List of fda approved bioidentical hormones - May 31, 2019 · The FDA has approved bioidentical formulations of both estrogen and progesterone. Products include (FDA) oral, transdermal, and vaginal 17β-estradiol and oral progesterone. These products are carefully controlled and regulated, allowing for improved safety and known risks. If women are interested in using bioidentical hormone therapy, consider

 
To learn more, review the BIJUVA Patient Information and talk about BIJUVA with your healthcare provider or pharmacist. The FDA-approved product labeling, including Patient Information, can be found here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088. . Nationpercent27s giant hamburgers and great pies castro valley menu

Background In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)—despite concerns within the medical community and the availability of new FDA approved “bioidentical” products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women. Methods ...The U.S. Food and Drug Administration (FDA) has approved dozens of hormone therapy products for men and women, including estrogen, progesterone, testosterone, and related compounds. These products have been reviewed for safety and efficacy and are indicated for treatment of symptoms resulting from hormonal changes associated with menopause or other endocrine-based disorders. In recent decades ...Prescribers Should Restrict the Use of Non-FDA-Approved Compounded Bioidentical Hormones, Except for Specific Medical Circumstances. The National Academies of Sciences Engineering Medicine ...The FDA’s Pharmacy Compounding Advisory Committee (PCAC) should review select hormones for the Difficult to Compound list, including estradiol, estrone, estradiol, progesterone, estriol, testosterone, and the pellet dosage form. The federal government and State Boards of Pharmacy should expand and improve oversight of 503A “traditional ... In recent years, CBHT has emerged as a popular alternative to manufactured, FDA-approved hormone therapy—despite concerns within the medical community and the availability of new FDA-approved “bioidentical” products. This study investigated the motivations for choosing and using CBHT in a U.S. sample of ordinary midlife women.Jul 8, 2020 · Custom hormone treatments, called compounded bioidentical hormone therapies (cBHTs), are often promoted by celebrities as natural or safer than FDA-approved therapies. Compounded bioidentical hormone replacement therapy (BHRT) products such as progesterone and testosterone, are used at times instead of FDA-approved drugs for hormone replacement therapy. Companies that make bioidentical hormone therapy use the term “bioidentical” to suggest that their products are exactly the same as natural hormones. Many of these companies also claim that their products are safer than menopausal hormone therapy. However, the FDA does not recognize this term or regulate these products. No studies have been ...The following lists some basic information about the FDA-approved hormone medicines for menopause. Use this information to help you talk to your healthcare provider about whether hormone...Dec 7, 2022 · The term "natural" means the hormones in the product come from plant or animal sources. They're not made in a lab. But many of these products still need to be commercially processed to become bioidentical. Traditional hormone therapies don't necessarily exclude natural hormones. Some FDA-approved products come from plants. Examples include ... For example, one study found that only 1 of 10 compounding pharmacies provided progesterone vaginal suppositories that were all within the potency range required of similar FDA-approved products. 2. This article will focus on compounded bioidentical hormone preparations aimed at menopausal and perimenopausal women.Mar 11, 2021 · Bioidentical hormones are available as FDA-approved hormone formulations. Nonapproved custom-compounded preparations are marketed as bioidentical, but content is uncertain. The widespread use of compounded bioidentical hormone therapy despite the lack of evidence to support its safety and efficacy is concerning. The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” 11 This broad definition does not address the manufacturing, source, or delivery methods of the products and thus can include non–FDA-approved custom-compounded ... The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” 11 This broad definition does not address the manufacturing, source, or delivery methods of the products and thus can include non–FDA-approved custom-compounded ...FDA Approved Drugs. The following database contains a listing of drugs approved by the Food and Drug Administration (FDA) for sale in the United States. Drug information typically includes the drug name, approval status, indication of use, and clinical trial results. A.14 uses of U.S. Food and Drug Administration (FDA) approved hormone therapies include 15 replacement during menopause, oncology therapies, and for endocrine or genetic disorders. 