Menstruation during second pregnancy. Causes of menstruation during pregnancy. Important date, last menstruation before pregnancy

• Such cases, of course, are not frequent. The presence of menstruation during pregnancy depends on the duration and health of the woman’s hormonal system. Sometimes bleeding tends to be confused with menstruation, when the presence of pregnancy is not yet known
• To deal with such a difficult problem as menstruation during pregnancy, it is necessary to consider various causes and situations.

Is it possible to have periods in early pregnancy?

• From an anatomical point of view, menstruation during pregnancy is impossible. It is necessary to remember the anatomy course in order to understand that full periods in the presence of a fertilized egg in the uterus are fraught with miscarriage
• However, on the other hand, the pregnancy process does not occur instantly. In order to reach the uterus, a fertilized egg needs from 7 to 14 days
• So, if the egg is still “making its way”, and menstruation should begin according to schedule, then, in principle, this is quite possible
• In fact, you will not yet be pregnant during this period. The egg will reach the right place before the bleeding stops
• In rare cases, menstruation occurs during pregnancy if two eggs have matured, but only one has been fertilized

Why do I have periods during pregnancy?

• Quite often, periods are simply confused with bleeding. This happens especially often in the early stages, when pregnancy is unknown.
• In the first month of pregnancy, menstruation is quite acceptable. Further it is simply impossible
• In late pregnancy, there is also spotting from the vagina. This is not menstruation, but only discharge from damaged vessels
• Sometimes discharge can begin due to hormonal imbalance in the body

Why do my periods come with clots during pregnancy?

• Heavy bleeding with blood clots is abnormal during pregnancy. This indicates serious problems in the course of pregnancy.
• A miscarriage is often accompanied by heavy bleeding with clots, as well as severe pain in the lower abdomen
• Another pathology is the death of the embryo due to a lack of development or other pathologies
• An ectopic pregnancy can sometimes be accompanied by bleeding and severe nagging pain in the abdomen
• Placental presentation during pregnancy also causes bleeding

Heavy periods during pregnancy

• Menstruation during pregnancy from 2 months is no longer normal
• To find out exactly the cause of heavy bleeding, you need to consult a doctor.
• If the pregnancy test shows a negative result, but your periods have changed (discharge color, pain), then you should also consult a doctor. Very often the test is negative for an ectopic pregnancy

How long do periods last during pregnancy?

• Pregnancy and the presence of bleeding during the first period of gestation are quite common problems. However, if you do not improve your hormonal balance, there can be tragic consequences.
• At later stages, the presence of bleeding is already a dangerous sign - this can pose a serious threat of miscarriage
• There are no full periods during pregnancy. Bleeding during pregnancy varies in color, consistency and pain.

Menstruation and ectopic pregnancy

• An ectopic pregnancy is a pathological course of pregnancy. It carries fetal loss and a number of complications for the mother
• In the early stages, it is very difficult to recognize an ectopic pregnancy. It either does not manifest itself at all, or proceeds like a normal pregnancy.
• The essence of an ectopic pregnancy is that the fertilized egg did not reach the uterus, but attached to the fallopian tubes
• In the future, ectopic pregnancy leads to an inflammatory process, internal bleeding and often to infertility
• Full periods are impossible even with an ectopic pregnancy. The discharge that will appear is only slight bleeding.
• Discharge during an ectopic pregnancy will occur spontaneously, and not in conjunction with menstruation. In addition, they are often accompanied by severe pain in the lower abdomen

• Quite often, women themselves confuse menstruation with bleeding.
• This happens due to irregular visits to the gynecologist and failure to monitor your menstrual cycle.
• If a pregnancy test shows a negative value (and this happens quite often), then the woman may not be aware of her situation
• Sometimes a woman is quite plump, and her position is not discovered until 4 - 5 months of pregnancy
• There are quite a lot of such cases in medical practice. Therefore, to avoid this, regular examination by a gynecologist is necessary.

How to distinguish periods from bleeding during pregnancy?

• By color. Your period is usually a darker burgundy color. And the color of bleeding is scarlet
• According to pain. When bleeding, the pain is usually much more noticeable than during menstruation.
• By consistency. Periods are thicker than blood when bleeding
• Menstruation and bleeding differ in the way they occur. As a rule, menstruation has 1 day when the discharge is small. Bleeding usually begins spontaneously

Why do menstruation occur during pregnancy?

