{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:20:27Z","timestamp":1787584827703,"version":"build-2736575974"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005378","name":"Hacettepe University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005378","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to investigate the acute effects of pelvic floor muscle training (PFMT) on vaginal dryness in postmenopausal women using an objective measurement method within the framework of a randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This randomized controlled pilot study included postmenopausal women who were allocated into two groups: a PFMT group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200945) and a control group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200958). The PFMT group performed a single set of exercises in the lithotomy position, consisting of 10 slow and 10 fast pelvic floor muscle contractions. The control group received no intervention.\n                    <\/jats:p>\n                    <jats:p>The primary outcome was vaginal dryness, assessed objectively using the Vaginal Lubrication Kit (VLK). Secondary outcomes included Visual Analog Scale (VAS) scores for vaginal dryness, burning, and dyspareunia, as well as smear test results. Associations of baseline VLK and VAS scores with smear test findings were analyzed. Pre- and post-treatment differences, as well as between-group comparisons, were evaluated using parametric and non-parametric tests, with a 95% confidence interval.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 105 women randomized, 103 completed the study. Baseline characteristics did not differ significantly between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Following the intervention, the PFMT group demonstrated statistically significant improvements in VLK scores (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt; 0.05). Baseline VAS scores were statistically significantly negatively correlated with the initial VLK score (VAS vaginal dryness, VLK r: \u22120.571, VAS vaginal burning, VLK r: \u22120.451, VAS dyspareunia, VLK r: \u22120.460,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). In addition, the presence of atrophy in the pre-treatment smear test was found to be statistically significantly negatively correlated with the initial VLK score (r: \u22120.346,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PFMT significantly reduced vaginal dryness in postmenopausal women compared with the control group. It may be considered a potential treatment option for vaginal dryness. The VLK appears to be a promising objective tool for both assessing vaginal dryness and monitoring treatment outcomes in postmenopausal women. Although these findings are promising, they should be interpreted with caution given the pilot design and the short follow-up. Larger randomized trials are needed to confirm the long-term efficacy of PFMT and to validate the VLK as an objective outcome measure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-025-08267-1","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:29:14Z","timestamp":1768213754000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Objective evaluation of the acute effects of pelvic floor muscle training on vaginal dryness in postmenopausal women: a randomized controlled pilot study"],"prefix":"10.1007","volume":"313","author":[{"given":"Hatice Gulsah","family":"Kurne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nebahat","family":"Uzunay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doruk Cevdi","family":"Katlan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turkan","family":"Akbayrak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"issue":"10","key":"8267_CR1","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1097\/GME.0000000000000329","volume":"21","author":"DJ Portman","year":"2014","unstructured":"Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference Panel (2014) Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the international