Menopause Archive

Romosozumab Followed by Denosumab Effective for BMD Increase in Postmenopausal Women

Romosozumab Followed by Denosumab Effective for BMD Increase in Postmenopausal Women

Romosozumab increased bone mineral density in postmenopausal women through increased bone formation and decreased bone resorption.

Sex Hormone Levels May Affect Postmenopausal Heart Disease Risk

Sex Hormone Levels May Affect Postmenopausal Heart Disease Risk

Researchers assessed the effect of testosterone, estradiol, dehydroepiandrosterone, and sex hormone-binding globulin levels on coronary heart disease, heart failure, and cardiovascular disease in postmenopausal women.

Imvexxy Approved for Moderate to Severe Dyspareunia Due to Menopause

Imvexxy Approved for Moderate to Severe Dyspareunia Due to Menopause

The FDA approval was supported by findings from a Phase 3, randomized, double-blind, placebo-controlled study that evaluated Imvexxy (4mcg and 10mcg) vs placebo from baseline to week 12.

Asthma Risk Increased for Premenopausal Women Using Oral Contraceptives

Asthma Risk Increased for Premenopausal Women Using Oral Contraceptives

Oral contraceptive use in women of reproductive age may increase the risk for lifetime asthma.

Anxiety Levels Tied to Bone Mineral Density in Postmenopausal Women

Anxiety Levels Tied to Bone Mineral Density in Postmenopausal Women

Anxiety levels are associated with bone mineral density and fracture risk in the lumbar spine and femoral neck among postmenopausal women.

Certain Foods May Impact Timing of Menopause

Certain Foods May Impact Timing of Menopause

Researchers studied women aged 40 to 65 years participating in the UK Women's Cohort Study, who had experienced natural menopause and responded to a food frequency questionnaire.

Later Natural Menopause Can Benefit Future Verbal Memory

Later Natural Menopause Can Benefit Future Verbal Memory

Women who have a later natural menopause maintain a small benefit in verbal memory compared with women with earlier menopause.

Waist-to-Height Ratio Tied to Anxiety in Middle-Aged Women

Waist-to-Height Ratio Tied to Anxiety in Middle-Aged Women

Researchers conducted secondary analysis of data from a multicenter study of 5580 women from 11 Latin America countries in order to assess the association between waist-to-height ratio and anxiety.

Reproductive, Hormonal Factors Affect Risk for Total Knee Arthroplasty in Women

Reproductive, Hormonal Factors Affect Risk for Total Knee Arthroplasty in Women

Researchers sought to identify associations of female reproductive factors with incidence of total knee arthroplasty in osteoarthritis.

Menopause Symptom Severity May Predict Heart Disease

Menopause Symptom Severity May Predict Heart Disease

Researchers examined whether menopausal symptoms, quality of life, and depression are related to arterial stiffness, a risk factor for cardiovascular disease.

Effect of Menopausal Hormone Therapy on Cardiac Structure, Function

Effect of Menopausal Hormone Therapy on Cardiac Structure, Function

Researchers examined the effect of menopausal hormone therapy on left ventricular and left atrial chamber structure and function changes, which are markers of subclinical cardiovascular disease.

Menopausal Hormone Therapy Linked to Reduced Abdominal Fat

Menopausal Hormone Therapy Linked to Reduced Abdominal Fat

Physicians should be aware that the benefit of menopausal hormone therapy (MHT) on body composition might rapidly disappear after its withdrawal and strongly encourage women to optimize nutrition and increase physical activity when stopping MHT.

Hormone Therapy May Impact Brain Structure, Cognition

Hormone Therapy May Impact Brain Structure, Cognition

Researchers assessed the effects of 2 frequently used formulations of menopausal hormone therapy on brain structure and cognition 3 years after the completion of a randomized clinical trial.

Bone Mineral Density Response Rates With Abaloparatide in Postmenopausal Women

Bone Mineral Density Response Rates With Abaloparatide in Postmenopausal Women

At the 43-month endpoint, a total of 60.7% (307/506) of the abaloparatide followed by alendronate group had ≥3% increase in bone mass at all 3 sites (P<0.0001) vs. 24% (121/505) of the placebo followed by alendronate group.