• The main purpose of calling your period during pregnancy is to interrupt it.
• However, this process is not as simple as it seems at first glance. And especially not harmless. It is fraught with serious health complications for women
• As a rule, menstruation is induced with special medications under the supervision of a doctor. This is a kind of medical abortion. It is possible in early pregnancy
• There are also traditional ways to induce menstruation during pregnancy. But resorting to them is under no circumstances acceptable.

• Anatomically, menstruation is impossible during pregnancy
• During pregnancy, periods are often confused with bleeding or discharge.
• Menstruation in the first month of pregnancy is possible with a long journey of the egg to the uterus and with a short menstrual cycle (21 days)
• Bleeding is abnormal at any stage of pregnancy. If they exist, you should consult a doctor
• If you are not sure that you are not pregnant, and your periods have changed in nature, be sure to be examined by a gynecologist
• The presence of bleeding during pregnancy is fraught with miscarriage and a number of health complications
• Inducing menstruation during pregnancy means stopping it

Video: Menstruation during pregnancy

Lack of menstruation is the first sign through which a woman learns about her interesting situation. But can menstruation occur during pregnancy and what do they mean? In the article we will look at the main reasons for this phenomenon and discuss whether this state of the body is dangerous for the fetus.

Causes

Perhaps your colleagues or friends sometimes talked about the appearance of menstruation in the early stages of pregnancy. And if you ask our grandmothers, they can say that they did not know about their interesting position until 4-5 months, when the belly began to round.

Female physiology implies the absence of menstruation for the entire period of bearing a child. If a malfunction suddenly occurs in the body, as a result of which bloody discharge appears, then you should immediately visit a gynecologist. Such discharge does not always mean the presence of pathologies or diseases, and in some cases is even considered normal. But a visit to the doctor is still necessary so as not to risk your health and the fetus.

The reasons for the appearance of menstruation during pregnancy are quite varied. The main ones:

• ectopic pregnancy;
• stress;
• hormonal disorders;
• injuries;
• risk of miscarriage.

Also, the presence of menstruation in the early stages of pregnancy is due to the following factor. Fertilization occurs in the middle of the menstrual cycle, and the fertilized egg reaches the uterus only after one or two weeks. The female body does not have time to completely rebuild itself during this period of time, which is why menstruation occurs. But after a month, the hormonal levels return to normal, and menstruation stops.

But there is another situation. The embryo is actively and correctly developing, and menstruation continues. As a rule, this pathology disappears a few months after conception. This condition of a pregnant woman is caused by a small amount of estrogen.

Sometimes spotting during pregnancy is a sign of an incipient miscarriage. If the discharge is accompanied by pain, you should immediately call an ambulance.

Menstruation in the early stages of pregnancy is an alarming symptom that means the presence of serious diseases in your body. Often the cause of discharge is hyperandrogenism. If it is detected in a timely manner, then the life of the fetus will not be in danger.

Types of menstruation during pregnancy

Every month, an egg matures in a woman’s body. In the absence of fertilization, it dies and leaves the body along with menstrual flow. If conception has occurred, the body begins to actively produce progesterone. This hormone increases the growth of the endometrium so that the embryo attaches tightly. Progesterone has a positive effect on pregnancy; its sufficient amount in the blood guarantees safe pregnancy.

Menstruation during pregnancy is not the usual menstruation that a woman is used to seeing monthly. The cause of this condition may be hormonal imbalance or pathology. Sometimes this condition indicates rejection of the fertilized egg or a threat of miscarriage.

A decrease in the amount of progesterone causes spotting. In this case, the gynecologist prescribes hormonal drugs to prevent miscarriage.

When several embryos are born at the same time, one of them may be rejected. This condition is accompanied by bloody discharge. In this case, rejection itself occurs due to pathology of fetal development.

Features of menstruation during pregnancy

Menstruation after conception is called color pregnancy. In the first few months after conception, a pregnant woman may periodically have periods. But such discharge is scanty and not bright red in color. Such bleeding is not considered a pathology. The sensations during them are the same as during normal menstruation: breast tenderness, mood swings, weakness and drowsiness.