society for the study of women\u2019s sexual health and the north American menopause society. Menopause 21(10):1063\u20131068. https:\/\/doi.org\/10.1097\/GME.0000000000000329","journal-title":"Menopause"},{"issue":"2","key":"8267_CR2","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.maturitas.2009.03.021","volume":"63","author":"RE Nappi","year":"2009","unstructured":"Nappi RE, Lachowsky M (2009) Menopause and sexuality: prevalence of symptoms and impact on quality of life. Maturitas 63(2):138\u2013141. https:\/\/doi.org\/10.1016\/j.maturitas.2009.03.021","journal-title":"Maturitas"},{"issue":"3","key":"8267_CR3","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1080\/13697137.2018.1446930","volume":"21","author":"S Palacios","year":"2018","unstructured":"Palacios S, Nappi RE, Bruyniks N, Particco M, Panay N, EVES Study Investigators (2018) The European vulvovaginal epidemiological survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric 21(3):286\u2013291. https:\/\/doi.org\/10.1080\/13697137.2018.1446930","journal-title":"Climacteric"},{"issue":"2","key":"8267_CR4","doi-asserted-by":"publisher","first-page":"129","DOI":"10.5978\/islsm.14-OR-11","volume":"23","author":"MS Lee","year":"2014","unstructured":"Lee MS (2014) Treatment of vaginal relaxation syndrome with an erbium: YAG laser using 90 degrees and 360 degrees scanning scopes: a pilot study and short-term results. Laser Ther 23(2):129\u2013138. https:\/\/doi.org\/10.5978\/islsm.14-OR-11","journal-title":"Laser Ther"},{"issue":"11","key":"8267_CR5","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1089\/jwh.2010.2151","volume":"20","author":"JA Simon","year":"2011","unstructured":"Simon JA (2011) Identifying and treating sexual dysfunction in postmenopausal women: the role of estrogen. J Womens Health (Larchmt) 20(11):1453\u20131465","journal-title":"J Womens Health (Larchmt)"},{"issue":"3","key":"8267_CR6","doi-asserted-by":"publisher","first-page":"154","DOI":"10.6118\/jmm.2016.22.3.154","volume":"22","author":"M Shirvani","year":"2016","unstructured":"Shirvani M, Heidari M (2016) Quality of life in postmenopausal female members and non-members of the elderly support association. J Menopausal Med 22(3):154\u2013160","journal-title":"J Menopausal Med"},{"issue":"3","key":"8267_CR7","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.ogc.2018.07.010","volume":"45","author":"CM Mitchell","year":"2018","unstructured":"Mitchell CM, Waetjen LE (2018) Genitourinary changes with aging. Obstet Gynecol Clin North Am 45(3):737\u2013750. https:\/\/doi.org\/10.1016\/j.ogc.2018.07.010","journal-title":"Obstet Gynecol Clin North Am"},{"issue":"3","key":"8267_CR8","doi-asserted-by":"publisher","first-page":"419","DOI":"10.31086\/tjgeri.2018344057","volume":"21","author":"T Var","year":"2018","unstructured":"Var T, Turkcapar AF, Efe C, Aktulay A (2018) Sexual function and quality of life in a sample of postmenopausal women admitted in a menopause clinic in Turkey. Turk J Geriatr 21(3):419\u2013428","journal-title":"Turk J Geriatr"},{"issue":"1","key":"8267_CR9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1038\/sj.ijir.3901250","volume":"17","author":"EO Laumann","year":"2005","unstructured":"Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T, GSSAB Investigators\u2019 Group (2005) Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the global study of sexual attitudes and behaviors. Int J Impot Res 17(1):39\u201357. https:\/\/doi.org\/10.1038\/sj.ijir.3901250","journal-title":"Int J Impot Res"},{"issue":"9","key":"8267_CR10","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001500.pub3","volume":"2016","author":"A Lethaby","year":"2016","unstructured":"Lethaby A, Ayeleke RO, Roberts H (2016) Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev 2016(9):CD001500. https:\/\/doi.org\/10.1002\/14651858.CD001500.pub3","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"8267_CR11","doi-asserted-by":"publisher","first-page":"151","DOI":"10.3109\/13697137.2015.1124259","volume":"19","author":"D Edwards","year":"2016","unstructured":"Edwards