the use of platelets, but also to repair the damage that's been done to that superficial part of your skin such that, except in the most deepest cuts, there's no scar left over. And so to do that, your body is bringing in essentially the structure that holds up all of our skin, which is things like collagen and elastin. Think of those as the steel girders inside of a building. So with the laser light, what we're doing is creating micro injuries, thousands of micro injuries inside the vagina and on the surface of the vulva that are to a depth of approximately one one thousandth of a millimeter. But we're recreating that same response such that within a few days of treatment, your body has brought in all kinds of new blood flow to the the area as well as the supporting structure cells like collagen and elastin. In addition, it brings in those cells that create the normal lubrication for intercourse.

How are MonaLisa Touch procedures performed?

The MonaLisa Touch is a specific medical device. It, using carbon dioxide gas, generates a light in a particular wavelength at a particular power, and that's called a laser. At the end of the device, we have two treatment wands. One is designed to fit inside the vagina, just like for women who've gone to have a vaginal ultrasound, there's a particular vaginal ultrasound probe that's designed to fit inside the vagina. The MonaLisa Touch has a probe that's exactly like that. And there's also a second treatment wand that is designed to treat the skin on the outside of the vulva.

Is MonaLisa Touch treatment painful?

When I'm sitting with potential patients and discussing the MonaLisa Touch and explaining that it causes thousands of tiny little micro-injuries, the first thing that comes to their mind is, "Oh my goodness, this must be painful". In fact, it's exactly the opposite. When we're treating the vagina with the probe that's designed to fit inside the vagina, women don't feel any pain at all. They feel a sense of vibration. There's no sedation required. You don't have to be put to sleep. After the treatment, you get up, you leave the office, you go back to your usual activities. So it's not painful. And when we treat the surface of the vulva, the vulva is a very sensitive area. There are lots of nerve endings on the surface of your vagina. So before we treat the vulva we apply an anesthetic gel.

There are no injections, it's just a gel. We let that sit for 10 or 20 minutes and then we treat afterwards. At that time, women might feel a slight sense of an electric vibration, but again, it's not a painful thing to have done. It's important to understand that it takes about two minutes to treat the vagina and about two minutes to treat the vulva. So it's not a long drawn out thing. Most of our patients, by the time that they're in the room, have gotten changed, have their treatment and out the door making their next appointment, it's 20 minutes.

How many MonaLisa Touch treatments are needed for it to be effective?

To be able to alleviate the common genitourinary symptoms of menopause, most women will require three treatments, spaced four to six weeks apart. Some women will require a fourth treatment, and that is obviously individualized to their particular symptoms after the third treatment.

What's really interesting is that most women, including my wife's experience, will see a resolution of their symptoms even after the first treatment. Things like the development of normal lubrication, can come on even after the first treatment. When you look at trying to relieve symptoms that are related to bladder function, like leakage of urine or that sense of urgency, many times that relief will come on after the second or third treatment or even a little bit longer as your body continues this healing process. The beauty of the MonaLisa Touch is that after that first series of three treatments, most women do not have to come back again for at least 12 months.

Are there any risks with MonaLisa Touch Treatment?

Mona Lisa touch is a safe procedure. It's non-surgical and non-hormonal. Like any treatment, there are some minor complications that can happen, rarely. Some women can have a little bit of bleeding or spotting. It's not unusual in the first day or two afterwards that women will have a sensation like having a urinary tract infection. That's not uncommon at all. I think the reason that is happening is that the bladder is a little bit irritated because of this healing response. It's actually coming into the tissues around the bladder. But that goes away in a very short period of time. When I call women after their first treatment on the following day, by that point they're not having any symptoms at all. Immediately after the treatment, some women will feel some warmth in the area, which usually dissipates within an hour or so. Occasionally, some women might have some bleeding or spotting after the treatment, and that's because before we did the treatment, things were so dry that the skin is still quite brittle. When we talk about severe complications, there have been no major complications related to the MonaLisa Touch treatment that have been reported.

Is MonaLisa Touch approved for use in Canada?

The MonaLisa Touch carbon dioxide laser is health Canada approved.

Is MonaLisa Touch covered by my public health insurance?

Unfortunately, your provincial health insurance program does not fund treatment for MonaLisa Touch. Why is that? Well, we live in an environment where healthcare costs for governments are very high. The MonaLisa Touch is a treatment for symptoms, but it's not life saving. But it does make people's lives better. The government has decided not to fund this treatment. The MonaLisa Touch treatment is so new that private insurance companies, just like you and like your healthcare provider, are still learning about it. To date they have not been funding, the MonaLisa Touch treatment. But I encourage all of my patients who do have private health care coverage to inquire of their insurance company whether they can get funding for their treatment. I think as the insurance companies learn more about this treatment and its effectiveness and see the demand from their clients, we may see a change in their policy.

