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1.
Toxicol In Vitro ; 27(6): 1753-61, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23680332

ABSTRACT

T47D-ERß breast cancer cells with tetracycline-dependent ERß expression and constant ERα expression can be used to investigate effects of varying ERα/ERß ratios on estrogen-induced cellular responses. This study defines conditions at which ERα/ERß ratios in T47D-ERß cells best mimic ERα/ERß ratios in breast and other estrogen-sensitive tissues in vivo in rat as well as in human. Protein and mRNA levels of ERα and ERß were analyzed in T47D-ERß cells exposed to a range of tetracycline concentrations and compared to ERα and ERß levels found in breast, prostate, and uterus from rat and human origin. The ERα/ERß ratio in T47D-ERß cells exposed to >150ng/ml tetracycline is comparable to the ratio found in rat mammary gland and in human breast tissue. The ERα/ERß ratio of other estrogen-sensitive rat and human tissues can also be mimicked in T47D-ERß cells. The ERα/ERß ratio found in MCF-7 and native T47D breast cancer cell lines did not reflect ratios in analyzed rat and human tissues, which further supports the use of T47D-ERß cells as model for estrogen-responsive tissues. Using 17ß-estradiol and the T47D-ERß cells under the conditions defined to mimic various tissues it could be demonstrated how these different tissues vary in their proliferative response.


Subject(s)
Breast Neoplasms/metabolism , Breast/metabolism , Estrogen Receptor alpha/metabolism , Estrogen Receptor beta/metabolism , Mammary Glands, Animal/metabolism , Adult , Aged , Animals , Cell Line, Tumor , Female , Humans , Male , Middle Aged , Prostate/metabolism , Rats , Tetracycline , Uterus/metabolism
2.
Prostate ; 72(9): 1013-22, 2012 Jun 15.
Article in English | MEDLINE | ID: mdl-22025007

ABSTRACT

BACKGROUND: Prostate cancer is a common malignancy in men and although hormone ablation therapy is effective, men develop hormone resistance. There is need for therapies applicable earlier, such as treatment of prostatic intraepithelial neoplasia (PIN). Estrogens besides androgens play a role in prostate cancer pathogenesis via two receptors ERα and ERß and both receptors are thought to play different, opposing, roles with ERα having proliferative properties and ERß having anti-proliferative properties. To differentiate between the roles both receptors play in prostate cancer an ERα and an ERß agonist, ERA-45 and ERB-26, have been tested in a rodent model for prostate carcinogenesis. METHODS: The influence of ERα on prostate cancer progression was studied in intact male rats treated with testosterone in combination with the ERα agonist, ERA-45 for either a long-term (20-week) period or a shorter term (6-week) period. The ERß agonist was tested in the shorter term model in intact male rats treated with testosterone in combination with the ERα agonist, ERA-45, followed by administration of the ERß agonist, ERB-26, during the last 2 weeks. RESULTS: Treatment of rats with testosterone in combination with ERA-45 induced mild PIN lesions at 6 weeks and severe precancerous PIN lesions at 20 weeks. The ERß agonist prevented the onset of PIN lesions at 6 weeks. Moreover, prostate epithelial cell apoptosis was increased and proliferation was decreased. CONCLUSION: These findings confirm the opposing roles ERα and ERß play in prostate carcinogenesis and suggest a therapeutic opportunity of ERß for treating precancerous PIN lesions.


Subject(s)
Adenocarcinoma/metabolism , Adenocarcinoma/pathology , Disease Progression , Estrogen Receptor alpha/physiology , Estrogen Receptor beta/physiology , Prostatic Neoplasms/metabolism , Prostatic Neoplasms/pathology , Adenocarcinoma/etiology , Animals , Estrogen Receptor alpha/agonists , Estrogen Receptor beta/agonists , Male , Prostate/drug effects , Prostate/pathology , Prostatic Neoplasms/etiology , Rats , Rats, Wistar , Severity of Illness Index , Testosterone/analogs & derivatives , Testosterone/pharmacology
3.
Osteoarthritis Cartilage ; 17(10): 1356-61, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19410028