D, Panay N (2016) Treating vulvovaginal atrophy\/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric 19(2):151\u2013161. https:\/\/doi.org\/10.3109\/13697137.2015.1124259","journal-title":"Climacteric"},{"key":"8267_CR12","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.maturitas.2019.03.002","volume":"125","author":"J Mercier","year":"2019","unstructured":"Mercier J, Morin M, Zaki D, Reichetzer B, Lemieux MC, Khalif\u00e9 S et al (2019) Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: a single-arm feasibility study. Maturitas 125:57\u201362. https:\/\/doi.org\/10.1016\/j.maturitas.2019.03.002","journal-title":"Maturitas"},{"issue":"2","key":"8267_CR13","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3109\/13697137.2015.1113517","volume":"19","author":"N Bruyniks","year":"2016","unstructured":"Bruyniks N, Nappi RE, Castelo-Branco C, de Villiers TJ, Simon J (2016) Effect of ospemifene on moderate or severe symptoms of vulvar and vaginal atrophy. Climacteric 19(2):60\u201365. https:\/\/doi.org\/10.3109\/13697137.2015.1113517","journal-title":"Climacteric"},{"issue":"2","key":"8267_CR14","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/lsm.22637","volume":"49","author":"Y Tadir","year":"2017","unstructured":"Tadir Y, Gaspar A, Lev-Sagie A, Alexiades M, Alinsod R, Bader A et al (2017) Light and energy based therapeutics for genitourinary syndrome of menopause: consensus and controversies. Lasers Surg Med 49(2):137\u2013159. https:\/\/doi.org\/10.1002\/lsm.22637","journal-title":"Lasers Surg Med"},{"issue":"9","key":"8267_CR15","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1097\/GME.0b013e3182a122c2","volume":"20","author":"North American Menopause Society","year":"2013","unstructured":"North American Menopause Society (2013) Management of symptomatic vulvovaginal atrophy: 2013 position statement of the north American menopause society. Menopause 20(9):888\u2013902. https:\/\/doi.org\/10.1097\/GME.0b013e3182a122c2","journal-title":"Menopause"},{"issue":"6","key":"8267_CR16","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1111\/jsm.12125","volume":"10","author":"J Chen","year":"2013","unstructured":"Chen J, Geng L, Song X, Li H, Giordan N, Liao Q (2013) Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med 10(6):1575\u20131584. https:\/\/doi.org\/10.1111\/jsm.12125","journal-title":"J Sex Med"},{"issue":"10","key":"8267_CR17","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.7326\/ANNALS-24-00610","volume":"177","author":"ER Danan","year":"2024","unstructured":"Danan ER, Sowerby C, Ullman KE, Ensrud K, Forte ML, Zerzan N, Anthony M, Kalinowski C, Abdi HI, Friedman JK, Landsteiner A, Greer N, Nardos R, Fok C, Dahm P, Butler M, Wilt TJ, Diem S (2024) Hormonal treatments and vaginal moisturizers for genitourinary syndrome of menopause: a systematic review. Ann Intern Med 177(10):1400\u20131414. https:\/\/doi.org\/10.7326\/ANNALS-24-00610","journal-title":"Ann Intern Med"},{"issue":"2","key":"8267_CR18","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1111\/jsm.12746","volume":"12","author":"IH Braekken","year":"2015","unstructured":"Braekken IH, Majida M, Ellstrom EM et al (2015) Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. J Sex Med 12(2):470\u2013480. https:\/\/doi.org\/10.1111\/jsm.12746","journal-title":"J Sex Med"},{"issue":"7","key":"8267_CR19","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1111\/j.1743-6109.2012.02721.x","volume":"9","author":"M Liebergall-Wischnitzer","year":"2012","unstructured":"Liebergall-Wischnitzer M, Paltiel O, Hochner CD, Lavy Y, Manor O, Woloski Wruble AC (2012) Sexual function and quality of life of women with stress urinary incontinence: a randomized controlled trial comparing the Paula method (circular muscle exercises) to pelvic floor muscle training (PFMT) exercises. J Sex Med 9(7):1613\u20131623","journal-title":"J Sex Med"},{"issue":"1","key":"8267_CR20","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1097\/GME.0000000000001416","volume":"27","author":"MFR Paraiso","year":"2020","unstructured":"Paraiso