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Hormonal shifts with perimenopause and menopause and symptomatic onset Perimenopause has its erratic cycles as the ovarian reserve diminishes

As previously discussed, bacterial products, collectively known as PAMPs and MAMPs, derived from the gut, reach the liver via portal circulation and systemic circulation through the mesenteric lymph nodes, and may induce an inflammatory response by activating Toll-like receptors (TLRs)

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1 Excess weightis also a risk factor for vitamin B 12 deficiency

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