How much does MonaLisa Touch treatment cost?

At my clinic, Avantia Restorative Health, the cost of the initial three MonaLisa Touch treatments is $2,100. Then women are encouraged to come back on an annual basis because, over time, the effectiveness of those initial three treatments will wane and their symptoms will return. We do make an appointment for women 12 months after their last treatment at a cost of $500 on an annual basis.

Does MonaLisa Touch really work?

When I meet with women who are considering MonaLisa Touch, especially in the context that it's not funded by their provincial health insurer and they're making that decision "is this money that I should be spending on my health?", I can reassure them that the studies that have been published so far show that about 90% of women get the relief from the symptoms that they're looking for. So it's really important to understand that I didn't say 100%, and some of my own patients have not seen the relief that they're after, but the very, very large majority do get relief from their symptoms. They notice an improvement in vaginal lubrication almost immediately, and they notice an improvement in their bladder health. Certainly that's been my wife's experience.

How many women have received the MonaLisa Touch?

I think it's important to understand that the MonaLisa Touch treatment has been available around the world since 2012. In Canada we're one of the last westernized countries to introduce this treatment option. Over 2 million women have been treated so far. The studies that have been done consistently show about 90% of women get relief of their symptoms, and that's certainly been my experience in my practice.

How has the medical community embraced Mona Lisa Touch?

There's a lot of discussion in the medical community about the MonaLisa Touch and it's use as an option in the treatments of the genitourinary symptoms of menopause. As I mentioned, there have now been over 30 studies, but relatively small studies, consistently showing about 90% of women get the relief of the symptoms they're after. What we're missing in the medical literature, and what I'm the first person to acknowledge that we're missing, is that really large study that looks at hundreds if not thousands of women and their response to the MonaLisa Touch and what can they expect in the short term and the long term.

Is MonaLisa Touch right for me?

For women who are having the genitourinary symptoms of menopause that could be treated with the MonaLisa Touch, almost all of them are going to be good candidates. There are certain women, for example, women who are on blood thinners where it's contraindicated. However, when you come to see me for your personal consultation, part of that consultation is a very detailed review of your overall medical health, your medications, and then the determination together whether this is the right treatment for you. So for women who have been treated for breast cancer and who have had their ovaries removed as part of that treatment and have now gone through menopause, even if they're in their thirties or forties, the MonaLisa Touch is a really great non-hormonal non-surgical alternative to try and relieve those symptoms and get some normalcy back into their life, whether it's getting rid of symptoms like vulvar itch or restoring normal intimacy. Now that their treatment with breast cancer is over and life is getting back to normal and they're feeling good about their prognosis, let's work on the things that can get that intimate part of their life back to normal again.

Can MonaLisa Touch treat other conditions?

One of the interesting new advances in the use of the MonaLisa Touch that I've been reading about and we've treated some patients with, is the use of MonaLisa Touch for the treatment of lichen sclerosus. Lichen sclerosus is, unfortunately, a common disorder of the vulva where women get a thinning of the vulva. It can happen to women of any age, even before menopause. There is increasing literature about the use of MonaLisa Touch as a non-hormonal, non-steroid option to treat that particular disorder.

Why aren't more women getting MonaLisa Touch treatment?

The beauty of the internet is that women now have the opportunity to gather their own information. They're not solely relying on their health care providers to get information to them about their health. The MonaLisa Touch is relatively new around the world. It's been available since 2012, and in Canada since 2017. So this is new technology. It's new technology that I totally believe in, that I can see on a firsthand basis how well it works, not only for my own wife, but for the patients that we've treated. But, like any new technology, it takes time for women and their health care providers to learn about this particular treatment and its effectiveness.

Where can I get MonaLisa Touch Treatment?

The most important thing to think about when you're trying to decide on the provider of a treatment like MonaLisa Touch is that this is a medical procedure. This needs to be done by a medical professional who is trained in gynecologic health. Somebody like myself. I've had 30 years of experience as an obstetrician gynecologist. Not only are we doing the treatment but, as part of our evaluation, we're talking to you in detail about your symptoms. We're looking at your overall medical health. We're looking at whether you are a good candidate for this. Are there contraindications that dictate why you shouldn't have it? And we're providing that ongoing support and evaluation to ensure that you're getting the response that you're looking for.

What's Next?

Thank you for joining me for this third video in our series where I have explained this new concept about using laser light to treat the genitourinary symptoms of menopause, the device that we use called MonaLisa Touch and the results that can be expected from that. In our next video, I'm going to explain to you in even further detail how we do the procedure, what you can expect during the procedure, what you can expect afterwards, and the kind of followup that we will be providing.

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