{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T22:35:46Z","timestamp":1773527746583,"version":"3.50.1"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>To improve understanding of genitourinary symptoms (GUS) in women with breast cancer (BC).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Women with BC completed a survey assessing the type, severity, and impact of GUS experienced, and perceptions of treatment options.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Surveys were completed by 506 women: median age 60\u00a0years (range 30 \u2013 83). The majority reported: being sexually active (52%); currently taking endocrine therapy (58%); and having early-stage BC (84%). 69% had GUS, with some changing (5%) or stopping (4%) endocrine therapy as a result. Vaginal dryness was the most common symptom (62%), followed by pain during penetration (41%) and itch (33%). Only 44% recalled being warned by their cancer doctor that BC treatment can cause GUS, and 38% reported never being asked about GUS. Being uncomfortable talking to a male healthcare professional was a moderate or major barrier to accessing advice and treatment for GUS in 28% of respondents. A minority reported using vaginal: lubricants (40%); moisturisers (25%); or oestrogens (16%). Amongst those using vaginal oestrogens, 45% found they helped \u201cquite a bit\u201d or \u201cvery much\u201d. The most frequently reported moderate to major barrier to using vaginal oestrogens was product information warning against use in women with BC.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Although GUS are very common in women with BC, the majority of women in our study do not recall being warned or asked about these symptoms. Healthcare professionals should initiate conversations about GUS and treatment options with women with BC to help reduce the impact of these symptoms.\n<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00520-025-09297-w","type":"journal-article","created":{"date-parts":[[2025,3,9]],"date-time":"2025-03-09T23:46:16Z","timestamp":1741563976000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Genitourinary symptoms in women with breast cancer: frequency, severity and impact"],"prefix":"10.1007","volume":"33","author":[{"given":"Antonia","family":"Pearson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haryana M.","family":"Dhillon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janine","family":"Lombard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha","family":"Hickey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda E.","family":"Kiely","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"issue":"1","key":"9297_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10549-015-3434-z","volume":"152","author":"S Mazzarello","year":"2015","unstructured":"Mazzarello S et al (2015) Management of urogenital atrophy in breast cancer patients: a systematic review of available evidence from randomized trials. Breast Cancer Res Treat 152(1):1\u20138","journal-title":"Breast Cancer Res Treat"},{"issue":"2","key":"9297_CR2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3390\/jpm5020050","volume":"5","author":"J Lester","year":"2015","unstructured":"Lester J et al (2015) Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue. J Pers Med 5(2):50\u201366","journal-title":"J Pers Med"},{"issue":"10","key":"9297_CR3","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1097\/GME.0000000000000329","volume":"21","author":"DJ Portman","year":"2014","unstructured":"Portman DJ, Gass ML (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","journal-title":"Menopause"},{"issue":"21","key":"9297_CR4","doi-asserted-by":"publisher","first-page":"4261","DOI":"10.1200\/JCO.2004.08.029","volume":"22","author":"L Fallowfield","year":"2004","unstructured":"Fallowfield L et al (2004) Quality of life of postmenopausal women in the Arimidex, Tamoxifen, Alone or in Combination (ATAC) adjuvant breast cancer trial. J Clin Oncol 22(21):4261\u20134271","journal-title":"J Clin Oncol"},{"issue":"2","key":"9297_CR5","doi-asserted-by":"publisher","first-page":"108","DOI":"10.3816\/CBC.2009.n.020","volume":"9","author":"SN Chin","year":"2009","unstructured":"Chin SN et al (2009) Prevalence and severity of urogenital symptoms in postmenopausal women receiving endocrine therapy for breast cancer. Clin Breast Cancer 9(2):108\u2013117","journal-title":"Clin Breast Cancer"},{"issue":"2","key":"9297_CR6","doi-asserted-by":"publisher","first-page":"219","DOI":"10.3109\/13697137.2014.975197","volume":"18","author":"S Salvatore","year":"2015","unstructured":"Salvatore S et al (2015) Sexual function after fractional microablative CO(2) laser in women with vulvovaginal atrophy. Climacteric 