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Breast Cancer Research : BCR Nov 2015Exposure to high levels of endogenous estrogens is a main risk factor for breast cancer in women, and in observational studies was found to be inversely associated with... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Exposure to high levels of endogenous estrogens is a main risk factor for breast cancer in women, and in observational studies was found to be inversely associated with physical activity. The objective of the present study is to determine the effect of physical activity interventions on sex hormone levels in healthy women.
METHODS
Electronic databases (MEDLINE, EMBASE, CENTRAL), from inception to December 2014, and reference lists of relevant reviews and clinical trials were searched, with no language restrictions applied. Randomized controlled trials (RCTs) were included if they compared any type of exercise intervention to no intervention or other interventions, and assessed the effects on estrogens, androgens or the sex hormone binding globulin (SHBG) in cancer-free women. Following the method described in the Cochrane Handbook for Systematic Reviews of Interventions, data on populations, interventions, and outcomes were extracted, and combined using the inverse-variance method and a random-effects model. A pre-established protocol was drawn up, in which the primary outcome was the difference in circulating estradiol concentrations between the physical activity (experimental) and the control groups after intervention. Pre-specified subgroup analyses and sensitivity analysis according to the risk of bias were conducted.
RESULTS
Data suitable for quantitative synthesis were available from 18 RCTs (1994 participants) for total estradiol and from 5 RCTs (1245 participants) for free estradiol. The overall effect of physical activity was a statistically significant decrease of both total estradiol (standardized mean difference [SMD] -0.12; 95 % confidence interval [CI] -0.20 to -0.03; P = 0.01; I (2) = 0 %) and free estradiol (SMD -0.20; 95 % CI -0.31 to -0.09; P = 0.0005; I (2) = 0 %). Subgroup analyses suggest that this effect is independent of menopausal status and is more noticeable for non-obese women and for high intensity exercise. Meta-analysis for secondary outcomes found that physical activity induces a statistically significant decline of free testosterone, androstenedione, dehydroepiandrosterone-sulfate and adiposity markers, while a significant increase of SHBG was observed.
CONCLUSIONS
Although the effect is relatively modest, physical activity induces a decrease in circulating sex hormones and this effect is not entirely explained by weight loss. The findings emphasize the benefits of physical activity for women.
Topics: Androgens; Estrogens; Female; Humans; Motor Activity; Randomized Controlled Trials as Topic
PubMed: 26541144
DOI: 10.1186/s13058-015-0647-3 -
Biomarkers in Body Fluids as Indicators of Skeletal Maturity: A Systematic Review and Meta-analysis.Rambam Maimonides Medical Journal Aug 2023This review aimed to critically appraise the evidence for biomarkers in blood serum, gingival crevicular fluid (GCF), saliva, and urine in comparison with standard... (Review)
Review
OBJECTIVES
This review aimed to critically appraise the evidence for biomarkers in blood serum, gingival crevicular fluid (GCF), saliva, and urine in comparison with standard radiographic indices for skeletal maturation assessment.
MATERIALS AND METHODS
A thorough literature search in multiple databases was conducted for biomarkers in body fluids for skeletal maturation assessed with cervical vertebrae in lateral cephalograms or on hand-wrist radiographs. Different combinations including free text, MeSH terms, and Boolean operators were used. Two researchers used strict inclusion and exclusion criteria to screen title, abstract, and full text, and used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 instrument for risk of bias assessment of individual studies. Meta-analysis was performed on eligible studies using RevMan 5 software.
RESULTS
A total of 344 articles were screened, of which 33 met the inclusion criteria and quality assessment. The skeletal maturity indicators included insulin-like growth factors (IGF-1), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), dehydroepiandrosterone sulfate (DHEAS), vitamin D binding protein (DBP), parathormone-related protein (PTHrP), osteocalcin, metalloproteins, and serotransferrin (TF) along with different metabolites. At puberty, a significant rise was seen in IGF-1, DBP, ALP, osteocalcin, TF, and BALP. However, the serum DHEAS and PTHrP increased from pre-pubertal to post-pubertal stages. Due to the data heterogeneity, a meta-analysis could be performed on seven studies in total on IGF-1 in serum and blood. Of these, five were included for data in males and six in females, and four studies on IGF-1 in serum and blood. A significant difference in IGF-1 levels was seen between stages of peak pubertal growth spurt (CS3 and CS4) and decelerating pubertal growth (CS5) compared with growth initiation stage (CS2).