Effect of High Androgen Levels on Cardiovascular Risk in Postmenopausal Women

Effect of High Androgen Levels on Cardiovascular Risk in Postmenopausal Women

Researchers conducted a prospective, population-based cohort study to assess the risk for cardiovascular disease in postmenopausal women with increased androgen levels.

Oral Micronized Progesterone May Decrease Perimenopausal Vasomotor Symptoms

Oral Micronized Progesterone May Decrease Perimenopausal Vasomotor Symptoms

Oral micronized progesterone may diminish hot flushes and night sweats in perimenopausal women, according to research presented at ENDO 2018.

Menopausal Hormone Therapy Linked to Kyphosis Severity

Menopausal Hormone Therapy Linked to Kyphosis Severity

Researchers examined the correlation between Cobb angle of kyphosis from lateral spine radiographs and pattern of self-reported menopausal hormone therapy use.

Damaging Effects of Gastric Bypass Surgery on Bone Mass and Microarchitecture

Damaging Effects of Gastric Bypass Surgery on Bone Mass and Microarchitecture

Researchers observed detrimental effects of RYGB on bone turnover, mass, structure, and strength just 6 months postoperatively, and these effects persisted throughout the duration of the 12-month study.

Nonhormonal Options Available for Menopause Symptom Relief

Nonhormonal Options Available for Menopause Symptom Relief

A nonhormonal treatment option for the relief of symptoms associated with menopause is now available alongside other drug-free supplements.

Hormone Therapy After Menopause Onset Reduces Stroke Risk

Hormone Therapy After Menopause Onset Reduces Stroke Risk

The use of hormone therapy up to 5 years after onset of menopause is associated with a lower risk for ischemic and hemorrhagic stroke compared with late hormone therapy initiation or no hormone therapy use.

USPSTF's Final Recommendation on Menopausal HT for Chronic Disease Prevention

USPSTF's Final Recommendation on Menopausal HT for Chronic Disease Prevention

To update its 2012 recommendation, the US Preventive Services Task Force reviewed evidence on the benefits and harms of systemic hormone therapy for the prevention of chronic conditions in postmenopausal women.

Accuracy of BMI as a Measurement of Obesity in Postmenopausal Women

Accuracy of BMI as a Measurement of Obesity in Postmenopausal Women

Findings indicate that using a BMI cutpoint of 30 may lead to bias in measuring the effects of obesity on health outcomes in postmenopausal women.

Estradiol Therapy May Benefit Overall Cognition in Postmenopausal Women

Estradiol Therapy May Benefit Overall Cognition in Postmenopausal Women

There may be other roles of estradiol therapy besides relief from menopause-related symptoms, including limiting effects of stress on working memory.

Early Menopause: A Greater Risk for Underweight Women

Early Menopause: A Greater Risk for Underweight Women

Underweight women have a significantly greater risk of experiencing early menopause compared with lean or overweight women.

Stopping Postmenopausal HT May Increase Risk for Cardiac, Stroke Death

Stopping Postmenopausal HT May Increase Risk for Cardiac, Stroke Death

Increased mortality risks were limited to the first post-HT year because increases in risks markedly decreased when the follow-up time was extended over more than 1 year.

Menopausal Hormone Therapy and Risk of All-Cause Mortality

Menopausal Hormone Therapy and Risk of All-Cause Mortality

No other randomized clinical trial of hormone therapy has been large enough to assess a potential modifying effect of age on all-cause mortality, and most previous trials of chronic disease outcomes have focused on older women.

Compounded Bioidentical Hormone Therapy in Menopause: Clinician Caution Advised

Compounded Bioidentical Hormone Therapy in Menopause: Clinician Caution Advised

Rates of cBHT prescriptions are not yet being systemically tracked, and few data exist to demonstrate the safety, efficacy, or utility of the treatment.

Managing Menopausal Symptoms in Breast Cancer Survivors

Managing Menopausal Symptoms in Breast Cancer Survivors

Lifestyle modification and an individualized treatment approach are effective strategies for managing menopausal symptoms in breast cancer survivors who are largely advised to avoid hormone replacement therapy.

Does Transdermal Estrogen Improve Sexual Function in Early Postmenopause?

Does Transdermal Estrogen Improve Sexual Function in Early Postmenopause?

The Female Sexual Functioning Index was used to assess aspects of sexual function and experience in early postmenopausal women.