18(2):219\u2013225","journal-title":"Climacteric"},{"issue":"6","key":"9297_CR7","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.clbc.2015.06.005","volume":"15","author":"N Biglia","year":"2015","unstructured":"Biglia N et al (2015) Genitourinary syndrome of menopause in breast cancer survivors: are we facing new and safe hopes? Clin Breast Cancer 15(6):413\u2013420","journal-title":"Clin Breast Cancer"},{"key":"9297_CR8","doi-asserted-by":"crossref","unstructured":"Collaborative Group on Hormonal Factors in Breast Cancer (2019) Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 394:1159-1168","DOI":"10.1016\/S0140-6736(19)31709-X"},{"key":"9297_CR9","doi-asserted-by":"crossref","unstructured":"Bhupathiraju SN et al (2018) Vaginal estrogen use and chronic disease risk in the Nurses' Health Study. Menopause 26(6):603\u2013610.","DOI":"10.1097\/GME.0000000000001284"},{"issue":"1","key":"9297_CR10","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/GME.0000000000000956","volume":"25","author":"CJ Crandall","year":"2018","unstructured":"Crandall CJ et al (2018) Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women\u2019s Health Initiative Observational Study. Menopause 25(1):11\u201320","journal-title":"Menopause"},{"issue":"1","key":"9297_CR11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1080\/cmt.6.1.45.52","volume":"6","author":"JE Dew","year":"2003","unstructured":"Dew JE, Wren BG, Eden JA (2003) A cohort study of topical vaginal estrogen therapy in women previously treated for breast cancer. Climacteric 6(1):45\u201352","journal-title":"Climacteric"},{"issue":"10","key":"9297_CR12","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1093\/jnci\/93.10.754","volume":"93","author":"ES O'Meara","year":"2001","unstructured":"O\u2019Meara ES et al (2001) Hormone replacement therapy after a diagnosis of breast cancer in relation to recurrence and mortality. J Natl Cancer Inst 93(10):754\u2013762","journal-title":"J Natl Cancer Inst"},{"issue":"2","key":"9297_CR13","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10549-012-2198-y","volume":"135","author":"I Le Ray","year":"2012","unstructured":"Le Ray I et al (2012) Local estrogen therapy and risk of breast cancer recurrence among hormone-treated patients: a nested case-control study. Breast Cancer Res Treat 135(2):603\u2013609","journal-title":"Breast Cancer Res Treat"},{"issue":"10","key":"9297_CR14","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1093\/jnci\/djac112","volume":"114","author":"S Cold","year":"2022","unstructured":"Cold S et al (2022) Systemic or vaginal hormone therapy after early breast cancer: a Danish observational cohort study. J Natl Cancer Inst 114(10):1347\u20131354","journal-title":"J Natl Cancer Inst"},{"key":"9297_CR15","doi-asserted-by":"crossref","unstructured":"American College of, O., P. Gynecologists\u2019 Committee on Gynecologic, and R. Farrell, ACOG Committee Opinion No. 659 (2016) The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol 127(3):e93\u20136","DOI":"10.1097\/AOG.0000000000001351"},{"key":"9297_CR16","unstructured":"Cancer Australia (2016) Management of menopausal symptoms in women who have received breast cancer treatment: systematic review. Cancer Australia, Surry Hills"},{"key":"9297_CR17","unstructured":"Australasian menopause society. Vaginal health after breast cancer: a guide for patients. 2018 [cited 2024 May]; Available from: https:\/\/www.menopause.org.au\/health-info\/fact-sheets\/vaginal-health-after-breast-cancer-a-guide-for-patients"},{"issue":"7","key":"9297_CR18","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1097\/GME.0000000000002028","volume":"29","author":"SS Faubion","year":"2022","unstructured":"Faubion SS et al (2022) The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 29(7):767\u2013794","journal-title":"Menopause"},{"issue":"9","key":"9297_CR19","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1097\/GME.0000000000000316","volume":"21","author":"JE Manson","year":"2014","unstructured":"Manson JE et al (2014) Why the product labeling for low-dose vaginal estrogen should be changed. Menopause 21(9):911\u2013916","journal-title":"Menopause"},{"issue":"6","key":"9297_CR20","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1007\/s12282-021-01260-x","volume":"28","author":"A Pearson","year":"2021","unstructured":"Pearson A, Dhillon HM, Kiely BE (2021) Genitourinary symptoms in women with breast cancer: what do oncology health professionals think and do about them? Breast Cancer 28(6):1243\u20131251","journal-title":"Breast Cancer"},{"issue":"2","key":"9297_CR21","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1097\/GME.0000000000000281","volume":"22","author":"AJ Huang","year":"2015","unstructured":"Huang AJ et al (2015) Day-to-day impact of vaginal aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women. Menopause 22(2):144\u2013154","journal-title":"Menopause"},{"issue":"1","key":"9297_CR22","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.ajog.2003.12.027","volume":"191","author":"ST Brookes","year":"2004","unstructured":"Brookes ST et al (2004) A scored form of the Bristol female lower urinary tract symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am J Obstet Gynecol 191(1):73\u201382","journal-title":"Am J Obstet Gynecol"},{"key":"9297_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","volume":"95","author":"PA Harris","year":"2019","unstructured":"Harris PA et al (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95:103208","journal-title":"J Biomed Inform"},{"issue":"2","key":"9297_CR24","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris PA et al (2009) Research electronic data capture (REDCap)\u2013a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377\u2013381","journal-title":"J Biomed Inform"},{"issue":"11","key":"9297_CR25","doi-asserted-by":"publisher","first-page":"2737","DOI":"10.1200\/JCO.1995.13.11.2737","volume":"13","author":"RJ Couzi","year":"1995","unstructured":"Couzi RJ, Helzlsouer KJ, Fetting JH (1995) Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. J Clin Oncol 13(11):2737\u20132744","journal-title":"J Clin Oncol"},{"issue":"4","key":"9297_CR26","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1080\/13697130802244422","volume":"11","author":"C Antoine","year":"2008","unstructured":"Antoine C et al (2008) A survey among breast cancer survivors: treatment of the climacteric after breast cancer. Climacteric 11(4):322\u2013328","journal-title":"Climacteric"},{"issue":"1","key":"9297_CR27","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1186\/s12889-024-19280-5","volume":"24","author":"Y Fang","year":"2024","unstructured":"Fang Y et al (2024) Mapping global prevalence of menopausal symptoms among middle-aged women: a systematic review and meta-analysis. BMC Public Health 24(1):1767","journal-title":"BMC Public Health"},{"issue":"6","key":"9297_CR28","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1007\/s11136-021-03003-z","volume":"31","author":"R Campbell","year":"2022","unstructured":"Campbell R et al (2022) Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies. Qual Life Res 31(6):1597\u20131620","journal-title":"Qual Life Res"},{"issue":"12","key":"9297_CR29","doi-asserted-by":"publisher","first-page":"1418","DOI":"10.1097\/GME.0000000000001148","volume":"25","author":"E Moral","year":"2018","unstructured":"Moral E et al (2018) The impact of genitourinary syndrome of menopause on well-being, functioning, and quality of life in postmenopausal women. Menopause 25(12):1418\u20131423","journal-title":"Menopause"},{"issue":"3","key":"9297_CR30","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1080\/13697137.2018.1446930","volume":"21","author":"S Palacios","year":"2018","unstructured":"Palacios S et al (2018) The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric 21(3):286\u2013291","journal-title":"Climacteric"},{"issue":"5","key":"9297_CR31","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1001\/jamainternmed.2018.0116","volume":"178","author":"CM Mitchell","year":"2018","unstructured":"Mitchell CM et al (2018) Efficacy of vaginal estradiol or vaginal moisturizer vs placebo for treating postmenopausal vulvovaginal symptoms a randomized clinical trial. JAMA Intern Med 178(5):681\u2013690","journal-title":"JAMA Intern Med"},{"issue":"3","key":"9297_CR32","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.jsxm.2017.01.010","volume":"14","author":"SA Kingsberg","year":"2017","unstructured":"Kingsberg SA et al (2017) The Women\u2019s EMPOWER Survey: identifying women\u2019s perceptions on vulvar and vaginal atrophy and its treatment. J Sex Med 14(3):413\u2013424","journal-title":"J Sex Med"},{"issue":"2","key":"9297_CR33","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1007\/s10549-014-2930-x","volume":"145","author":"G Donders","year":"2014","unstructured":"Donders G et al (2014) Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor()) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study. Breast Cancer Res Treat 145(2):371\u2013379","journal-title":"Breast Cancer Res Treat"},{"key":"9297_CR34","doi-asserted-by":"crossref","unstructured":"Sanchez-Rovira P et al (2017) 0.005% estriol vaginal gel in hormone receptor-positive postmenopausal women with early stage breast cancer in treatment with aromatase inhibitors (AIs) in the adjuvant setting. A phase II prospective, randomized, double-blind placebo-controlled study - \"The Blissafe study\". Cancer Research. Conference: San Antonio Breast Cancer Symposium, SABCS. 