16 Although oral contraceptives are a common use of hormones, their primary use for the preventionThe quick answer is yes, bioidentical hormones are FDA approved but hold on, this is a very controversial and somewhat complex topic that requires more explanation. Some bioidentical hormones are manufactured by drug companies, are approved by the FDA, and sold in standard doses. On the other hand some bioidentical hormone preparations are made ...Oct 11, 2019 · The quick answer is yes, bioidentical hormones are FDA approved but hold on, this is a very controversial and somewhat complex topic that requires more explanation. Some bioidentical hormones are manufactured by drug companies, are approved by the FDA, and sold in standard doses. On the other hand some bioidentical hormone preparations are made ... Bioidentical progesterone replacement therapy is commonly used by perimenopausal and postmenopausal women whose shifting hormone levels severely affect their well-being, causing symptoms such as irritability, hot flashes, difficulty concentrating, loss of libido, and more. However, women of reproductive age may also choose to take bioidentical ...The FDA wants to restrict compounded hormones to patients who are allergic to manufactured products or who need an unavailable specific dosage. People other than estrogen-deficient women use ...Oct 11, 2019 · The quick answer is yes, bioidentical hormones are FDA approved but hold on, this is a very controversial and somewhat complex topic that requires more explanation. Some bioidentical hormones are manufactured by drug companies, are approved by the FDA, and sold in standard doses. On the other hand some bioidentical hormone preparations are made ... Bioidentical hormone therapy used to treat menopausal symptoms typically contains estradiol which is, in fact, identical to the estradiol used in traditional hormone therapy. Thus, the term bioidentical hormone therapy can be confusing; there are bioidentical hormones approved by the FDA, but there are also compounded bioidentical hormone ...These types are approved and regulated by the FDA, and they are made by drug companies. Some bioidentical hormones are available in a compounding pharmacy. Compounded bioidentical hormones may be put into a capsule, a skin cream or gel, a tablet to dissolve under your tongue, a suppository, or a nose spray.Sep 29, 2021 · Doses should be as low as possible to help ease the symptoms, and then taken for the shortest amount of time. For some women, this may be for a few months, for others, years. If you are taking HRT for serious menopause symptoms, you may be reluctant to stop taking HRT, for fear the symptoms will return. However, there are also commercially available FDA-approved products that fit the definition of “bioidentical,” and some bioidentical hormones are derived from animal sources or made synthetically (Cirigliano 2007). These products are seldom marketed or prescribed by anti-aging and other alternative health practitioners, who instead favor ...Compounded “bioidentical hormone therapy” (BHT) products, such as progesterone and testosterone, are used by some providers and patients instead of FDA-approved drug products for hormone therapy.The FDA has latched onto this false conclusion from a report it commissioned, and it is another direct threat compounded bioidentical hormones’ future. The FDA’s announcement regarding bioidentical hormones came just hours after the National Academy of Sciences, Engineering, and Medicine (NASEM) released their report reviewing the ...Apr 19, 2023 · These types are approved and regulated by the FDA, and they are made by drug companies. Some bioidentical hormones are available in a compounding pharmacy. Compounded bioidentical hormones may be put into a capsule, a skin cream or gel, a tablet to dissolve under your tongue, a suppository, or a nose spray. “The [widely available] FDA-approved bioidentical hormones produced in monitored facilities demonstrate a high quality of safety and efficiency in trials; therefore, there is no rationale for the routine prescribing of unregulated, untested, and potentially harmful custom-compounded bioidentical HTs.” Bioidentical Hormone Therapy. The change in hormonal milieu associated with perimenopause and menopause can lead to a variety of symptoms that can affect a woman's quality of life. Postmenopausal hormone therapy (HT) is an effective, well-tolerated treatment for these symptoms. However, combined HT consisting of conjugated equine estrogen and ...A wide variety of FDA-approved bioidentical hormones are currently available. New transdermal biodentical estradiol gels have been approved by the FDA for menopausal symptoms. In the future, new ... Dec 12, 2022 · The U.S. Food and Drug Administration (FDA) has