Evaluation of the Efficacy and Safety of Lactobacillus Crispatus M247 (Crispact®) With Vaginal Laser Therapy in Menopausal Women With Atrophic Vulvovaginitis (VVA)

Inclusion Criteria: * Menopausal women with no menstrual cycle for \>12 months. * Diagnosed with atrophic vulvovaginitis (VVA) and experiencing related symptoms (vaginal dryness, introital and profound dyspareunia, itching, burning, bleeding during intercourse). * Symptoms related to genitourinary syndrome of menopause (GSM), including urinary urgency, increased frequency, nocturia, recurrent cystitis, or post-coital cystitis. * Prior negative PAP test performed within one year of enrollment. * Women who are unresponsive to or dissatisfied with prior topical estrogen therapy or who have contraindications to local and/or systemic estrogen prescription. Exclusion Criteria: * Pregnancy or breastfeeding. * Presence of preneoplastic or neoplastic lesions of the cervix, vagina, or vulva. * Active genital and/or urinary tract infections. * Dermatological contraindications to laser therapy. * Ongoing systemic or local hormone therapy. * Neurological or psychiatric disorders. * Chronic systemic diseases of autoimmune or dysmetabolic nature.