MFR, Ferrando CA, Sokol ER, Rardin CR, Matthews CA, Karram MM, Iglesia CB (2020) A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: the velvet trial. Menopause 27(1):50\u201356. https:\/\/doi.org\/10.1097\/GME.0000000000001416","journal-title":"Menopause"},{"issue":"5","key":"8267_CR21","doi-asserted-by":"publisher","first-page":"437","DOI":"10.2147\/IJWH.S44579","volume":"12","author":"SJ Parish","year":"2013","unstructured":"Parish SJ, Nappi RE, Krychman ML, Kellogg-Spadt S, Simon JA, Goldstein JA et al (2013) Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Womens Health 12(5):437\u2013447. https:\/\/doi.org\/10.2147\/IJWH.S44579","journal-title":"Int J Womens Health"},{"issue":"76","key":"8267_CR22","first-page":"45","volume":"24","author":"S Stevens","year":"2011","unstructured":"Stevens S (2011) Schirmer\u2019s test. Community Eye Health 24(76):45","journal-title":"Community Eye Health"},{"key":"8267_CR23","doi-asserted-by":"publisher","DOI":"10.25259\/CMAS_03_06_2021","volume":"19","author":"M Kamal","year":"2022","unstructured":"Kamal M, Topiwala F (2022) Nonneoplastic cervical cytology. Cytojournal 19:25. https:\/\/doi.org\/10.25259\/CMAS_03_06_2021","journal-title":"Cytojournal"},{"issue":"6","key":"8267_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/13697137.2025.2517131","volume":"28","author":"A Ozturk","year":"2025","unstructured":"Li FG, Knapman BL, Nesbitt-Hawes E, Deans R, Abbott J. Effects of repeat fractional CO\u2082 laser for postmenopausal vaginal symptoms following unblinding from a double-blind RCT. Climacteric. 2025;28(6):1\u20139. https:\/\/doi.org\/10.1080\/13697137.2025.2517131","journal-title":"Climacteric"},{"issue":"8","key":"8267_CR25","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1093\/jsxmed\/qdae068","volume":"21","author":"GMV Pereira","year":"2024","unstructured":"Pereira GMV, Almeida CM, Martinho N, de Andra KC, Juliato CRT, Brito LGO (2024) Pelvic floor muscle training vs radiofrequency for women with vaginal laxity: randomized clinical trial. J Sex Med 21(8):700\u2013708. https:\/\/doi.org\/10.1093\/jsxmed\/qdae068","journal-title":"J Sex Med"},{"issue":"3","key":"8267_CR26","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.maturitas.2014.12.006","volume":"80","author":"A Perino","year":"2015","unstructured":"Perino A, Calligaro A, Forlani F, Tiberio C, Cucinella G, Svelato A et al (2015) Vulvo-vaginal atrophy: a new treatment modality using thermo-ablative fractional CO2 laser. Maturitas 80(3):296\u2013301. https:\/\/doi.org\/10.1016\/j.maturitas.2014.12.006","journal-title":"Maturitas"},{"issue":"5","key":"8267_CR27","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1080\/13697137.2020.1724942","volume":"23","author":"J Mercier","year":"2020","unstructured":"Mercier J, Morin M, Tang A, Reichetzer B, Lemieux MC, Samir K, Zaki D, Gougeon F, Dumoulin C (2020) Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric 23(5):468\u2013473. https:\/\/doi.org\/10.1080\/13697137.2020.1724942","journal-title":"Climacteric"},{"issue":"4","key":"8267_CR28","first-page":"235","volume":"32","author":"VP Piassarolli","year":"2010","unstructured":"Piassarolli VP, Hardy E, Andrade NF et al (2010) Pelvic floor muscle training in female sexual dysfunctions. Rev Bras Ginecol Obstet 32(4):235\u2013240","journal-title":"Rev Bras Ginecol Obstet"},{"key":"8267_CR29","volume-title":"Pelvic floor muscle training for the prevention of pelvic floor dysfunction","author":"National Institute for Health and Care Excellence (NICE)","year":"2021","unstructured":"National Institute for Health and Care Excellence (NICE) (2021) Pelvic floor muscle training for the prevention of pelvic floor dysfunction. NICE, London"},{"issue":"5","key":"8267_CR30","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1016\/j.contraception.2005.12.007","volume":"73","author":"RE Nappi","year":"2006","unstructured":"Nappi RE, Liekens G, Brandenburg U (2006) Attitudes, perceptions and knowledge about the vagina: the international vagina dialogue survey. Contraception 