approved some forms of manufactured bioidentical hormones, including bioidentical estriol (a weak form of estrogen) and progesterone. Jun 27, 2023 · Biote is a company that specializes in hormone optimization using bioidentical hormone pellets, explains David J. Watson, M.D., an OB-GYN at Littleton Gynecology and Wellness in Littleton ... Feb 18, 2022 · The Food and Drug Administration (“FDA”) is currently considering placing eleven hormones used in Compounded Bioidentical Hormone Therapy (“cBHT”) on a “difficult to compound list”, effectively banning the compounding of these ingredients. The “difficult to compound list” is a list of drug products and categories of drug ... The FDA’s Pharmacy Compounding Advisory Committee (PCAC) should review select hormones for the Difficult to Compound list, including estradiol, estrone, estradiol, progesterone, estriol, testosterone, and the pellet dosage form. The federal government and State Boards of Pharmacy should expand and improve oversight of 503A “traditional ... October 17, 2019 | Filed under: Health, Menopause. I’m so thrilled to have Dr. Barbie Taylor a.k.a. “Menopause Taylor” with us today! She’s a retired OB/GYN who’s dedicated her 2nd half to educating women about menopause! If you’re a woman (of any age), this is a must watch video! I was a typical aging woman who had NO ….Compounded “bioidentical hormone therapy” (BHT) products, such as progesterone and testosterone, are used by some providers and patients instead of FDA-approved drug products for hormone therapy.The quick answer is yes, bioidentical hormones are FDA approved but hold on, this is a very controversial and somewhat complex topic that requires more explanation. Some bioidentical hormones are manufactured by drug companies, are approved by the FDA, and sold in standard doses. On the other hand some bioidentical hormone preparations are made ...The FDA has approved several bioidentical hormones. Somers' books, however, describes custom-compounded bioidentical hormones, meaning they are produced by a pharmacy mixing ingredients of various ...FDA-approved. FDA does not have evidence that compounded “bioidentical hormones” are safe and effective, or safer or more effective than FDA-approved hormone therapy. FDA has approved drugs ...The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” 11 This broad definition does not address the manufacturing, source, or delivery methods of the products and thus can include non–FDA-approved custom-compounded ..."It is important that women understand what bioidentical hormones are and the differences between those that are FDA-approved and those that are compounded or "mixed" at the pharmacy level," said ...A wide variety of FDA-approved bioidentical hormones are currently available. New transdermal biodentical estradiol gels have been approved by the FDA for menopausal symptoms. In the future, new ... Compounded “bioidentical hormone therapy” (BHT) products, such as progesterone and testosterone, are used by some providers and patients instead of FDA-approved drug products for hormone therapy.Jul 9, 2020 · The agency has latched onto this false conclusion from a report it commissioned, and it is another direct threat to estriol and compounded bioidentical hormones’ future. Action Alert! The FDA’s announcement regarding bioidentical hormones came just hours after the National Academy of Sciences, Engineering, and Medicine (NASEM) released their report reviewing the “clinical utility” of (See Table for a list of FDA-approved bioi-dentical HT products.) Another hormone, testosterone (shown to improve sexual desire), is not currently available as an FDA-approved bioidentical product. Confusion and unsubstantiated claims surround the custom-compounded bioidentical hormone therapy products used to treat Companies that make bioidentical hormone therapy use the term “bioidentical” to suggest that their products are exactly the same as natural hormones. Many of these companies also claim that their products are safer than menopausal hormone therapy. However, the FDA does not recognize this term or regulate these products. No studies have been ...There are FDA-approved bioidentical hormone products available, including estradiol (Estrace, Climara, Vivelle) and progesterone (Prometrium). Many compounded hormones are also considered to be bioidentical. These are hormones made just for you. But they aren’t FDA-approved and can vary in quality. Table of contents About bioidentical hormones UsesMar 7, 2007 · For example, one study found that only 1 of 10 compounding pharmacies provided progesterone vaginal suppositories that were all within the potency range required of similar FDA-approved products. 