If you start menstruation and suspect pregnancy, be sure to take a test. The presence of menstruation does not affect the result of a pregnancy test.

At the beginning of embryo development, bloody discharge from the woman’s genital organ is likely. When a fertilized egg attaches to the wall of the uterus, a small tear occurs in the mucous membrane, which leads to red discharge. And it is completely safe for the health of the fetus and the woman.

What do periods mean during pregnancy?

Bloody discharge during pregnancy means the following:

1. The hormonal background of the expectant mother does not have time to adjust to the onset of conception.
2. Discharge in the second and third months of pregnancy means detachment of endometrial particles.
3. Menstruation practically does not appear in late pregnancy. If they occur, then this means the fertilization of another egg. But this happens extremely rarely.

In any case, if bloody discharge appears, be sure to visit a doctor.

Are periods during pregnancy dangerous for the fetus?

Should menstruation during pregnancy be considered dangerous for the fetus? There is no clear answer to this question. Any discharge from the genital tract during pregnancy must be examined by a doctor. This procedure will protect the child and the expectant mother herself from various complications.

The main danger of bloody discharge lies in the risk of placental abruption, resulting in fetal death. To prevent such situations, limit any physical activity on the days when you are scheduled to have your period.

Normal bleeding does not affect the development and growth of the fetus. They do not provoke the development of pathologies or diseases. But this does not mean that you should be calm about all changes in your body. If you have bloody discharge, nausea, or a migraine, call an ambulance immediately. Only a gynecologist can judge whether your discharge is normal or pathological.

If there is discharge, the doctor will carefully examine you and take blood to determine your hormone levels. Do not ignore your doctor's instructions and prescribed tests. Only in this case will you have a healthy and strong baby!

Oddly enough, uterine bleeding, especially in the first trimester, is observed quite often, and the ensuing pregnancy turns out to be a real surprise for a woman. You can distinguish normal menstruation from false menstruation by a number of characteristic signs indicating the birth of a new life.

Symptoms of pregnancy while having menstruation

After conception, multiple processes are launched in the female body, preparing it for bearing a fetus. First of all, the hormonal background changes, and with it the functions of many organ systems. Until the 2nd trimester, pregnancy practically does not appear outwardly, so you need to take a closer look at yourself.

In the early stages

If there is a suspicion that conception has occurred, but menstruation has arrived on time, then you should pay attention to the nature of the discharge itself. First of all, they become scarce. In addition to the reduction in blood volume, its color usually changes: from light red and pink to brown and brown. Such “menstruation” can occur repeatedly and require a visit to the gynecologist to confirm or rule out pregnancy.

Another reliable sign of imminent motherhood is a change in the condition of the mammary glands. The breasts increase in size and become quite painful. Such signs are characteristic of premenstrual syndrome, but with the onset of menstruation they disappear. If pregnancy occurs, the breasts remain swollen, and the nipples and areolas become darker due to increased pigmentation.

At a later date

As a rule, spotting at the beginning of pregnancy does not pose a threat to it and stops by the second trimester. However, regular bleeding can occur throughout the entire pregnancy, and more pronounced signs will help to reliably determine its presence:

• In the third or fourth month, drops of cloudy whitish liquid are released from the nipples when pressed (or spontaneously) - colostrum. In this way, the mammary glands prepare for the lactation period after childbirth.
• Marked frequent urge to urinate, and the volume of urine is insignificant. This is explained by the increase in the size of the uterus: it begins to put pressure on the nearby bladder, and it has to be emptied more often.
• Uterine growth becomes obvious: the stomach begins to protrude forward, the first movements of the fetus are felt. Body weight generally increases, which is especially noticeable in thin women who are watching their figure (at the same time, diets and sports do not produce results - the weight is steadily growing).
• Pregnant women's taste preferences change, sometimes taking quite bizarre forms. There is a tendency towards foods that were not previously on the list of favorites, and pica is often observed. This term refers to the uncontrollable desire to eat obviously inedible things, for example, chalk (the body thus replenishes calcium reserves).
• A common sign of pregnancy is fatigue along with irritability. Energy is spent by the body of the expectant mother to maintain the vital functions of the fetus, and unstable hormonal levels contribute to sudden changes in mood.
• During pregnancy, the production of melanocyte-stimulating hormone melanotropin increases significantly and, accordingly, increased skin pigmentation. Already in the third month, a vertical dark line appears in the center of the abdomen, and spots (chloasma) may appear on the face. After childbirth, pigmentation quickly disappears and the skin returns to normal.
• Due to weight gain, hereditary factors and changes in hormonal levels, the skin undergoes another change: on the chest, hips and abdomen appear stretch marks.
• An increase in the concentration of estrogen in the blood may manifest itself as erythema (redness of the skin of the palms) or formation of spider veins.
• Likely multiple acne on the face, since the sebaceous glands begin to work more actively when hormonal levels change.