78(4 Supplement 1)","DOI":"10.1158\/1538-7445.SABCS17-P3-12-01"},{"issue":"3","key":"9297_CR35","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1001\/jamaoncol.2016.3904","volume":"3","author":"ME Melisko","year":"2017","unstructured":"Melisko ME et al (2017) Vaginal testosterone cream vs estradiol vaginal ring for vaginal dryness or decreased libido in women receiving aromatase inhibitors for early-stage breast cancer a randomized clinical trial. JAMA Oncol 3(3):313\u2013319","journal-title":"JAMA Oncol"},{"key":"9297_CR36","doi-asserted-by":"publisher","unstructured":"Van Cauwenberge J et al (2023) RE: systemic or vaginal hormone therapy after early breast cancer: a Danish observational cohort study. JNCI: J Natl Cancer Inst 115(2):222\u2013223. https:\/\/doi.org\/10.1093\/jnci\/djac213","DOI":"10.1093\/jnci\/djac213"},{"issue":"2","key":"9297_CR37","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1093\/jnci\/djac211","volume":"115","author":"HJ Pederson","year":"2022","unstructured":"Pederson HJ et al (2022) RE: systemic or vaginal hormone therapy after early breast cancer: a Danish observational cohort study. JNCI: J Natl Cancer Inst 115(2):220\u2013221","journal-title":"JNCI: J Natl Cancer Inst"},{"issue":"2","key":"9297_CR38","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1093\/jnci\/djac213","volume":"115","author":"RT Chlebowski","year":"2022","unstructured":"Chlebowski RT, Aragaki AK, Pan K (2022) RE: Systemic or vaginal hormone therapy after early breast cancer: a Danish observational cohort study. JNCI: J Natl Cancer Inst 115(2):222\u2013223","journal-title":"JNCI: J Natl Cancer Inst"},{"issue":"1","key":"9297_CR39","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1097\/GME.0000000000000955","volume":"25","author":"VL Cruz","year":"2018","unstructured":"Cruz VL et al (2018) Randomized, double-blind, placebo-controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women. Menopause 25(1):21\u201328","journal-title":"Menopause"},{"issue":"6","key":"9297_CR40","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1097\/GME.0000000000001053","volume":"25","author":"T Pagano","year":"2018","unstructured":"Pagano T et al (2018) Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study. Menopause J N Am Menopause Soc 25(6):657\u2013662","journal-title":"Menopause J N Am Menopause Soc"},{"key":"9297_CR41","doi-asserted-by":"crossref","unstructured":"Pearson A et al (2019) Vaginal CO2 laser for the treatment of vulvovaginal atrophy in women with breast cancer: LAAVA pilot study. Breast Cancer Res Treat 178(1):135-140","DOI":"10.1007\/s10549-019-05384-9"},{"key":"9297_CR42","unstructured":"FDA. FDA Warns Against Use of Energy-Based Devices to Perform Vaginal 'Rejuvenation' or Vaginal Cosmetic Procedures: FDA Safety Communication. 2018 16\/11\/2018 [cited 2020 26\/08\/2020]; Available from:  https:\/\/www.fda.gov\/news-events\/press-announcements\/statement-fda-commissioner-scott-gottlieb-md-efforts-safeguard-womens-health-deceptive-health-claims"}],"container-title":["Supportive Care in Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-025-09297-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-025-09297-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-025-09297-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T07:09:54Z","timestamp":1745305794000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00520-025-09297-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":42,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["9297"],"URL":"https:\/\/doi.org\/10.1007\/s00520-025-09297-w","relation":{},"ISSN":["0941-4355","1433-7339"],"issn-type":[{"value":"0941-4355","type":"print"},{"value":"1433-7339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,10]]},"assertion":[{"value":"25 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval was granted by the Northern Sydney Local Health District Human Research Ethics Committee, 2020\/ETH01955.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Martha Hickey: Clinical Expert for NICE Guidelines on Menopause, NHMC Investigator Grant, Leadership (L2) level. Belinda Kiely: funding for giving talks from Eisai, MSD, Novartis and Astra Zeneca, funding for advisory boards from Roche and Gilead, registration for online meetings \u2013 MSD, Novartis, Pfizer. Janine Lombard: Advisory boards \u2013 Astra Zeneca and GSK; Financial support to attend virtual education meetings from AZ, GSK, Novartis; Honoraria for educational speaker for Gilead and Eisai. Antonia Pearson: Financial support to attend virtual education meetings from GSK and Novartis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"258"}}