ABSTRACT

OBJECTIVE: Estrogens are suggested to play a role in the development of osteoarthritis as indicated by the increased prevalence in women after menopause. We studied whether deletion of the estrogen receptor (ER) alpha, beta, or both in female mice results in cartilage damage, osteophytosis, and changes in subchondral bone of skeletally mature animals. METHODS: We studied knee joints of 6-month-old female ERalpha-/-, ERbeta-/-, and (double) ERalpha-/-beta-/- mice and their wild type (wt) littermates. The presence and size of osteophytes and osteoarthritic changes in cartilage were analyzed using histology. Changes in subchondral plate and trabecular bone were studied using micro-CT. RESULTS: In ERalpha-/-beta-/- mice, we observed an increase in number and/or size of osteophytes and thinning of the lateral subchondral plate. However, cartilage damage was not different from wt. In ERalpha-/- or ERbeta-/- mice, no significant differences in cartilage damage score, osteophyte formation, or subchondral plate thickness were found. The bone volume fraction of the epiphyseal trabecular bone was unchanged in ERalpha-/- mice, increased in ERbeta-/- mice, and decreased in ERalpha-/-beta-/- mice. CONCLUSIONS: We conclude that deletion of both ERs leads to increased osteophytosis, but deletion of one or both ERs does not lead to overt cartilage damage in 6-month-old mice.


Subject(s)
Arthritis, Experimental/pathology , Cartilage, Articular/pathology , Knee Joint/pathology , Osteoarthritis/pathology , Receptors, Estrogen/deficiency , Animals , Cartilage, Articular/diagnostic imaging , Disease Models, Animal , Female , Knee Joint/diagnostic imaging , Mice , Mice, Knockout , Osteoarthritis/diagnostic imaging , Receptors, Estrogen/genetics , Tibia/diagnostic imaging , Tibia/pathology , Tomography, X-Ray Computed/methods
4.
Endocrinology ; 149(11): 5783-90, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18635654

ABSTRACT

Ovulation is triggered by the preovulatory surge of gonadotropins that, in rodents, is defined by the concomitant rise in circulating LH and FSH at the afternoon of proestrus (primary surge), followed by persistently elevated FSH levels at early estrus (secondary surge). In recent years, kisspeptins, products of the KiSS-1 gene that act via G protein-coupled receptor 54, have emerged as an essential hypothalamic conduit for the generation of the preovulatory LH surge by conveying positive feedback effects of estradiol onto GnRH neurons, an event that involves not only estradiol-induced transcription of the KiSS-1 gene at the anteroventral periventricular nucleus but also its ability to modulate GnRH/LH responses to kisspeptin. However, little is known about the potential modulation of FSH responsiveness to kisspeptin by sex steroids in the cyclic female. We report herein analyses on the consequences of selective blockade of estrogen receptors (ER)-alpha and -beta, as well as progesterone receptor (PR), on the ovulatory surges of FSH and their modulation by kisspeptin. Antagonism of ERalpha or PR equally blunted the primary and secondary surges of FSH and nullified FSH responses to kisspeptin at the preovulatory period. Conversely, selective blockade of ERbeta failed to induce major changes in terms of endogenous FSH surges, yet it decreased FSH responses to exogenous kisspeptin. In contrast, FSH responses to GnRH were fully conserved after ERbeta blockade and partially preserved after inhibition of ERalpha and PR signaling. Finally, secondary FSH secretion was rescued by kisspeptin in females with selective blockade of ERalpha but not PR. In sum, our results substantiate a concurrent, indispensable role of ERalpha and PR in the generation of FSH surges and the stimulation of FSH responses to kisspeptin at the ovulatory period. In addition, our data suggest that ERbeta might operate as a subtle, positive modulator of the preovulatory FSH responses to kisspeptin, a role that is opposite to its putative inhibitory action on kisspeptin-induced LH secretion and might contribute to the dissociation of gonadotropin secretion at the ovulatory phase in the cyclic female rat.


