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Sometimes they come from other pigments like hemosiderin or lipofuscin too

Kidney Int 2024;105:132-49.ArticlePubMed 128

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It is also suggested that women with endometriosis due to genetic mutations, over respond to estrogen which encourages growth of the lesions, while progesterone receptors are being silenced and becoming unresponsive to progesterone, which would normally balance out the strong influence of estrogen

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