K-Postn Assay New Tool to Assess Fracture Risk in Postmenopausal Women

K-Postn Assay New Tool to Assess Fracture Risk in Postmenopausal Women

According to a study published in the Journal of Bone and Mineral Research, researchers hypothesized that serum K-Postn levels may be able to predict low-trauma fractures.

FDA Approves Treatment for Menopause Associated Dyspareunia

FDA Approves Treatment for Menopause Associated Dyspareunia

Intrarosa, the first FDA approved local, non-estrogen product for treating dyspareunia, is now available.

AACE/ACE Updated Position Statement on Menopause

AACE/ACE Updated Position Statement on Menopause

Although the updated statement does not change the recommendations outlined in previous treatment guidelines, the authors have added 8 new recommendations based on evidence that has emerged in the interim.

Estrogen Exposure and Depression Risk Examined

Estrogen Exposure and Depression Risk Examined

A combination of early menstruation with more frequent periods may lower a woman's depression risk.

Increased RA Risk in Post-Menopause, Early Post-Menopause

Increased RA Risk in Post-Menopause, Early Post-Menopause

Acute decline in ovarian function may contribute to the autoimmunity associated with rheumatoid arthritis.

North American Menopause Society Releases New Guidelines for Hormone Therapy

North American Menopause Society Releases New Guidelines for Hormone Therapy

The North American Menopause Society released updated guidelines for hormone therapy use in women who are postmenopausal.

Fracture Risk Decreases, Bone Mineral Density Increases With Long-Term Denosumab

Fracture Risk Decreases, Bone Mineral Density Increases With Long-Term Denosumab

Long-term denosumab increased bone mineral density in postmenopausal women.

Frequent Hot Flashes Worsened Endothelial Function in Younger Midlife Women

Frequent Hot Flashes Worsened Endothelial Function in Younger Midlife Women

Age significantly affected the association between hot flash status and flow-mediated dilation, particularly in younger women.

Fewer Menstrual Cycles May Lead to Increased Risk for Heart Failure

Fewer Menstrual Cycles May Lead to Increased Risk for Heart Failure

The fewer menstrual cycles women had over a lifetime placed them at greater risk for incident heart failure.

Oral HRT Increases Postmenopausal Hearing Loss Risk

Oral HRT Increases Postmenopausal Hearing Loss Risk

Research results indicate that more randomized clinical trials are needed to examine the relationship between hearing loss and oral hormone replacement therapy.

Bone Mineral Density Changes Related to Adrenal Incidentalomas in Menopausal Women

Bone Mineral Density Changes Related to Adrenal Incidentalomas in Menopausal Women

After 24 months, bone mineral density was statistically different from baseline.

Decline in Lung Function Linked to Menopausal Status

Decline in Lung Function Linked to Menopausal Status

Serum samples, spirometry, and questionnaire data were collected from nearly 1500 women to determine if menopausal status affected lung function.

Is Normal Basal Bone Metabolism Vitamin D-Dependent in Postmenopausal Women With T2D?

Is Normal Basal Bone Metabolism Vitamin D-Dependent in Postmenopausal Women With T2D?

Findings in postmenopausal women with T2DM; correlations prominent in those with higher 25(OH)D

Intravisceral Abdominal Fat Mass Reduction With Menopausal Hormone Therapy

Intravisceral Abdominal Fat Mass Reduction With Menopausal Hormone Therapy

Researchers examined body mass index differences in current, past, and never users of menopausal hormone therapy.

Decreased Mortality, CAC Scores With Hormone Replacement Therapy

Decreased Mortality, CAC Scores With Hormone Replacement Therapy

HRT in postmenopausal women was linked to lower CAC scores and a lower risk of long-term, all-cause mortality.

Postmenopausal Anxiety Linked to Severe Quality of Life Impairment

Postmenopausal Anxiety Linked to Severe Quality of Life Impairment

Severe anxiety was independently associated with poor quality of life in postmenopausal patients.

Early Menopause Tied to Rheumatoid Arthritis Risk

Early Menopause Tied to Rheumatoid Arthritis Risk

Data from the Nurses' Health Studies were analyzed to determine if there is a link between seropositive and seronegative rheumatoid arthritis and age of menopause onset.

Menopause Predicted by Anti-Müllerian Hormone in HIV

Menopause Predicted by Anti-Müllerian Hormone in HIV

For women with HIV, anti-Müllerian hormone is associated with age of menopause onset.