CONCLUSIONS
Pubertal growth spurts were correlated with peak serum IGF-1 and BALP in both sexes individually. Peak ALP levels in GCF were correlated with the pubertal spurt in a combined sample of males and females. Standard biofluid collection protocols and homogeneity in sampling and methodology are strongly recommended for future research.
PubMed: 37669407
DOI: 10.5041/RMMJ.10506 -
Surgery For Obesity and Related... Jan 2022Bariatric surgery is an effective treatment for severe obesity. Several studies have been conducted on the effects of bariatric surgery on the reproductive function of... (Meta-Analysis)
Meta-Analysis Review
Effects of bariatric surgery on the menstruation- and reproductive-related hormones of women with obesity without polycystic ovary syndrome: a systematic review and meta-analysis.
BACKGROUND
Bariatric surgery is an effective treatment for severe obesity. Several studies have been conducted on the effects of bariatric surgery on the reproductive function of women with obesity who do not have polycystic ovary syndrome (PCOS).
OBJECTIVES
To evaluate the effects of bariatric surgery on the menstruation and reproductive related hormones of women of childbearing age with who do not have PCOS.
SETTING
A systematic review and meta-analysis at a university hospital.
METHODS
Online databases were searched for all studies reporting the efficacy of bariatric surgery for women with obesity until March 2021. The language of publication was limited to English and Chinese. Incidence of abnormal menstruation and reproductive-related hormone levels were the primary outcomes.
RESULTS
Fifteen studies comprising 725 patients were enrolled in this meta-analysis. Results showed a significantly lower incidence of abnormal menstruation (relative risk: .40, 95% confidence interval [CI]: .20-.79, P = .008) after bariatric surgery. Moreover, bariatric surgery led to a decrease in serum insulin levels (mean difference [MD] = -13.12 mIU/L, 95% CI: -15.03 to -11.22, P < .00001), glucose (MD = -.91 mmol/L, 95% CI: -1.26 to -.56, P < .00001), triglyceride (MD = -.61 g/L, 95% CI: -.76 to -.46, P < .00001), total testosterone (MD = -.22 ng/mL, 95% CI: -.24 to -.20, P < .00001), dehydroepiandrosterone (DHEA) (MD = -25.34 μg/dL, 95% CI: -31.19 to -19.49, P < .00001), estradiol (MD = -25.13 pg/mL, 95% CI: -34.13 to -16.13, P < .00001), and anti-Mullerian hormone (AMH) (MD = -.40 ng/mL, 95% CI: -.67 to -.13, P = .003). Serum sex hormone binding globulin (SHBG) levels increased after bariatric surgery (MD = 43.99 nmol/L, 95% CI: 34.99-52.99, P < .00001).
CONCLUSION
Bariatric surgery can lower fasting insulin, glucose, and triglyceride levels, reduce the incidence of abnormal menstruation, decrease total serum testosterone, DHEA, estradiol, and AMH levels, and increase SHBG level for women with obesity of childbearing age who do not have PCOS. This meta-analysis indicated that bariatric surgery could be effective in improving reproductive function for women with severe obesity.
Topics: Anti-Mullerian Hormone; Bariatric Surgery; Female; Humans; Menstruation; Obesity; Polycystic Ovary Syndrome; Testosterone
PubMed: 34756568
DOI: 10.1016/j.soard.2021.09.008 -
Annals of Palliative Medicine Aug 2021There is a close relationship between hormones, oxidative stress, and inflammatory factors and polycystic ovary syndrome (PCOS). This meta-analysis was conducted to... (Meta-Analysis)
Meta-Analysis
Efficacy of omega-3 polyunsaturated fatty acids on hormones, oxidative stress, and inflammatory parameters among polycystic ovary syndrome: a systematic review and meta-analysis.