2. This article will focus on compounded bioidentical hormone preparations aimed at menopausal and perimenopausal women. products are FDA approved for use in the U.S. (Moskowitz, 2006). Custom compounded HT formulations may include any combination of P4, E1, E2, or E3 (Stanczyk et al., 2021). FDA approved 17-beta estradiol is available in the U.S. in oral, transdermal, and vaginal formulations; under generic and brand names such as Estrace, Alora patch, and VagifemThe Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” 11 This broad definition does not address the manufacturing, source, or delivery methods of the products and thus can include non–FDA-approved custom-compounded ...A list of FDA-approved testosterone products can be found by searching for ... Testosterone is a hormone essential for the growth and development of male sex organs and maintenance of secondary ...In contrast to FDA-approved drug products, compounded bioidentical hormone therapy (cBHT) preparations lack standardized production methods, potentially leading to state-by-state and even pharmacy-by-pharmacy variability in the medications dispensed to patients.A wide variety of FDA-approved bioidentical hormones are currently available. New transdermal biodentical estradiol gels have been approved by the FDA for menopausal symptoms. In the future, new ... The Endocrine Society has defined bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” 11 This broad definition does not address the manufacturing, source, or delivery methods of the products and thus can include non–FDA-approved custom-compounded ...To learn more, review the BIJUVA Patient Information and talk about BIJUVA with your healthcare provider or pharmacist. The FDA-approved product labeling, including Patient Information, can be found here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088.The use of compounded bioidentical hormone therapies (cBHTs) — an increasingly popular approach to relieve symptoms of menopause and male hypogonadism — should be limited to the small number of patients who cannot benefit from an FDA-approved hormone therapy product, says a new report from the National Academies of Sciences, Engineering, and Medicine.The phrase bioidentical hormone therapy has been recognized by the FDA and the Endocrine Society as a marketing term and not one based on scientific evidence 4. Examples of compounded hormones include Biest (biestrogen) and Triest (triestrogen) preparations. The name Biest commonly refers to an estrogen preparation based on a ratio of 20% ...Dec 7, 2020 · Compounding pharmacies should be aware of recent developments in the law surrounding bioidentical hormone therapy (cBHT). In the field of pharmacy, compounding (performed in compounding pharmacies) is preparation of a custom formulation of a medication to fit the unique need of a patient which cannot be met with commercially available products. Compounded drugs are not FDA-approved. The Food ... Compounded “Bioidentical” Hormone Therapy (cBHT), particularly estrogen and progesterone, have been promoted by some as safer and more effective alternatives to manufactured FDA-approved hormone therapies (HT) for relief of symptoms of the menopause. In fact, little or no scienti˜ c evidence exists to support suchThere are FDA-approved bioidentical hormone products available, including estradiol (Estrace, Climara, Vivelle) and progesterone (Prometrium). Many compounded hormones are also considered to be bioidentical. These are hormones made just for you. But they aren’t FDA-approved and can vary in quality. Table of contents About bioidentical hormones UsesBioidentical hormones are synthetic (artificial) hormones often confused with natural hormones derived from plants. Standard BHRT is tested, approved, and regulated by the FDA, while cBHRT is not. Many people prefer BHRT because of its perceived safety and because it can be customized.BIOIDENTICAL HORMONE THERAPY WHAT ARE BIOIDENTIcAL HORMONES? “Bioidentical” means identical in molecular structure to endogenous hormones. Howev-er, as we will see, a better distinction should be made between products that are approved and regulated by the US Food and Drug Ad-ministration (FDA) and those that are not. Custom hormone treatments, called compounded bioidentical hormone therapies (cBHTs), are often promoted by celebrities as natural or safer than FDA-approved therapies. UConn toxicologist José Manautou, who heads the department of pharmaceutical sciences, served on the committee that wrote the National Academies report.The FDA requires manufacturers of FDA-approved products that contain estrogen and progestin to include a black box warning that reflects the findings of the Women’s Health Initiative. However, compounded products (including “bio-identical hormones”) are not approved by the FDA and have been exempt from having to provide patient package Jul 13, 2021 · Group Tells the FDA to Restrict the Use of Compounded Hormones. That is the message this group is using to convince the FDA to make prescribing compounded products a very restricted field. The use of compounded bioidentical