Aging vs Menopausal Status as a Predictor of Depression, Negative Mood

Aging vs Menopausal Status as a Predictor of Depression, Negative Mood

Women in the menopausal transition and early postmenopause are at higher risk for depressive symptoms and negative mood than those in late postmenopause.

Menopause Tied to Faster Decline in Lung Function

Menopause Tied to Faster Decline in Lung Function

Menopausal status is associated with accelerated lung function decline.

FDA Green-lights Intrarosa for Dsypareunia in Menopause

FDA Green-lights Intrarosa for Dsypareunia in Menopause

The FDA recently approved Intrarosa (prasterone) for moderate to severe pain during sexual intercourse due to menopause.

Bone Health Improved With Menopausal Hormone Therapy

Bone Health Improved With Menopausal Hormone Therapy

The use of menopausal hormone therapy was associated with improved bone mineral density and better bone microarchitecture.

Acupuncture May Decrease Menopausal Vasomotor Symptoms

Acupuncture May Decrease Menopausal Vasomotor Symptoms

Half of women treated with acupuncture report a decline in the frequency of menopausal vasomotor symptoms, according to a study published in Menopause.

Changes in Concerns About Sexual Health for Menopausal Women

Changes in Concerns About Sexual Health for Menopausal Women

Although a majority of women reported sexual satisfaction, many felt that it could improve.

Women Adapt to Changes in Sexual Function During Midlife

Women Adapt to Changes in Sexual Function During Midlife

Many women are able to adapt to the negative changes in sexual function that they experience as they age.

Menopause Transition Linked to Worsening Insomnia Symptoms

Menopause Transition Linked to Worsening Insomnia Symptoms

After 10 years follow-up, researchers found that women who experienced surgical menopause were more likely to suffer worse insomnia symptoms.

Depression Tied to Coronary Artery Disease Risk in Women

Depression Tied to Coronary Artery Disease Risk in Women

Nearly 2000 women underwent screening to determine if a link exists between depression or depressive symptoms and coronary artery disease.

Poor Sleep May Increase Odds for Atherosclerosis in Peri-, Postmenopausal Women

Poor Sleep May Increase Odds for Atherosclerosis in Peri-, Postmenopausal Women

Both peri- and postmenopausal women were assessed to find a relationship between sleep time, sleep quality, and carotid atherosclerosis.

Nighttime Hot Flashes Associated With Mild Depression

Nighttime Hot Flashes Associated With Mild Depression

During menopause, women who experience more hot flashes at night are more likely to experience worsening mood.

Heart Disease, Mortality Risk Up With Early Menopause

Heart Disease, Mortality Risk Up With Early Menopause

Women who enter menopause before age 45 had a 50% greater risk for cardiovascular disease as well as an increased risk for cardiovascular death.

Soy Isoflavone May Improve Bone Health After Menopause

Soy Isoflavone May Improve Bone Health After Menopause

For postmenopausal women, soy isoflavone supplementation is associated with improvement in bone health.

Metabolic Syndrome Severity May Change Throughout Menopausal Transition

Metabolic Syndrome Severity May Change Throughout Menopausal Transition

African-American women in particular experienced more rapid progression in metabolic syndrome severity during pre- and perimenopausal periods compared to post-menopausal period.

Woman's Reproductive Period Tied to Type 2 Diabetes Risk

Woman's Reproductive Period Tied to Type 2 Diabetes Risk

The Women's Health Initiative found that women's reproductive history is associated with risk of type 2 diabetes.

New Index Predicts Women at Risk for Rapid Bone Loss During Menopausal Transition

New Index Predicts Women at Risk for Rapid Bone Loss During Menopausal Transition

An index accounting for both bone formation and resorption may help identify which women may experience faster bone loss during menopause.

Factors Related to Temporal Patterns of Vasomotor Symptoms During Menopause Identified

Factors Related to Temporal Patterns of Vasomotor Symptoms During Menopause Identified

Researchers identified 4 distinct trajectories of vasomotor symptoms predicted by reproductive hormones, race and ethnicity, BMI, and psychosocial characteristics.

Assessing the Impact of Postmenopausal Hormone Therapy on Cardiovascular Health

Assessing the Impact of Postmenopausal Hormone Therapy on Cardiovascular Health

In light of ELITE trial results, estradiol hormone therapy may have a role in coronary heart disease treatment.

