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Supplementary information The online version contains supplementary material available at 10.1038/s41421-024-00700-0

That is a reason to steer with a light hand, not a heavy one

A prospective study of postmenopausal estrogen therapy and coronary heart disease

It describes the sagging
It is non-bloody and often occurs in the setting of poorly controlled diabetes
If your current dose is not producing effects, increase by one increment, not three
