“The risks and benefits of MHT differ for women during the menopause transition compared to those for older women”.1

Umbrella
What may the Hormone Therapy Benefits and Risks Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • HRT/HT/MHT Benefits and Risks
  • HRT/HT/MHT Health Benefits and Risks
  • HRT/HT/MHT Pros and Cons
  • HRT/HT/MHT Risks and Benefits
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Menopausal Hormone Therapy (MHT)

Date

What can it be important to be clear about with hormone therapy (HT) benefits and risks information?

I think it can be important to be clear about the date of all information including the date of HT benefits and risks information, because this information may have been updated.

Symptoms or Chronic Conditions

What can it also be important to be clear about with HT benefits and risks information?

I think it can also be important to be clear about whether HT benefits and risks information is about the use of HT for the management of menopausal symptoms such as hot flushes, night sweats and vaginal dryness or for the prevention of chronic conditions such as cardiovascular disease, cancer and osteoporosis.

Potential Benefits

What are potential HT benefits?

On page one in Deciding About Hormone Therapy Use: Potential Benefits published in June 2017, the North American Menopause Society (NAMS) explain:

“Hormone therapy is one of the most effective treatments available for bothersome hot flashes and night sweats. If night sweats are waking you throughout the night, HT may improve sleep and fatigue, mood, ability to concentrate, and overall quality of life. Treatment of bothersome hot flashes and night sweats is the principal reason women use HT. Hormone therapy also treats vaginal dryness and painful sex associated with menopause. Hormone therapy keeps your bones strong by preserving bone density and decreasing your risk of osteoporosis and fractures. If preserving bone density is your only concern, and you do not have bothersome hot flashes, other treatments may be recommended instead of HT”.2

Benefits and Risks Differences

Can hormone therapy (HT) benefits and risks be different for different women?

Yes. HT benefits and risks can be different for different women. These differences may include:

Hormone Therapy Benefits and Risks Differences

  1. Product Differences
  2. Symptom Differences
  3. Individual Differences
  4. Age Differences
  5. Time Since Menopause Differences
  6. Risk Factor Differences
  7. Health Conditions Differences
  8. Uterus Differences
  9. EPT and ET Differences
  10. Option Differences
  11. Duration Differences

1. Product Differences

Can menopausal hormone therapy (MHT) benefits and risks be different for different hormonal products?

One of the governing principles in the International Menopause Society’s (IMS) 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT published online 12 February 2016, is:

  • “MHT includes a wide range of hormonal products and routes of administration, with potentially different risks and benefits. Thus, the term ‘class effect’ is confusing and inappropriate. However, evidence regarding differences in risks and benefits between different products is limited”.3

2. Symptom Differences

Can MHT benefits and risks differ for women with different menopause symptoms?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT is:

  • “Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for the prevention of recurrent urinary tract infections”.4

3. Individual Differences

Can MHT benefits and risks differ for individual women?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.5

What is VTE?

VTE can be an abbreviation for Venous Thromboemolism.

4. Age Differences

Can MHT benefits and risks differ for women of different ages?

One of the governing principles in the 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT is:

Hormone Therapy Benefits and Risks

  • “The risks and benefits of MHT differ for women during the menopause transition compared to those for older women”.6

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT is:

  • “MHT, including tibolone and the combination of conjugated equine estrogens and bazedoxifene (CE/BZA), is the most effective treatment for vasomotor symptoms (VMS) associated with menopause at any age, but benefits are more likely to outweigh risks if initiated for symptomatic women before the age of 60 years or within 10 years after menopause”.7

What are vasomotor symptoms?

The International Menopause Society explain:

“Hot flushes and night sweats are also referred to as Vasomotor Symptoms (VMS)”.8

5. Time Since Menopause Differences

Can MHT benefits and risks differ for women with different times since menopause?

As noted above, one of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT is:

  • “MHT, including tibolone and the combination of conjugated equine estrogens and bazedoxifene (CE/BZA), is the most effective treatment for vasomotor symptoms (VMS) associated with menopause at any age, but benefits are more likely to outweigh risks if initiated for symptomatic women before the age of 60 years or within 10 years after menopause”.9

6. Risk Factor Differences

Can HT risks differ for women with different risk factors?

On page one in the NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use published on 20 June 2017, the NAMS elaborate on:

  • “The risks of HT differ for different women, depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is needed. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation for the benefits and risks of HT continuation”.10

In Menopause: Menopause – Hormone Treatments the (United States) U.S. Food and Drug Administration (FDA) also note:

“In some women, Menopause Hormone Therapy may increase risks of serious side effects including blood clots, heart attacks, strokes, breast cancer, and gall bladder disease”.11

7. Health Conditions Differences

Can HT risks differ for different women with different health conditions?