Phytoestrogen Supplementation May Reduce Menopause Symptoms

Phytoestrogen Supplementation May Reduce Menopause Symptoms

The review shows modest reductions in frequency of hot flashes and vaginal dryness, but not in night sweats.

Paroxetine Reduced Vasomotor Symptoms During, After Menopause

Paroxetine Reduced Vasomotor Symptoms During, After Menopause

Moderate-quality evidence shows a reduction in the frequency of hot flashes with paroxetine.

New Vaginal Estrogen Capsule May Relieve Symptoms of Menopausal Vulvar, Vaginal Atrophy

New Vaginal Estrogen Capsule May Relieve Symptoms of Menopausal Vulvar, Vaginal Atrophy

Investigational drug improved vaginal cells and vaginal pH at all dose levels.

Estrogen Deficiency in Women Linked to Nonalcoholic Fatty Liver Disease

Estrogen Deficiency in Women Linked to Nonalcoholic Fatty Liver Disease

Duration of estrogen deficiency in women with nonalcoholic fatty liver disease may be more likely to have severe fibrosis.

Stroke Risk Higher in Women on Hormone Therapy With Worsening Migraines

Stroke Risk Higher in Women on Hormone Therapy With Worsening Migraines

More than 20% of women currently using hormone replacement therapy experienced an increase in migraine severity.

Pregnancy at an Advanced Age May Up Stroke Risk After Menopause

Pregnancy at an Advanced Age May Up Stroke Risk After Menopause

Postmenopausal women whose last pregnancy occurred at 40 years of age or older may have a greater risk of hemorrhagic stroke.

Sedentary Women Experienced Worse Menopause Symptoms

Sedentary Women Experienced Worse Menopause Symptoms

Sedentary lifestyles were common among middle-aged Hispanic women and were also associated with worse menopausal symptoms.

Menopause Symptom Treatment Guideline Focuses on Individualized Approach

Menopause Symptom Treatment Guideline Focuses on Individualized Approach

An individualized approach based on patient preferences is important for treatment of menopause.

Chinese Medicine Acupuncture Not Superior for Treatment of Menopausal Hot Flashes

Chinese Medicine Acupuncture Not Superior for Treatment of Menopausal Hot Flashes

Noninsertive sham acupuncture is a superior treatment option for menopausal women with hot flashes compared to Chinese medicine acupuncture.

Older Age At Menopause, Longer Reproductive Period May Decrease Risk for Depression

Older Age At Menopause, Longer Reproductive Period May Decrease Risk for Depression

Recent data suggest that older age at menopause as well as a longer reproductive period have a lower risk for depression later in life.

DHEA Suppository May Improve Vaginal Symptoms of Menopause

DHEA Suppository May Improve Vaginal Symptoms of Menopause

For postmenopausal women, suppositories containing the hormone dehydroepiandrosterone (DHEA) may reduce vaginal dryness, discomfort, and pain during sex without raising overall estrogen levels.

Risk for Infertility, Early Menopause Up With Active Tobacco Exposure

Risk for Infertility, Early Menopause Up With Active Tobacco Exposure

Active smoking and secondhand smoke exposure increases the risk for infertility and natural menopause before age 50.

Vulvovaginal Symptoms Impact Lives of Many Postmenopausal Women

Vulvovaginal Symptoms Impact Lives of Many Postmenopausal Women

Common vulvovaginal symptoms can have emotional, lifestyle, and sexual effects in postmenopausal women.

Follicle-Stimulating Hormone Linked to LDL Cholesterol in Postmenopausal Women

Follicle-Stimulating Hormone Linked to LDL Cholesterol in Postmenopausal Women

Follicle-stimulating hormone may interact with its receptors and lead to elevated LDL cholesterol in postmenopausal women.

Hormone Therapy, Age at Menopause Associated With Basal Cell Carcinoma Risk

Hormone Therapy, Age at Menopause Associated With Basal Cell Carcinoma Risk

An increased risk was seen with late age at natural menopause and with any use of menopausal hormone therapy.

Intense Menopausal Symptoms Reported in Women With HIV

Intense Menopausal Symptoms Reported in Women With HIV

Symptoms during the menopausal transition appear to be worse in women with HIV.