BACKGROUND
There is a close relationship between hormones, oxidative stress, and inflammatory factors and polycystic ovary syndrome (PCOS). This meta-analysis was conducted to evaluate the changes in hormones, oxidative stress, and inflammatory factors of PCOS patients who were supplemented with omega-3 polyunsaturated fatty acids (n-3 PUFAs).
METHODS
The databases of PubMed, Cochrane Library, Embase, and Web of Science were searched from inception to February 2021. We have included all randomized controlled trials (RCTs) that reported the n-3 PUFA treatment in PCOS. Weighted mean differences (WMD) and 95% confidence interval (CI) were calculated, and either the fixed effects model or random effects model was used.
RESULTS
314 studies were initially identified, and 10 RCTs with 610 patients were finally included in the current study. Results suggested that PCOS patients with n-3 PUFAs supplementation may have a reduction in C-reactive protein (CRP; -8.97 mg/dL; 95% CI: -17.66 to -0.28 mg/dL; P=0.04; I2=99%); serum malondialdehyde (MDA; -0.40 mg/dL; 95% CI: -0.56 to -0.25 mg/dL; P<0.00001; I2=42); luteinizing hormone (LH; -1.33 mg/dL; 95% CI: -2.63 to -0.04 mg/dL; P=0.04; I2=0%); serum total testosterone (TT; -0.11 mg/dL; 95% CI: -0.18 to -0.04 mg/dL; P=0.02; I2=73%); and an increase in total antioxidant capacity (TAC; 72.24 mg/dL; 95% CI: 22.32 to 122.16 mg/dL; P=0.005; I2=50%) and serum sex hormone binding globulin (SHBG; 0.68 mg/dL; 95% CI: 0.06 to 1.31 mg/dL; P=0.03; I2=0%).However, no effect on glutathione (GSH; -12.63 mg/dL; 95% CI: -50.34 to 25.07 mg/dL; P=0.51; I2=56%), dehydroepiandrosterone sulfate (DHEAS; -0.01 mg/dL; 95% CI: -1.53 to 1.50 mg/dL; P=0.99; I2=78%), free androgen index (FAI; 0.00 mg/dL; 95% CI: -0.03 to 0.03 mg/dL; P=0.99; I2=0%), or follicle-stimulating hormone (FSH; 0.37 mg/dL; 95% CI: -0.55 to 1.29 mg/dL; P=0.43; I2=61) was found.
CONCLUSIONS
This meta-analysis showed that supplementation of n-3 PUFAs in PCOS women can significantly improve CRP, MDA, LH, TT, TAC, and SHBG, but did not affect the concentrations of GSH, DHEAS, FAI, or FSH.
Topics: Fatty Acids, Omega-3; Female; Hormones; Humans; Oxidative Stress; Polycystic Ovary Syndrome; Sex Hormone-Binding Globulin
PubMed: 34488386
DOI: 10.21037/apm-21-2018 -
Frontiers in Nutrition 2023Synbiotics, refer to a combination of probiotics and prebiotics in a form of synergism that beneficially affect the host's health by alternating the composition and/or...
BACKGROUND
Synbiotics, refer to a combination of probiotics and prebiotics in a form of synergism that beneficially affect the host's health by alternating the composition and/or function of the gut microbiota. Numerous meta-analyses of randomized clinical trials have proven that pro, pre-, and synbiotics supplementation has health outcomes in women with polycystic ovary syndrome (PCOS). However, the strength and quality of this evidence in aggregate have not yet been synthesized in great detail.
METHODS
PubMed, Scopus, Web of Sciences, and Google Scholar were searched up to March 2023. We pooled the mean difference and its 95% confidence interval (CI) by applying a random-effects model.
RESULTS
Overall, nine meta-analyses including a total of 12 trials were identified. The results of the present study indicated that probiotic supplementation significantly reduced the homeostatic model assessment for insulin resistance (HOMA-IR; WMD: -0.29, 95% CI: -0.57 to -0.02, = 0.03, = 4; moderate certainty) and fasting glucose concentration (FGC; WMD: -7.5 mg/dL, 95% CI: -13.60 to -0.51, = 0.03; = 4; low certainty). Moreover, synbiotic supplementation had beneficial effects on glycemic control, lipid profile, and hormonal parameters, but the certainty of the evidence was rated as low to very low. However, supplementation with pro-/synbiotics did not affect inflammation and oxidative stress in women with PCOS. Furthermore, waist/hip circumference, fasting glucose concentration, lipid profile, dehydroepiandrosterone sulfate, high-sensitivity C-reactive protein, and hirsutism score were significantly reduced after prebiotics supplementation with low certainty of evidence.