The above signs clearly indicate pregnancy, and they are noticeable not only to the woman herself, but also to those around her. Regular uterine bleeding in this case is not normal menstruation at all, but a threat of miscarriage and a reason to urgently consult a doctor. After a diagnostic examination, a specialist will determine the cause and prescribe appropriate treatment.

Menstruation during pregnancy: reasons

Menstruation and pregnancy are mutually exclusive concepts, however, the presence of scanty monthly discharge can be considered normal if the woman feels well.

• Conceiving at the very end of the cycle may not affect the overall hormonal background and the uterus ready for menstruation. Most often happens spontaneous, which the woman doesn’t even know about, but if the fertilized egg managed to implant, the pregnancy continues.
• When an embryo is implanted into the uterine wall, it is possible implantation bleeding. A small amount of blood is released, which is mistakenly taken for the beginning of the next menstruation.
• Possible and banal error in calculations, when pregnancy occurs after menstruation, but the woman is sure that conception occurred earlier.
• Quite rare, but quite probable situation with two mature eggs: one of them is fertilized and fixed in the uterus, and the other causes menstruation.
• During intense sexual intercourse There may be damage to the cervix and, consequently, slight bleeding.

In the situations described, menstrual bleeding stops in the first trimester and pregnancy proceeds normally until childbirth. However, in exceptional cases, the fetus develops under the same hormonal background: the phases of estrogenic and gestagenic activity alternate monthly, and menstruation occurs. This condition of the body requires medical correction with hormonal drugs to reduce the likelihood of miscarriage.

Menstruation and pregnancy (video)

Heavy and painful bleeding poses a real threat to the health of the fetus and the pregnant woman herself. In this case, spontaneous abortion is an almost inevitable outcome of events. In addition, menstruation can continue against the background of an ectopic pregnancy, so if certain suspicions arise, it is unacceptable to delay a visit to the gynecologist. The doctor will tell you in detail whether a pregnancy can be carried to term during menstruation and what symptoms really pose a danger to the unborn baby.

A woman’s body is designed in such a way that in the absence of pregnancy, an unfertilized egg becomes the cause of menstrual periods. The discharge of blood in the second half of the cycle may indicate conception and not be menstruation.

Pregnancy if you have your period is possible in extremely rare cases. Bloody discharge in this case indicates endometrial detachment and the threat of miscarriage. Even more rarely, it is possible for two eggs to mature - one develops, the second dies and causes menstruation on time.

The logic of many women is clear: if you have your period, it means you are not pregnant. However, possible fertilization of the egg cannot be ruled out.

There are a number of conditions under which they can go:

1. Time of implantation of the fertilized egg. At 2–4 weeks after fertilization, the fertilized egg implants and damages blood vessels, which cause spotting that vaguely resembles menstruation. More often, this process occurs without bleeding; in rare cases, a woman may notice, during her period when her period should have begun, small brownish spotting for 1–3 days in a row. This is a harmless condition that does not require medical intervention.
2. The period when the egg has not yet implanted into the lining of the uterus before the onset of menstruation. In this case, scanty discharge may be observed. The whole process takes from 1 to 2 weeks, especially when conception occurred towards the end of the second half of the cycle. That is, menstruation begins exactly at the time when the fertilized egg “looks” for a place for implantation.
3. The maturation of two eggs at the same time is the rarest case when a woman can become pregnant during menstruation. The eggs develop in different ovaries. One is rejected, stimulating the onset of menstruation, the second is fertilized and continues to develop.
4. Hormonal imbalance. An excess of male hormones and a lack of progesterone can cause slight bleeding during conception.