In Menopause: Menopause – Hormone Treatment? the FDA explain:

“You should not take hormone therapy for menopause if:

  • You think you are pregnant
  • You have problems with vaginal bleeding
  • You have had certain kinds of cancers
  • You have had a stroke or heart attack
  • You have had blood clots
  • You have liver disease”.12

8. Uterus Differences

Can HT benefits and risks differ for women who have a uterus?

Hormone Therapy Benefits and RisksIn Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? the NAMS note:

“A. …Women who still have a uterus need to take a progestogen in addition to estrogen or the estrogen-SERM combination to protect against uterine cancer”.13

Hormone Therapy Benefits and RisksIf you do not have a uterus, in Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? the NAMS also note:

“A. …Women who have had a hysterectomy (had their uterus removed) can use estrogen alone to control their hot flashes”.14

9. ET and EPT Differences

Can HT benefits and risks differ for women who use ET and women who use EPT?

The NAMS explain:

Hormone Therapy Benefits and RisksHormone Therapy Benefits and Risks“…you and your healthcare provider need to balance the benefits and risks you have. For example, if you don’t have a uterus and can take estrogen therapy (ET) alone, your risks are different from those of women who still have a uterus and must use estrogen plus progestogen (EPT) to protect against uterine cancer”.15

10. Option Differences

Can HT benefits and risks differ for women who choose to use different HT options?

The NAMS explain:

  • “ET delivered through the skin (by patch, cream, gel, or spray) and low‐dose oral estrogen may have lower risks of blood clots and stroke than standard doses of oral estrogen, but all the evidence is not yet available”.16

11. Duration Differences

Can HT benefits and risks differ for women who choose to use HT for different durations or lengths of time?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “Duration of treatment should be consistent with the treatment goals of the individual, and the benefit/risk profile needs to be individually reassessed annually. This is important in view of new data indicating longer duration of VMS in some women”.17

The NAMS explain:

  • “How long you should take HT is different for EPT and ET”.18

In the NICE Guideline Menopause: Diagnosis and Management – Information for the Public: Treating Menopausal Symptoms the (British) National Institute for Health and Care Excellence’s (NICE) elaborate on:

“If HRT is suitable for you and you are interested in taking it, your GP should discuss the benefits and risks with you, both in the short term (the next 5 years) and in the future, before you decide to start it. You should also be given information about:

  • Non-hormonal treatments, for example a drug called clonidine
  • Other types of treatments, such as cognitive behavioural therapy (CBT), a type of psychological therapy that helps people to manage the way they think and feel”.19

Who is a GP?

Dots and/or DotC (Depending on the Country) a GP may be a registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Health Care Provider

If I choose to use HT, how can I find out what my benefits and risks are?

If you choose to use HT, it may be in your best interest to also choose to talk to your health care provider about this.

In Hormone Replacement Therapy (HRT): Risks the (United Kingdom) NHS (National Health Service) elaborate on:

Hormone Therapy Benefits and Risks

“When deciding whether to have hormone replacement therapy (HRT), it’s important to understand the risks. It’s also important to consider HRT as only 1 of a range of options to improve menopausal and postmenopausal health and wellbeing”.20

One of the governing principles in the 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT is:

  • “Consideration of MHT should be part of an overall strategy including lifestyle recommendations regarding diet, exercise, smoking cessation and safe levels of alcohol consumption for maintaining the health of peri- and postmenopausal women”.21

In Menopause: Diagnosis & Treatment: Treatment – Hormone Therapy the Mayo Clinic note:

“You and your doctor will discuss the benefits and risks of hormone therapy and whether it’s a safe choice for you”.22

On page one in Deciding About Hormone Use the NAMS explain:

“Every woman is different—and you must make a decision about whether to use HT based on the severity of your symptoms, your personal and family health history, and your own beliefs about menopause treatments. Your healthcare provider will be able to help you with your decision”.23

In Menopause Management: Menopause Hormone Therapy (MHT) – Should You Take MHT? the (Australian) Jean Hailes for Women’s Health (JH) elaborate on:

  • “Jean Hailes strongly advocates that women take a balanced, evidence-based and informed approach to their healthcare: all risks and benefits should be considered when deciding whether to use MHT
  • Current recommendations by world experts in menopause, including our own doctors, suggest the benefits of MHT outweigh the risks for healthy menopausal women”.24

The JH also note:

  • “Jean Hailes recommends each woman discusses her decision about taking MHT with her doctor regularly and whenever there are any concerns”.25

Health Topics A-Z

Where may I find Health Topics related to Hormone Therapy Benefits and Risks?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

Where may I find Links related to Hormone Therapy Benefits and Risks?

