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You should contact your GP or diabetes specialist nurse if you experience any of the following: Significant changes in menstrual pattern : Periods that become markedly heavier or lighter than usual Cycles that become significantly shorter (less than 21 days) or longer (more than 35 days) Complete absence of periods (amenorrhoea) for three months or more, particularly if you previously had regular cycles New onset of bleeding between periods or after intercourse Associated symptoms requiring prompt evaluation : Severe pelvic or abdominal pain accompanying menstrual changes Unexplained fatigue, dizziness, or signs of anaemia Sudden onset of very heavy bleeding requiring frequent pad or tampon changes (especially if soaking through a pad/tampon hourly) Any postmenopausal bleeding (if applicable) this requires urgent referral via the two-week suspected cancer pathway Fertility and pregnancy considerations : If you are of childbearing age and sexually active, be aware that weight loss and improved metabolic health may increase fertility, particularly in women with PCOS
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Nicotinic acid is then assimilated into Lactobacillus arabinosis during growth 97
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