Subject(s)
Follicle Stimulating Hormone/metabolism , Follicular Phase/drug effects , Proteins/pharmacology , Receptors, Estrogen/physiology , Receptors, Progesterone/physiology , Animals , Estrenes/pharmacology , Female , Follicle Stimulating Hormone/blood , Follicular Phase/blood , Follicular Phase/metabolism , Furans/pharmacology , Hormone Antagonists/pharmacology , Kisspeptins , Proteins/physiology , Rats , Rats, Wistar , Receptors, Estrogen/antagonists & inhibitors , Receptors, Progesterone/antagonists & inhibitors
5.
Endocrinology ; 149(4): 1627-37, 2008 Apr.
Article in English | MEDLINE | ID: mdl-18174277

ABSTRACT

Ovulation is triggered by the preovulatory rise of gonadotropins, which is in turn elicited by the preceding increase in circulating estrogen. Kisspeptins, ligands of G protein-coupled receptor 54 encoded by the KiSS-1 gene, have emerged as potent stimulators of GnRH/LH secretion, and KiSS-1 neurons at the anteroventral periventricular nucleus have been shown to be involved in the generation of preovulatory LH surge, estrogen being a potent elicitor of KiSS-1 gene expression selectively at the anteroventral periventricular nucleus. Whether, in addition to transcriptional effects, estrogen influences other aspects of kisspeptin-induced GnRH/LH release in the female remains unexplored. We provide herein evidence for the specific roles of estrogen receptor (ER)-alpha and ERbeta in the modulation of LH responses to kisspeptin and the generation of the preovulatory surge. Selective blockade of ERalpha in cyclic females blunted LH responses to kisspeptin, eliminated the endogenous preovulatory rise of LH, and blocked ovulation. In contrast, antagonism of ERbeta failed to cause major changes in terms of LH surge and ovulatory rate but significantly augmented acute LH responses to kisspeptin. Notably, defective LH secretion and ovulation after ERalpha blockade were not observed after GnRH stimulation, which elicited maximal acute (<2 h) LH responses regardless of ERalpha/ERbeta signaling. In addition, net LH secretion in response to kisspeptin was decreased by ovariectomy and increased after selective activation of ERalpha but not ERbeta. Altogether, our data document the prominent positive role of ERalpha in the regulation of GnRH/LH responsiveness to kisspeptin and, thereby, ovulation. In addition, our results disclose the putative function of ERbeta as negative modifier of GnRH/LH response to kisspeptin, a phenomenon that might contribute to partially restraining LH secretion at certain physiological states.


Subject(s)
Estrogen Receptor alpha/physiology , Estrogen Receptor beta/physiology , Luteinizing Hormone/metabolism , Tumor Suppressor Proteins/pharmacology , Animals , Female , Gonadotropin-Releasing Hormone/pharmacology , Kisspeptins , Luteinizing Hormone/blood , Ovariectomy , Ovulation/blood , Rats , Rats, Wistar , Receptors, Progesterone/physiology
6.
J Steroid Biochem Mol Biol ; 101(1): 42-9, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16893645

ABSTRACT

In postmenopausal women, tibolone shows clear tissue differences in its stimulatory effects on the vagina and uterus. In rats, however, it has stimulatory effects on both tissues, with a different, more estrogenic, effect on the uterus than in humans. This may be due to differences in local metabolism. Therefore, in the present study, the metabolism of tibolone was analyzed in incubations of uterine and vaginal tissue from postmenopausal women and ovariectomized rats using radiolabeled tibolone in order to understand the tissue- and species-specific metabolism. In the rat, tibolone (50 nM) was mainly 3alpha-reduced to the estrogenic 3alpha-OH-tibolone in the uterus and vagina. The 3beta-OH tibolone can be isomerized to 3alpha-OH-tibolone with tibolone as intermediate. In contrast, in the same tissues from postmenopausal women, the progestagenic Delta4-isomer and estrogenic 3beta-OH-tibolone were the major metabolites of tibolone. The formation of the Delta4-isomer was higher in uterine tissue. The 3beta-hydroxysteroid dehydrogenase (HSD) inhibitor epostane had no effect on tibolone metabolism in human uterine and vaginal tissue microsomes and HEK293 cells expressing the human 3beta-HSD types 1 and 2 isoforms did not metabolize tibolone. Moreover, the 3beta-reduction of tibolone to 3beta-OH-tibolone was NADPH dependent, while the isomerization of tibolone to the Delta4-isomer did not require a cofactor. It was therefore concluded that human 3beta-HSD isoforms are not involved in the metabolism of tibolone, and that the 3beta-reduction and the Delta5-10 to Delta4 isomerization may be catalyzed by different enzymes. In conclusion, we showed that, in hormone therapy target tissues of the rat as compared with the human, different metabolic pathways for tibolone exist and therefore result in metabolites with different pharmacological properties. The rat is therefore a poor model to predict the effects of tibolone on the uterus in postmenopausal women.