Your Country may have Links similar to:

Links

This Links List to third party websites is neither comprehensive nor exhaustive. Inclusion on this Links List does not imply endorsement or recommendation. Non-inclusion on this Links List does not imply non-endorsement or non-recommendation. Third party websites are not under the control of Meno Martha International Menopause Directory. Third party websites may contain explicit medical images and/or sexual references. Please read Meno Martha International Menopause Directory’s Links Policy before proceeding to a Link. Please contact Webmaster if you experience a problem with a Link.
  1. 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy
  2. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT): 6. Myth – Complementary Medicines and Therapies Are As Effective As MHT and Safer
  3. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT): 7. Myth – Compounded Bioidentical Hormone Therapy Is Safer Than Conventional MHT
  4. Bioidentical Hormone Therapy
  5. Bioidentical Hormones Explained – A British Menopause Society Video
  6. Bioidentical Hormones: Are They Safer?
  7. Combined Menopausal Hormone Therapy (MHT)
  8. Complementary Medicine Options for Menopausal Symptoms
  9. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  10. Deciding About Hormone Therapy
  11. Deciding About Hormone Therapy Use
  12. Decidir Sobre La Hormonoterapia
  13. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  14. Estrogen & Hormones
  15. Estrogen & Hormones: Estrogen and the Cardiovascular System
  16. Estrogen & Hormones: Postmenopausal Hormone Replacement Therapy
  17. Family History
  18. HRT
  19. HRT and Breast Cancer: Overall Risks and Benefits Explained – A British Menopause Society Video
  20. HRT and the Risk of Breast Cancer Explained – A British Menopause Society Video
  21. HRT: The History
  22. Hormone Replacement Therapy
  23. Hormone Replacement Therapy (HRT)
  24. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  25. Hormone Replacement Therapy (HRT): Overview – Benefits of HRT
  26. Hormone Replacement Therapy (HRT): Overview – Who Can Take HRT
  27. Hormone Replacement Therapy (HRT): Risks
  28. Hormone Replacement Therapy (HRT): Types
  29. Hormone Replacement Therapy Safe, Despite Rare Blood Clot Risks From Tablets
  30. Index To Drug-Specific Information [United States]
  31. Information About Menopause [Multiply Languages] [Videos]
  32. MHT and Breast Cancer Risk
  33. Making Choices At Menopause
  34. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  35. Menopause
  36. Menopause
  37. Menopause
  38. Menopause
  39. Menopause & Hormones: Questions To Ask Your Doctor
  40. Menopause FAQs: Hormone Therapy for Menopause Symptoms
  41. Menopause Hormone Therapy and Your Heart
  42. Menopause Management: Hormone Replacement Therapy (HRT) – Benefits & Risks of HRT
  43. Menopause Management: Hormone Replacement Therapy (HRT) – What Are the Risks of HRT?
  44. Menopause Matters
  45. Menopause Symptoms and Relief
  46. Menopause Treatment
  47. Menopause – Is Menopausal Hormone Therapy (HRT) Safe? [Multiply Languages] [Video]
  48. Menopause – What Is Menopausal Hormone Therapy (HRT)? [Multiply Languages] [Video]
  49. Menopause: Diagnosis & Treatment
  50. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT [NICE Guideline]
  51. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  52. Menopause: Medicines To Help You
  53. Menopause: Menopause – Hormone Treatments
  54. Menopause: What Are the Benefits and Risks of Long-Term Hormone Therapy?
  55. Misinterpretation of WHI Results Decreased Use of Hormones, Even In Women Not At Risk [Women’s Health Initiative]
  56. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use
  57. National Center for Complementary and Integrative Health: Herbs At A Glance
  58. National Center for Complementary and Integrative Health: Know the Science: How Medications and Supplements Can Interact
  59. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  60. National Center for Complementary and Integrative Health: Natural Doesn’t Necessarily Mean Safer, or Better
  61. Non-Hormonal Treatment Options for Menopausal Symptoms
  62. NonHormonal Treatments for Menopausal Symptoms
  63. Oestrogen Only Menopausal Hormone Therapy
  64. Practical Prescribing Explained – A British Menopause Society Video
  65. Risks and Benefits of MHT/HRT
  66. Tipos de Hormonoterapia
  67. Types of Hormone Therapy
  68. Urogenital Atrophy Explained – A British Menopause Society Video
  69. Urogenital Problems
  70. Vaginal Dryness
  71. Vaginal Dryness Alternative Treatments
  72. Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments
  73. Video Series-2018 – Moisturizers, Lubricants, and Prasterone
  74. Video Series-2019 – What Is New In Hormone Therapy?
  75. Video Series-2020 – TSECs—A New Treatment for Hot Flashes and Night Sweats
  76. Hormone Therapy Benefits and RisksWhat Is Menopausal Hormone Therapy (MHT) and Is It Safe?
  77. Vietnamese: What Is Menopausal Hormone Therapy (MHT) and Is It Safe?
  78. Women Can Breathe Sigh of Relief When Using Vaginal Estrogen To Treat Menopause Symptoms
  79. Women’s Wellness: Treating Hot Flashes and Night Sweats Without Hormones [+ Video Courtesy: Mayo Clinic News Network]