hormone therapies (cBHTs) — an increasingly popular approach to relieve symptoms of menopause and male hypogonadism ... The U.S. Food and Drug Administration (FDA) has approved some forms of manufactured bioidentical hormones, including bioidentical estriol (a weak form of estrogen) and progesterone.May 25, 2023 · Bioidentical hormones. These hormones come from plant sources. The term "bioidentical" implies the hormones in the product are chemically identical to those your body produces. There are some commercially available bioidentical hormones approved by the Food and Drug Administration (FDA). The FDA requires manufacturers of FDA-approved products that contain estrogen and progestin to include a black box warning that reflects the findings of the Women’s Health Initiative. However, compounded products (including “bio-identical hormones”) are not approved by the FDA and have been exempt from having to provide patient packageThe Food and Drug Administration (“FDA”) is currently considering placing eleven hormones used in Compounded Bioidentical Hormone Therapy (“cBHT”) on a The Food and Drug Administration (“FDA”) is currently considering placing eleven hormones used in Compounded Bioidentical Hormone Therapy (“cBHT”) on a “difficult to compound list”[1],effectively banning the compounding of ...Jun 3, 2021 · Most of these hormones, except progesterone, are not approved by the FDA for use in women. Purchasing FDA-approved progesterone requires a medical prescription. Scientists report that FDA-approved progesterone BHRT products also adopt the name “body-identical” to avoid confusion with compounded bioidentical hormones (cBHRT). They are ... Mar 7, 2007 · For example, one study found that only 1 of 10 compounding pharmacies provided progesterone vaginal suppositories that were all within the potency range required of similar FDA-approved products. 2. This article will focus on compounded bioidentical hormone preparations aimed at menopausal and perimenopausal women. In October 2005 Wyeth Pharmaceuticals, a manufacturer of both FDA-approved bioidentical and non-bioidentical HRT preparations, filed a citizen petition with the FDA asking for enforcement action against compounding pharmacies that dispensed BHT and to investigate labelling and advertising guidelines. Soon after, the FDA took a number of ...Compounded bioidentical hormone replacement therapy (BHRT) products such as progesterone and testosterone, are used at times instead of FDA-approved drugs for hormone replacement therapy. In recent decades there has been a significant increase in both the supply and demand for compounded bioidentical hormone therapy (cBHT) products, raising the need for a better understanding of their safety and effectiveness. cBHT use has alarmed many providers as custom-compounded hormones are not Food and Drug Administration (FDA) approved and do not have labeling that details product risks ...Jul 13, 2021 · Group Tells the FDA to Restrict the Use of Compounded Hormones. That is the message this group is using to convince the FDA to make prescribing compounded products a very restricted field. The use of compounded bioidentical hormone therapies (cBHTs) — an increasingly popular approach to relieve symptoms of menopause and male hypogonadism ... Jun 23, 2021 · The categories of hormones gets broken down into bioidentical versus synthetic, and FDA-approved versus non-FDA-approved. FDA-Approved Hormone therapy Numerous FDA-approved hormone preparations are available for the treatment of menopausal symptoms, gender-affirming therapy, birth control, and menstrual regulation. Jun 23, 2021 · The categories of hormones gets broken down into bioidentical versus synthetic, and FDA-approved versus non-FDA-approved. FDA-Approved Hormone therapy Numerous FDA-approved hormone preparations are available for the treatment of menopausal symptoms, gender-affirming therapy, birth control, and menstrual regulation. May 25, 2023 · Bioidentical hormones. These hormones come from plant sources. The term "bioidentical" implies the hormones in the product are chemically identical to those your body produces. There are some commercially available bioidentical hormones approved by the Food and Drug Administration (FDA). Estrogen, progesterone and testosterone are the most commonly used bioidentical hormones. Some prescription forms of bioidentical hormones are premade by drug companies. The U.S. Food and Drug Administration (FDA) has approved certain types of bioidentical hormones.Mar 10, 2021 · Source: goodtoknow.co.uk. On the other hand, many of these points may be directly treated with bioidentical hormone alternative therapy. Hormone preparations specially tailor made for patients by compounding pharmacies, often known as bioidentical hormones, are extensively touted as being safer and more natural than Food and Drug Administration (FDA) approved variations of hormones.