Subject(s)
Norpregnenes/metabolism , Uterus/metabolism , Vagina/metabolism , Aged , Aged, 80 and over , Animals , Cell Line , Chromatography, High Pressure Liquid , Chromatography, Thin Layer , Female , Humans , Middle Aged , Ovariectomy , Rats , Rats, Wistar
7.
J Steroid Biochem Mol Biol ; 100(4-5): 152-60, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16781141

ABSTRACT

In this study, we assessed the effects of tibolone and its metabolites on the production of a progesterone sensitive parameter, prolactin, in human endometrium stroma cells in vitro. In addition, the metabolism of the compounds by isolated stromal and epithelial cells was evaluated. The reference compounds, progesterone, Org 2058, and DHT all induced prolactin production. Oestradiol also slightly induced prolactin production and enhanced the response to Org 2058. Tibolone and Delta4-tibolone were similar with regard to potency to induce prolactin levels in the culture supernatant. Their potency was lower than that of Org 2058, similar to that of progesterone and higher than that of DHT. The efficacies of tibolone, Delta4-tibolone and Org 2058 were similar (approximately 200-fold induction). The estrogenic tibolone metabolites 3alpha- and 3beta-OH tibolone also significantly stimulated prolactin production. Their potency, however, was low since significance was reached only at the highest concentrations tested. The PR antagonist Org 31710 inhibited both tibolone- and Delta4-tibolone-induced prolactin production. The responses of tibolone and Delta4-tibolone were not affected by co-incubation with the androgen receptor antagonist OH-flutamide. The effect of tibolone, but not Delta4-tibolone, was antagonized approximately 50% in combination with the highest dose (1 microM) estrogen receptor antagonist, ICI 164384. The induction of prolactin by 3alpha- and 3beta-OH tibolone was antagonized most potently by Org 31710, but also by ICI 164384 and OH-flutamide. Tibolone is metabolized differently in epithelial and stromal cells of the human endometrium. The epithelial cells mostly produce the progestagenic/androgenic Delta4-tibolone. The stromal cells produce predominantly the 3beta-OH tibolone, and some Delta4-tibolone, but the net effect observed with regard to prolactin production is progestagenic. When the metabolites 3alpha-OH, 3beta-OH, and Delta4-tibolone were added to the cultures no conversions were observed. The HPLC analyses showed no evidence for the production of sulfated metabolites. In conclusion, the net effects on endometrial stromal cells are predominantly progestagenic. Tibolone is converted by epithelial cells into Delta4-tibolone which displays progestagenic and androgenic activities, whereas in stromal cells also the estrogenic metabolites 3alpha- and 3beta-OH tibolone are formed.


Subject(s)
Endometrium/cytology , Estrogen Receptor Modulators , Norpregnenes , Prolactin/metabolism , Stromal Cells/drug effects , Stromal Cells/metabolism , Cells, Cultured , Dihydrotestosterone/metabolism , Dose-Response Relationship, Drug , Epithelial Cells/cytology , Epithelial Cells/drug effects , Epithelial Cells/metabolism , Estrogen Receptor Modulators/metabolism , Estrogen Receptor Modulators/pharmacology , Female , Humans , Norpregnenes/metabolism , Norpregnenes/pharmacology , Pregnenediones/chemistry , Pregnenediones/metabolism , Progesterone/chemistry , Progesterone/metabolism , Stromal Cells/cytology
8.
Bone ; 39(2): 392-400, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16644297

