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10.3109/10799893.2011.586353 163 KrishnarajR

(Basel) 16 , 591 (2023)

Most studies analyzed were single-arm, open-label investigations, underscoring the absence of RCTs necessary to establish definitive efficacy

Specifically, in women who are postmenopausal, exogenous estrogen causes homocysteine levels to drop, but prior to menopause, excess estrogen may increase homocysteine.[ref][ref] Both high and low homocysteine levels increase all-cause mortality, with the caveat that the increase in mortality risk is only seen if homocysteine is not low due to vitamin intake

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