In addition to this, these drugs used estriol, a weaker form of estrogen which does not have FDA approval. The Benefits and Risks of Bioidentical Hormone Therapy. As with any health treatment, bioidentical hormones come with benefits and risks. The benefits of FDA-approved bioidentical hormone therapy stem from the nature of their creation.. Georgia dor

list of fda approved bioidentical hormones

In contrast to FDA-approved drug products, compounded bioidentical hormone therapy (cBHT) preparations lack standardized production methods, potentially leading to state-by-state and even pharmacy-by-pharmacy variability in the medications dispensed to patients.Bioidentical hormones have the exact same chemical and molecular structure as hormones that are produced in the human body. Bioidentical hormones are available as FDA-approved hormone formulations. Nonapproved custom-compounded preparations are marketed as bioidentical, but content is uncertain.The U.S. Food and Drug Administration (FDA) has approved dozens of hormone therapy products for men and women, including estrogen, progesterone, testosterone, and related compounds. These products have been reviewed for safety and efficacy and are indicated for treatment of symptoms resulting from hormonal changes associated with menopause or other endocrine-based disorders. In recent decades ...A list of FDA-approved testosterone products can be found by searching for ... Testosterone is a hormone essential for the growth and development of male sex organs and maintenance of secondary ...The author falsely claims that bioidentical hormones have not been proven safe and effective as required for FDA approval process. Take a look at the list of bioidentical prescription hormones above. These are all FDA approved and proven safe and effective.The FDA requires manufacturers of FDA-approved products that contain estrogen and progestin to include a black box warning that reflects the findings of the Women’s Health Initiative. However, compounded products (including “bio-identical hormones”) are not approved by the FDA and have been exempt from having to provide patient packageJul 10, 2020 · Bioidentical progesterone replacement therapy is commonly used by perimenopausal and postmenopausal women whose shifting hormone levels severely affect their well-being, causing symptoms such as irritability, hot flashes, difficulty concentrating, loss of libido, and more. However, women of reproductive age may also choose to take bioidentical ... by DonnaWhite | Oct 11, 2019. The quick answer is yes, bioidentical hormones are FDA approved but hold on, this is a very controversial and somewhat complex topic that requires more explanation. Some bioidentical hormones are manufactured by drug companies, are approved by the FDA, and sold in standard doses.Compounded “bioidentical hormone therapy” (BHT) products, such as progesterone and testosterone, are used by some providers and patients instead of FDA-approved drug products for hormone therapy.May 13, 2016 · The author, an AP medical writer, might be horrified to know that these non-FDA approved bioidentical hormones, (estradiol, progesterone, estriol and testosterone), are floating around in her blood stream right now, and have been since she was born. So, please, don’t do anything impulsive or crazy, like trying to remove these non-FDA approved ... Jan 18, 2023 · FDA approved bioidentical hormones are intended for standard doses that are mass-produced by manufacturers. If you need a dose that is higher or lower than what a manufacturer makes, then you must have it compounded to your individual needs. There are 3 types of bioidentical estrogens. The stronger and more active estrogen against menopausal ... Estrogen, progesterone and testosterone are the most commonly used bioidentical hormones. Some prescription forms of bioidentical hormones are premade by drug companies. The U.S. Food and Drug Administration (FDA) has approved certain types of bioidentical hormones.Given the lack of well-designed and well-conducted clinical trials of these compounded hormones, ACOG recommended that all of them should be considered to have the same safety issues as those hormone products that are approved by the FDA and may also have additional risks unique to the compounding process. Bioidentical hormones are man-made hormones derived from plants, often soy and yams, that are chemically identical to those the human body produces. As such, they bind to the estrogen and testosterone receptors in the same way as women’s endogenous hormones have throughout their lives . The U.S. FDA has approved some forms of manufactured ...In October 2005 Wyeth Pharmaceuticals, a manufacturer of both FDA-approved bioidentical and non-bioidentical HRT preparations, filed a citizen petition with the FDA asking for enforcement action against compounding pharmacies that dispensed BHT and to investigate labelling and advertising guidelines. Soon after, the FDA took a number of ...The FDA wants to restrict compounded hormones to patients who are allergic to manufactured products or who need an unavailable specific dosage. People other than estrogen-deficient women use ....

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