ABSTRACT

Hormone therapy (HT) drugs and bisphosphonates prevent osteoporosis by inhibiting osteoclastic bone resorption. However, the effects of osteoporosis and anti-resorptive drugs on the mechanical behavior of the bone tissue constituting individual trabeculae have not yet been quantified. In this study, we test the hypothesis that the mechanical properties of bone trabecular tissue will differ for normal, ovariectomized and drug-treated rat bones over the course of ageing. Microtensile testing is carried on individual trabeculae from tibial bone of ovariectomized (OVX) rats, OVX rats treated with tibolone and placebo-treated controls. The method developed minimizes errors due to misalignment and stress concentrations at the grips. The local mineralization of single trabeculae is compared using micro-CT images calibrated for bone mineral content assessment. Our results indicate that ovariectomy in rats increases the stiffness, yield strength, yield strain and ultimate stress of the mineralized tissue constituting trabecular bone relative to normal; we found significant differences (P < 0.05) at 14, 34 and 54 weeks of treatment. These increases are complemented by a significant increase in the mineral content at the tissue level, although overall bone mineral density and mass are reduced. With drug treatment, the properties remain at, or slightly below, the placebo-treated controls levels for 54 weeks. The higher bone strength in the OVX group may cause the trabecular architecture to adapt as seen during osteopenia/osteoporosis, or alternately it may compensate for loss of trabecular architecture. These findings suggest that, in addition to the effects of osteoporosis and subsequent treatment on bone architecture, there are also more subtle processes ongoing to alter bone strength at the tissue level.


Subject(s)
Aging/physiology , Estrogen Receptor Modulators/pharmacology , Norpregnenes/pharmacology , Ovariectomy , Tibia/drug effects , Tibia/physiology , Animals , Biomechanical Phenomena , Bone Density/drug effects , Female , Finite Element Analysis , Rats , Rats, Wistar , Stress, Mechanical , Tensile Strength , Tomography, X-Ray Computed , Weight-Bearing
9.
Maturitas ; 48 Suppl 1: S24-9, 2004 Aug 30.
Article in English | MEDLINE | ID: mdl-15337245

ABSTRACT

This long-term study (2 years) was designed to compare the effects of tibolone (LoTib at 0.05 mg/kg and HiTib at 0.2 mg/kg) with those of conjugated equine oestrogens (CEE) alone (0.042 mg/kg) and CEE continuously combined with medroxyprogesterone acetate (MPA) (0.167 mg/kg) on coronary artery atherosclerosis, bone, mammary gland and uterus in ovariectomised cynomolgus monkeys fed a moderately atherogenic diet. Despite reductions in plasma concentrations of high density lipoprotein cholesterol in tibolone-treated monkeys, there was no exacerbation of coronary artery atherosclerosis. Tibolone was equivalent to, or slightly better than, CEE and CEE + MPA in protecting against postmenopausal bone loss and loss of bone strength. Tibolone also resulted in less stimulation of breast and endometrial tissue compared with CEE and CEE + MPA. In conclusion, the results suggest that tibolone is a cardiovascular-safe treatment that is effective for the prevention of osteoporosis and that may have advantages over CEE or CEE + MPA with regard to endometrial and breast safety.


Subject(s)
Estrogens, Conjugated (USP)/pharmacology , Norpregnenes/pharmacology , Selective Estrogen Receptor Modulators/pharmacology , Animals , Coronary Vessels/drug effects , Dose-Response Relationship, Drug , Estrogens, Conjugated (USP)/administration & dosage , Female , Longitudinal Studies , Lumbar Vertebrae/drug effects , Macaca fascicularis , Mammary Glands, Animal/drug effects , Menopause , Models, Animal , Norpregnenes/administration & dosage , Ovariectomy , Random Allocation , Selective Estrogen Receptor Modulators/administration & dosage , Uterus/drug effects
10.
J Bone Miner Res ; 18(10): 1725-36, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14584880

