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FIGURE 4 7 Conclusion Many in vitro , in vivo , and pre-clinical studies have demonstrated various effects of metformin, such as anti-diabetic, antioxidant, anti-inflammatory, anti-tumor, and cardioprotective effects in gynecological disorders, which are mainly due to the effects on the IGF system and several intracellular signaling transduction pathways, such as AMPK, PI3K/AKT/mTOR, and MAPK/ERK pathways
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