73(5):493\u2013500. https:\/\/doi.org\/10.1016\/j.contraception.2005.12.007","journal-title":"Contraception"},{"issue":"3","key":"8267_CR31","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.maturitas.2010.08.001","volume":"67","author":"RE Nappi","year":"2010","unstructured":"Nappi RE, Kokot-Kierepa M (2010) Women\u2019s voices in the menopause: results from an international survey on vaginal atrophy. Maturitas 67(3):233\u2013238. https:\/\/doi.org\/10.1016\/j.maturitas.2010.08.001","journal-title":"Maturitas"},{"issue":"6","key":"8267_CR32","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1111\/jsm.12190","volume":"10","author":"SA Kingsberg","year":"2013","unstructured":"Kingsberg SA, Wysocki S, Magnus L, Krychman ML (2013) Vulvar and vaginal atrophy in postmenopausal women: findings from the revive (real women\u2019s views of treatment options for menopausal vaginal changes) survey. J Sex Med 10(6):1790\u20131799. https:\/\/doi.org\/10.1111\/jsm.12190","journal-title":"J Sex Med"},{"issue":"4","key":"8267_CR33","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1097\/gme.0b013e31815a5168","volume":"15","author":"KB Levine","year":"2008","unstructured":"Levine KB, Williams RE, Hartmann KE (2008) Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause 15(4):661\u2013666","journal-title":"Menopause"},{"key":"8267_CR34","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1016\/j.jsxm.2021.05.005","volume":"18","author":"MM Franco","year":"2021","unstructured":"Franco MM, Pena CC, de Freitas LM, Antonio FI, Lara LAS, Ferreira CHJ (2021) Pelvic floor muscle training effect in sexual function in postmenopausal women: a randomized controlled trial. J Sex Med 18:1236\u20131244 ([Epub ahead of print] 2024)","journal-title":"J Sex Med"},{"issue":"5","key":"8267_CR35","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1071\/SH17203","volume":"15","author":"S Nazarpour","year":"2018","unstructured":"Nazarpour S, Simbar M, Majd HA et al (2018) Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women: a randomised clinical trial. Sex Health 15(5):396\u2013402","journal-title":"Sex Health"},{"issue":"2","key":"8267_CR36","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1080\/13697130701599876","volume":"10","author":"RE Nappi","year":"2007","unstructured":"Nappi RE (2007) New attitudes to sexuality in the menopause: clinical evaluation and diagnosis. Climacteric 10(2):105\u2013108. https:\/\/doi.org\/10.1080\/13697130701599876","journal-title":"Climacteric"},{"key":"8267_CR37","first-page":"3","volume":"8","author":"GA Bachmann","year":"1992","unstructured":"Bachmann GA, Notelovitz M, Kelly SJ, Thompson C, Owens A (1992) Long-term non-hormonal treatment of vaginal dryness. Clin Pract Sexuality 8:3\u20138","journal-title":"Clin Pract Sexuality"},{"issue":"1","key":"8267_CR38","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3109\/13697137.2015.1070564","volume":"18","author":"N Panay","year":"2015","unstructured":"Panay N (2015) Genitourinary syndrome of the menopause\u2013dawn of a new era? Climacteric 18(1):13\u201317. https:\/\/doi.org\/10.3109\/13697137.2015.1070564","journal-title":"Climacteric"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08267-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-025-08267-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08267-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T10:35:06Z","timestamp":1768473306000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-025-08267-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8267"],"URL":"https:\/\/doi.org\/10.1007\/s00404-025-08267-1","relation":{},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"assertion":[{"value":"1 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study protocol was approved by the Clinical Research Ethics Committee of the hospital (Date: December 22, 2023; approval number: 360) and registered at ClinicalTrials.gov (NCT06294197).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all participants prior to enrollment.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}],"article-number":"32"}}