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Postmenopausal women lack the protective mechanisms of a specific physiological period, and with the decrease in estrogen levels, the metabolism of the body changes, leading to an increase in the incidence of CVD (65, 67)

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This results in improved blood flow to the erectile tissues, the corpus cavernosus and corpus spongiosus in the penis, improving the ability to maintain an erection

These factors collectively drive the progressive damage of biliary epithelial cells by autoantibodies, leading to cholestasis, fibrosis, and potential progression to cirrhosis or liver failure (217)

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