The nature, color, and volume of this discharge determines whether such “periods” can threaten pregnancy. A small brownish smear most often does not pose a threat to the development of the fetus, while heavy bleeding is a symptom of miscarriage.

Many women very often wonder whether they can go. However, in this matter it is better to immediately contact a specialist to avoid serious consequences.

Will implantation occur if fertilization has occurred?

So-called implantation bleeding, which is often mistaken for normal periods, can occur if implantation occurs on the day it starts or a couple of days before.

Such bleeding is considered normal and occurs when the embryo naturally implants into the uterine mucosa. That is, it depends on the timing of implantation of the egg whether there can be a pregnancy if menstruation occurs (more likely, a spot).

Implantation does not occur immediately after fertilization of the egg. It moves through the tubes into the uterine cavity, after a few days it attaches, and the fetus begins its development.

If conception has occurred, but the egg has not yet implanted, menstruation may occur. The test will be negative, and only when your period has passed is a positive result possible.

Types of bleeding during implantation

There are two options for bleeding during implantation:

1. In the process of implantation of the egg into the endometrium, approximately a week after conception (on the 22nd day of the cycle), there is still no delay, but minor spotting may appear. This is a rare case in medical practice.
2. Most often, implantation bleeding occurs in the 6th week after the first day of the last menstruation. Just at this time, rapid growth of the chorion occurs, which corresponds to a pregnancy period of 4 to 5 weeks. This condition is observed in almost a quarter of expectant mothers and is often perceived by them as an ectopic pregnancy or miscarriage. Stops after 2–4 days.

Only in rare cases, slight bleeding can mean that the pregnancy is ectopic or there is a threat of miscarriage. If there is heavy bleeding, we can say that there was a pregnancy, but it was interrupted for some reason.

Implantation is also possible on the first day of the onset of regula. If fertilization occurs 5–6 days before its onset, then the embryo is implanted on the 1st day of menstruation. The reasons for this are the long stay of the sperm in the fallopian tubes and the displacement of ovulation. In this case, the woman became pregnant if her period came on time, towards the end of the second half of the cycle or immediately before the start of her period.

What do periods mean if you are pregnant?

Whether menstruation can occur after conception depends on many factors: inflammatory processes in the woman’s genital organs, hormonal levels, and the location of pregnancy (in the uterus or outside it).

Fertilization at the same time as menstruation can be a dangerous symptom for the woman and the fetus. Menstruation during pregnancy often indicates pathologies such as:

1. Unsuccessful embryo attachment. This may cause a small amount of blood to be released over a period of several weeks. As a rule, this occurs due to the presence of myoma/fibromyoma.
2. Hormonal imbalance, often an increase in the level of male hormones, as well as a decrease in the concentration of progesterone.
3. Rejection of one embryo from a couple. It rarely happens that two fetuses develop, after which one of them stops developing and is rejected, causing bleeding.
4. Abnormalities in fetal development during the intrauterine period can cause miscarriage.
5. Presence of an ectopic pregnancy. In this case, they are associated with the development of the fetus in the abdominal cavity, tubes, and cervix. As the embryo grows, soft tissue ruptures with damage to blood vessels and bleeding.

In general, the state of the mother’s reproductive system determines whether menstruation can occur upon conception. Normal levels of female and male hormones, the absence of chronic diseases of the genital organs, stress, and trauma guarantee the physiological attachment and further development of the egg.

Bleeding that looks like menstruation when tested positive is a serious cause for concern. If the bleeding increases, as during normal periods, and the color is bright red, you should consult a gynecologist.

You can suspect that fertilization has occurred if, instead of regular periods, a woman develops a brownish smudge that ends in 1–2 days. A test carried out over such a short period of time often gives a false negative answer, since the level of hCG in the body is still negligible.

In any case, if, it is necessary to repeat the test and consult a doctor.

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In the early stages, menstruation occurs during pregnancy, which can be considered a physiological or pathological process. A pregnant woman urgently needs to see a gynecologist and undergo a full examination of the pelvic organs. It is possible that immediate hospitalization will be necessary to maintain the pregnancy. This unpleasant symptom is used to determine ectopic pregnancy and more. The condition is dangerous because it can cost the life of an unborn baby.

