how to use viagra Studies were excluded for several reasons including a data of the outcome were unavailable or not expressed in the numerical form 39, b patients were treated with MI combined with other molecules such as multivitamin complex 40, lactoferrin and bromelin 41 or oral contraceptives pills OCPs 42, c menopausal women with metabolic syndrome 4, 5 and d the study was a non- randomized design 43, 44, 45