Increased HDL Cholesterol in Menopause May Not Protect Against Heart Disease

Increased HDL Cholesterol in Menopause May Not Protect Against Heart Disease

Increased HDL cholesterol during menopausal transition linked to greater carotid intima-media thickness.

Vitamin D Improved Muscle Strength in Postmenopausal Women

Vitamin D Improved Muscle Strength in Postmenopausal Women

Postmenopausal women experienced increased muscle strength, less muscle mass loss with vitamin D supplements.

Insomnia Reduced Sexual Satisfaction, Activity in Postmenopausal Women

Insomnia Reduced Sexual Satisfaction, Activity in Postmenopausal Women

Postmenopausal women with insomnia experienced less sexual satisfaction and frequency.

Hormone Therapy Earlier in Menopause May Lower Risk for Developing CHD

Hormone Therapy Earlier in Menopause May Lower Risk for Developing CHD

Initiating hormone therapy earlier in menopause may lower risk for later development of coronary heart disease.

Compounded Hormone Use Common Among Menopausal Hormone Therapy Users

Compounded Hormone Use Common Among Menopausal Hormone Therapy Users

One-third of women taking hormone therapy at menopause are using compounded hormones.

Survey: Abuse Associated with Menopause-Related Symptoms

Survey: Abuse Associated with Menopause-Related Symptoms

Women who reported recent abuse experienced more bother from menopausal symptoms.

Estrogen Treatment Method for Genitourinary Symptoms Affects Adherence

Estrogen Treatment Method for Genitourinary Symptoms Affects Adherence

Women demonstrate preference for oral estrogens for genitourinary menopausal symptoms.

Sexual QoL Higher for Post-Menopausal Women Who Use Vaginal Estrogen

Sexual QoL Higher for Post-Menopausal Women Who Use Vaginal Estrogen

Vaginal estrogen may provide numerous medical benefits without system side effects for women post menopause.

Bioidentical Hormones: Why Is There Controversy and How Do You Stay Safe?

Bioidentical Hormones: Why Is There Controversy and How Do You Stay Safe?

Women seeking relief from menopausal symptoms must be aware of the risks, benefits of different treatment options.

Menopause Tied to Increased Cardiovascular Fat

Menopause Tied to Increased Cardiovascular Fat

Peri- and postmenopausal women have a greater volume of fat around their hearts than premenopausal women.

Race Impacts Sex Differences in CHD Event Risk

Race Impacts Sex Differences in CHD Event Risk

There are larger differences in nonfatal events seen for whites vs. blacks, but risk for death not affected by race.

SSRIs May Increase Fracture Risk in Menopausal Women

SSRIs May Increase Fracture Risk in Menopausal Women

Risk remains high over several years.

Sleep Disruptions Likely in Perimenopausal Women

Sleep Disruptions Likely in Perimenopausal Women

Women in early menopause are more likely to experience sleep disruptions throughout menstrual cycle.

Yoga, Meditation May Relieve Menopause Symptoms After Breast Cancer

Yoga, Meditation May Relieve Menopause Symptoms After Breast Cancer

Randomized trial shows beneficial effect for yoga combined with meditation in breast cancer survivors.

ADHD Drug May Improve Cognition in Menopause

ADHD Drug May Improve Cognition in Menopause

Small study suggests lisdexamfetamine might help with concentration and thought organization.

Early Menopause Associated With Seropositivity in Rheumatoid Arthritis

Early Menopause Associated With Seropositivity in Rheumatoid Arthritis

Increased odds of seropositivity in women with menopause aged younger than 45 years vs. 45 years or older.

Vitamin D, Calcium Don't Mitigate Menopause Symptoms

Vitamin D, Calcium Don't Mitigate Menopause Symptoms

Researchers found no difference between women who took supplements and those who didn't.

Menopausal Hormone Therapy May Hike Risk for Lower GI Bleeding

Menopausal Hormone Therapy May Hike Risk for Lower GI Bleeding

No difference in incidence of upper GI bleeding in menopausal hormone therapy users vs. non-users.

After Menopause, Statins Plus Hormone Therapy May Reduce Death Risk

After Menopause, Statins Plus Hormone Therapy May Reduce Death Risk

Postmenopausal women using hormone therapy with statins may have a reduced risk for all-cause mortality.

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