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Shen, P

In addition, second-line treatments such as GnRH agonists effectively reduce pain but are compromised by significant menopausal side effects and challenges with long-term tolerability, which has prompted the development of novel oral GnRH antagonists like elagolix, linzagolix, and relugolix that offer dose-dependent estrogen suppression and rapid reversibility

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Oxidative stress (ROS due to inflammation, smoking, toxins, ) compromises mitochondrial oxidative phosphorylation