CONCLUSION
Although pro-, pre-, and synbiotics supplementation had beneficial effects on some PCOS-related outcomes, the certainty of the evidence was rated as low to very low. Therefore, further well-designed RCTs might help to confirm our findings in women with PCOS.
PubMed: 37829729
DOI: 10.3389/fnut.2023.1178842 -
Maturitas Oct 2018There is uncertainty whether treatment with dehydroepiandrosterone (DHEA) decreases menopausal symptoms for women in the peri- or postmenopausal phase. A previous... (Review)
Review
OBJECTIVE
There is uncertainty whether treatment with dehydroepiandrosterone (DHEA) decreases menopausal symptoms for women in the peri- or postmenopausal phase. A previous systematic review considering this subject suggested that DHEA may slightly improve sexual function compared with placebo (CS. Scheffers, S. Armstrong, AEP. Cantineau, C. Farquhar, V. Jordan Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD011066. DOI: https://doi.org/10.1002/14651858.CD011066.pub2). The purpose of this article is to review recent research investigating whether the use of DHEA, and in particular intravaginal DHEA (Prasterone), improves sexual function.
METHODS
We conducted an online search using Medline OVID for recent articles related to DHEA and menopause. We found 48 relevant publications, out of which 14 papers were original research, all related to the development and licensing of intravaginal DHEA. We critically analysed these 14 articles in relation to sexual function.
RESULTS
All the randomised controlled trials assessed the efficacy of vaginal DHEA in women with vulvovaginal atrophy and showed that sexual dysfunction improved with treatment regardless of the level of dyspareunia at baseline. Treatment with DHEA was found to be superior to placebo and at least as efficacious as vaginal oestrogens in improving symptoms.
CONCLUSION
Intravaginal DHEA appears to be a safe and effective treatment for menopausal vulvovaginal atrophy and dyspareunia in most women. Further studies are required before it can be recommended for women with a history of thrombosis, cardiovascular disease or hormone-sensitive neoplasms.
Topics: Administration, Intravaginal; Dehydroepiandrosterone; Female; Humans; Perimenopause; Postmenopause; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Treatment Outcome
PubMed: 30244783
DOI: 10.1016/j.maturitas.2018.07.016 -
Archives of Gynecology and Obstetrics May 2023Polycystic ovary syndrome (PCOS) is a complex endocrine disease that affects women of reproductive age and is characterised by biochemical and clinical androgen excess. (Meta-Analysis)
Meta-Analysis Review
Impact of pharmacological interventions on biochemical hyperandrogenemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials.
CONTEXT
Polycystic ovary syndrome (PCOS) is a complex endocrine disease that affects women of reproductive age and is characterised by biochemical and clinical androgen excess.
AIM
To evaluate the efficacy of pharmacological interventions used to decrease androgen hormones in women with PCOS.
DATA SOURCE
We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library and the Web of Science from inception up to March 2021.
DATA SYNTHESIS
Two reviewers selected eligible studies and extracted data, and the review is reported according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
RESULTS
Of the 814 randomised clinical trials (RCTs) located in the search, 92 met the eligibility criteria. There were significant reductions in total testosterone level with metformin versus (vs) placebo (SMD: - 0.33; 95% CI - 0.49 to - 0.17, p < 0.0001, moderate grade evidence) and dexamethasone vs placebo (MD:-0.86 nmol/L; 95% CI - 1.34 to - 0.39, p = 0.0004, very low-grade evidence). Significant reductions in the free testosterone with sitagliptin vs placebo (SMD: - 0.47; 95% CI - 0.97 to 0.04, p = 0.07, very low-grade evidence), in dehydroepiandrosterone sulphate (DHEAS) with flutamide vs finasteride (MD: - 0.37 µg/dL; 95% CI - 0.05 to - 0.58, p = 0.02, very low-grade evidence), a significant reduction in androstenedione (A4) with rosiglitazone vs placebo (SMD: - 1.67; 95% CI - 2.27 to - 1.06; 59 participants, p < 0.00001, very low-grade evidence), and a significant increase in sex hormone-binding globulin (SHBG) with oral contraceptive pill (OCP) (35 µg Ethinyl Estradiol (EE)/2 mg cyproterone acetate (CPA)) vs placebo (MD: 103.30 nmol/L; 95% CI 55.54-151.05, p < 0.0001, very low-grade evidence) were observed.