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Baber, R. J., Panay N. and Fenton, A., the IMS Writing Group. 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT. Climacteric 19:2, 110 https://www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf Accessed: 26 June 2020
  2. Deciding About Hormone Therapy Use: Potential Benefits. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 26 June 2020
  3. Baber, R. J., Panay N. and Fenton, A., the IMS Writing Group. 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT. Climacteric 19:2, 111 https://www.imsociety.org/manage/images/pdf/5aa613a059b5d11934333ff0ecc0da26.pdf Accessed: 26 June 2020
  4. De Villiers T. J., Hall J. E., Pinkerton J. V., Pérez S. C., Rees M., Yang C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 26 June 2020
  5. De Villiers, T. J., Hall, J. E, Pinkerton, J. V, Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 26 June 2020
  6. Baber, R. J., Panay N. and Fenton, A., the IMS Writing Group. 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT. Climacteric 19:2, 110 https://www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf Accessed: 26 June 2020
  7. De Villiers, T.J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 26 June 2020
  8. Hot Flushes and Night Sweats – Background Information: What Are Hot Flushes and Night Sweats? October 2011:1. International Menopause Society https://www.imsociety.org/downloads/world_menopause_day_2011/wmd_media_backgrounder.pdf Accessed: 26 June 2020
  9. De Villiers, T. J, Hall,  J. E., Pinkerton, JV, Pérez, S. C., Rees, M., Yang, C, and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 26 June 2020
  10. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 26 June 2020
  11. Menopause: Menopause – Hormone Treatments. Content Current As of: 22 August 2019. Food and Drug Administration https://www.fda.gov/consumers/womens-health-topics/menopause Accessed: 26 June 2020
  12. Menopause: Menopause – Hormone Treatments. Content Current As of: 22 August 2019. Food and Drug Administration https://www.fda.gov/consumers/womens-health-topics/menopause Accessed: 26 June 2020
  13. Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 26 June 2020
  14. Menopause FAQS: Hormone Therapy – Q. What Is Hormone Therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 26 June 2020
  15. News You Can Use About Hormone Therapy: Benefits. North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/news-you-can-use-about-hormone-therapy Accessed: 26 June 2020
  16. Hormone Therapy for Women In 2012. 2012:2. North American Menopause Society https://www.menopause.org/docs/default-document-library/psht12patient.pdf?sfvrsn=2 Accessed: 26 June 2020
  17. De Villiers,  T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 26 June 2020
  18. Hormone Therapy for Women In 2012. 2012:2. North American Menopause Society https://www.menopause.org/docs/default-document-library/psht12patient.pdf?sfvrsn=2 Accessed: 26 June 2020
  19. Menopause: Diagnosis and Management – Information for the Public: Treating Menopausal Symptoms. Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Treating-menopausal-symptoms Accessed: 26 June 2020
  20. Hormone Replacement Therapy (HRT): Risks. Page Last Reviewed: 09 September 2019. NHS (National Health Service) https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/ Accessed: 26 June 2020
  21. Baber, R. J., Panay N. and Fenton, A., the IMS Writing Group. 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT. Climacteric 19:2, 110 https://www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf Accessed: 26 June 2020
  22. Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy. 07 August 2017. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 Accessed: 26 June 2020
  23. Deciding About Hormone Therapy Use. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 26 June 2020
  24. Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 26 June 2020
  25. Menopause Management: Menopausal Hormone Therapy (MHT) – Should You Take MHT? Last Updated 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 26 June 2020
Topic Last Updated: 26 June 2020 – Topic Last Reviewed: 26 June 2020
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