ABSTRACT

UNLABELLED: 1alpha,25(OH)2-vitamin D strongly regulates the expression of the epithelial calcium channel CaT1. CaT1 expression is reduced in ERKOalpha mice and induced by estrogen treatment, pregnancy, or lactation in VDR WT and KO mice. Estrogens and vitamin D are thus independent potent regulators of the expression of this calcium influx mechanism, which is involved in active intestinal calcium absorption. INTRODUCTION: Active duodenal calcium absorption consists of three major steps: calcium influx into, transfer through, and extrusion out of the enterocyte. These steps are carried out by the calcium transport protein 1 (CaT1), calbindin-D9K, and the plasma membrane calcium ATPase (PMCA1b), respectively. We investigated whether estrogens or hormonal changes during the female reproductive cycle influence the expression of these genes, and if so, whether these effects are vitamin D-vitamin D receptor (VDR) dependent. MATERIALS AND METHODS: We evaluated duodenal expression patterns in estrogen receptor (ER)alpha and -beta knockout (KO) mice, as well as in ovariectomized, estrogen-treated, pregnant, and lactating VDR wild-type (WT) and VDR KO mice. RESULTS: Expression of calcium transporter genes was not altered in ERKObeta mice. CaT1 mRNA expression was reduced by 55% in ERKOalpha mice, while the two other calcium transporter genes were not affected. Ovariectomy caused no change in duodenal expression pattern of VDR WT and KO mice, whereas treatment with a pharmacologic dose of estrogens induced CaT1 mRNA expression in VDR WT (4-fold) and KO (8-fold) mice. Pregnancy enhanced CaTI expression equally in VDR WT and KO mice (12-fold). Calbindin-D9K and PMCA1b expression increased to a lesser extent and solely in pregnant VDR WT animals. In lactating VDR WT and KO mice, CaT1 mRNA expression increased 13 times, which was associated with a smaller increase in calbindin-D9K protein content and PMCA1b mRNA expression. CONCLUSIONS: Estrogens or hormonal changes during pregnancy or lactation have distinct, vitamin D-independent effects at the genomic level on active duodenal calcium absorption mechanisms, mainly through a major upregulation of the calcium influx channel CaT1. The estrogen effects seem to be mediated solely by ERalpha.


Subject(s)
Calcium Channels/physiology , Calcium/metabolism , Estrogens/metabolism , Receptors, Calcitriol/metabolism , Up-Regulation , Animals , Biological Transport , Enterocytes/metabolism , Estrogen Receptor alpha , Estrogen Receptor beta , Mice , Mice, Knockout , Models, Genetic , Mutagenesis , RNA, Messenger/metabolism , Receptors, Estrogen/genetics , Reverse Transcriptase Polymerase Chain Reaction , TRPV Cation Channels , Vitamin D/metabolism
11.
J Steroid Biochem Mol Biol ; 83(1-5): 157-65, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12650712

ABSTRACT

Tibolone, selective estrogen receptor modulators (SERMs) like tamoxifen and raloxifene, and estrogen (+/-progestogen) treatments prevent bone loss in postmenopausal women. They exert their effects on bone via the estrogen receptor (ER) and the increase in bone mass is due to resorption inhibition. The effect of SERMs on bone mineral density is less than that with the other treatments, but the SERM raloxifene still has a positive effect on vertebral fractures. In contrast to tibolone and estrogens (+/-progestogen), SERMs do not treat climacteric complaints, whilst estrogen plus progestogen treatments cause a high incidence of bleeding. Estrogen plus progestogen combinations have compromising effects on the breast. Tibolone and SERMs do not stimulate the breast or endometrium. Unlike SERMs, tibolone does not possess antagonistic biological effects via the ER in these tissues. Estrogenic stimulation in these tissues is prevented by local metabolism and inhibition of steroid metabolizing enzymes by tibolone and its metabolites. SERMs and estrogen (+/-progestogen) treatments increase the risk of venous thromboembolism (VTE), whilst estrogen (+/-progestogen) combinations have unwanted effects on cardiovascular events. So far, no detrimental effects of tibolone have been observed with respect to VTE or cardiovascular events. The clinical profile of tibolone therefore has advantages over those of other treatment modalities. It is also clear that tibolone is a unique compound with a specific mode of action and that it belongs to a separate class of compounds that can best be described as selective, tissue estrogenic activity regulators (STEARs).


Subject(s)
Estrogen Receptor Modulators/therapeutic use , Estrogens/therapeutic use , Norpregnenes/therapeutic use , Osteoporosis/drug therapy , Selective Estrogen Receptor Modulators/therapeutic use , Bone and Bones/drug effects , Endometrium/drug effects , Estrogen Receptor Modulators/adverse effects , Estrogens/adverse effects , Female , Humans , Models, Chemical , Norpregnenes/adverse effects , Postmenopause , Progestins/adverse effects , Progestins/therapeutic use , Receptors, Estrogen/metabolism , Selective Estrogen Receptor Modulators/adverse effects
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