CONCLUSION
Metformin, OCP, dexamethasone, flutamide, and rosiglitazone use were associated with a significant reduction in biochemical hyperandrogenemia in women with PCOS, though their individual use may be limited due to their side effects.
PROSPERO REGISTRATION NO
CRD42020178783.
Topics: Female; Humans; Polycystic Ovary Syndrome; Flutamide; Androgens; Rosiglitazone; Hyperandrogenism; Metformin; Testosterone; Dexamethasone; Randomized Controlled Trials as Topic
PubMed: 35434762
DOI: 10.1007/s00404-022-06549-6 -
Medicine Sep 2016The aim of this systematic review was to update, complete, and critically evaluate the evidence from placebo-controlled randomized clinical trials (RCTs) of ginseng for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of this systematic review was to update, complete, and critically evaluate the evidence from placebo-controlled randomized clinical trials (RCTs) of ginseng for managing menopausal women's health.
METHODS
We searched the literature using 13 databases (MEDLINE, AMED, EMBASE, the Cochrane Library, 6 Korean Medical, and 3 Chinese Databases) from their inception to July 2016 and included all double-blind RCTs that compared any type of ginseng with a placebo control in postmenopausal women. The methodological quality of all studies was assessed using a Cochrane risk of bias tool.
RESULTS
Ten RCTs met our inclusion criteria. Most RCTs had unclear risk of bias. One RCT did not show a significant difference in hot flash frequency between Korean red ginseng (KRG) and placebo. The second RCT reported positive effects of KRG on menopausal symptoms. The third RCT found beneficial effects of ginseng (Ginsena) on depression, well-being, and general health. Four RCTs failed to show significant differences in various hormones between KRG and placebo controls except dehydroepiandrosterone. Two other RCTs failed to show effects of KRG on endometrial thickness in menopausal women. The other RCT also failed to show the effects of American ginseng on oxidative stress markers and other antioxidant enzymes.
CONCLUSION
Our systematic review provided positive evidence of ginseng for sexual function and KRG for sexual arousal and total hot flashes score in menopausal women. However, the results of KRG or ginseng failed to show specific effects on hot flash frequency, hormones, biomarkers, or endometrial thickness. The level of evidence for these findings was low because of unclear risk of bias.
Topics: Complementary Therapies; Double-Blind Method; Female; Humans; Menopause; Panax; Phytotherapy; Plant Extracts; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome; Women's Health
PubMed: 27661038
DOI: 10.1097/MD.0000000000004914 -
Nutrition, Metabolism, and... Aug 2020Dehydroepiandrosterone (DHEA) supplementation has gained attention in individuals with adrenal insufficiency, and as a tool for increasing androgens and estrogens... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Dehydroepiandrosterone (DHEA) supplementation has gained attention in individuals with adrenal insufficiency, and as a tool for increasing androgens and estrogens whereby is proposed to improve the accretion of muscle and bone mass. However, DHEA supplementation has demonstrated negative effects on the lipid profile and, thus, we aimed to analyze the body of evidence in this regard.
METHODS AND RESULTS
A systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) was performed employing in Scopus, PubMed/Medline, Web of Science, Embase and Google Scholar, then including relevant articles that addressed the effects of DHEA supplementation on the lipid profile, up to February 2020. Combined findings were generated from 23 eligible articles. Hence, total cholesterol (TC) (weighted mean difference (WMD): -3.5 mg/dl, 95% confidence interval (CI): -8.5 to 1.6)), low-density lipoprotein-cholesterol (LDL-C) (WMD: 0.34 mg/dl, 95% CI: -3 to 3.7) and triglycerides (TG) levels (WMD: -2.85 mg/dl, 95% CI: -9.3 to 3.6) did not alter in DHEA group compared to the control, but HDL-C levels significantly reduced in DHEA group (WMD: -3.1 mg/dl, 95% CI: -4.9 to -1.3). In addition, a significant reduction in HDL-C values was observed in studies comprising women (WMD: -5.1 mg/dl, 95% CI: -7.2 to -3) but not in males (WMD: 0.13 mg/dl, 95% CI: -1.4 to 1.7).
CONCLUSIONS
Overall, supplementation with DHEA did not change circulating values of TC, LDL-C and TG, whereas it may decrease HDL-C levels. Further long-term RCTs are required to investigate the effects of DHEA particularly on major adverse cardiac events.
Topics: Adult; Aged; Biomarkers; Cardiovascular Diseases; Dehydroepiandrosterone; Dietary Supplements; Dyslipidemias; Female; Humans; Hypolipidemic Agents; Lipids; Male; Middle Aged; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome; Young Adult
PubMed: 32675010
DOI: 10.1016/j.numecd.2020.05.015 -
Menopause (New York, N.Y.) Feb 2022More information is needed about the efficacy and safety of compounded bioidentical hormone therapy (cBHT) in the published literature. A thorough synthesis of existing... (Meta-Analysis)
Meta-Analysis
Safety and efficacy of compounded bioidentical hormone therapy (cBHT) in perimenopausal and postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.
IMPORTANCE
More information is needed about the efficacy and safety of compounded bioidentical hormone therapy (cBHT) in the published literature. A thorough synthesis of existing data is not currently available.
OBJECTIVE
To provide a systematic review and meta-analysis of the existing evidence related to the safety and efficacy of commonly prescribed cBHT preparations in perimenopausal and postmenopausal women.
EVIDENCE REVIEW
PubMed, ClinicalTrials.gov, and The Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) comparing cBHT with a placebo or FDA-approved products in perimenopausal or postmenopausal women were eligible. The risk of bias was assessed by the Cochrane risk of bias tool. The primary safety outcome was changes in lipid profile and glucose metabolism, and the primary efficacy outcome was the change of vaginal atrophy symptoms. The secondary outcomes included the change of endometrial thickness, risk of adverse events, vasomotor symptoms, change of serum hormone levels, and change of bone mineral density.
FINDINGS
A total of 29 RCTs reported in 40 articles containing 1,808 perimenopausal and postmenopausal women were included. Two risk factors of cardiovascular disease, lipid profile, and glucose metabolism, were evaluated with cBHT. The results showed that compounded androgen was not associated with change of lipid profile or glucose metabolism. There was no change in endometrial thickness or serious adverse events. There were more androgenic side effects with compounded dehydroepiandrosterone compared with placebo as expected. Other safety measures including clinical cardiovascular events, endometrial biopsy, and risk of breast cancer were not studied. cBHT in the form of compounded vaginal androgen was found to significantly improve vaginal atrophy symptoms (SMD -0.66 [95% CI, -1.28 to -0.04]; I2 = 86.70%). This finding was supported by the association between compounded vaginal androgen and improved female sexual function scores. The changes of serum hormone levels were also evaluated. Despite the variations in absorption from different types of compounded hormones, routes, and strengths, the trends were consistent with published data from FDA-approved products.
CONCLUSIONS AND RELEVANCE
This review found that cBHT used in primarily short-term RCTs is not associated with adverse changes in lipid profile or glucose metabolism. cBHT in the form of vaginal androgens appears beneficial for vaginal atrophy symptoms. There are insufficient RCTs of cBHT to assess clinical risk of breast cancer, endometrial cancer, or cardiovascular disease. Long-term studies with clinical endpoints are needed.
Topics: Female; Hormones; Humans; Perimenopause; Postmenopause; Randomized Controlled Trials as Topic; Vaginal Diseases
PubMed: 35357369
DOI: 10.1097/GME.0000000000001937