What are periods

According to the laws of the female body, the menstrual cycle ends with uterine bleeding. If heavy discharge does not come, it is possible that the woman is in an “interesting situation.” With a delay in menstruation, thoughts of unexpected or planned motherhood come to mind. However, it happens that pregnancy has occurred, but the critical days still come. This is possible even after successful conception, but the nature of the discharge reduces its abundance and intensity. It is better to consult a gynecologist to find out the possible consequences for the health of the mother and child.

Can you have periods during pregnancy?

This question interests many expectant mothers, especially those who are preparing for motherhood for the first time. During the period of bearing a baby, this is real, and is explained by insufficient production of the hormone progesterone in the blood by the corpus luteum. As the period increases, the indicator should ideally increase, and then nothing threatens the intrauterine development of the embryo. Otherwise, there is a high probability of termination of pregnancy in the early stages. In addition, one should not exclude the following clinical picture: a weak embryo cannot attach to the uterine mucosa, so rejection occurs.

If menstruation appears during pregnancy in the early stages, it can last for several hours - a day, and is characterized by scarcity and an unusual color. If everything stops after a couple of days, you don’t have to panic, but still visit a gynecologist. Menstruation in the late stages of gestation, regardless of intensity and duration, eloquently indicates progressive pathology. A pregnant woman must respond to such alarming symptoms in a timely manner. In any case, the question of whether menstruation can occur during pregnancy has a clearly affirmative answer.

What they look like

More often this is a scarlet discharge, which is also called “spotting”. However, there are also brown blood clots that come out partially. In the latter case, this may be a sign of endometrial rejection, as a dangerous pathological process. During pregnancy, periods are light and come at short intervals. They are easy to distinguish from usual uterine bleeding. Pregnancy with menstruation is pathological and requires immediate medical attention as soon as the first symptoms appear.

How to distinguish periods during pregnancy from normal ones

Habitual menstruation is characterized by abundance, a stable cycle, lasting from 3-7 days. If a woman is not planning a child, it is recommended to maintain an individual schedule. Menstruation during pregnancy is characterized by scanty discharge, painful sensations in the lower abdomen, and internal discomfort. With unplanned bleeding, the time interval between discharges is reduced, and the woman develops iron deficiency anemia. Bloody discharge may also cause headaches, nausea, and weakness.

Menstruation during early pregnancy

The appearance of menstrual bleeding during pregnancy in the first trimester is an alarming sign for the expectant mother. A delay in menstruation can easily be explained by the successful process of fertilization of the egg, but the appearance of abnormal discharge may indicate that the corpus luteum of the uterus is being rejected. In addition, such a phenomenon is not excluded in case of hormonal disorders or diseases of the endocrine system in pregnant women. Other causes of minor spotting that accompany pregnancy and menstruation at the same time are:

• long-term use of hormonal drugs;
• progressive ectopic pregnancy;
• threat of early miscarriage;
• death of the embryo in one of the trimesters.

Scanty periods as a sign of pregnancy

If menstruation appears during pregnancy, it is possible that this is a systematic period of embryo implantation, which is not considered a pathology and may be accompanied by bleeding. It lasts from 7 to 15 days, and is not accompanied by hormonal changes in the female body. In the future, with minor discharge that does not stop, you need to be wary and voice your suspicions to your local gynecologist. Such a symptom may be a sign of an ectopic pregnancy, but doctors suggest other diagnoses.

If a woman does not know about her “interesting situation,” scanty periods are a clear symptom. In this case, the test may give a false negative answer - one strip. This is explained by the short duration and insufficient concentration of sex hormones, possibly progesterone. In such cases, it is necessary to monitor the onset of menstruation, and after its completion, wait and perform a repeat home study. It is possible that the tests will be positive.

What are the dangers of menstruation during pregnancy?

Rejection of fertilized eggs, as the main cause of menstruation during pregnancy, is preceded by disrupted hormonal levels, female internal diseases, severe physical exertion and mental turmoil. If 9 months proceed in a state of stress, it is possible that menstruation will appear at an early stage. There is no need to talk about its calm course and normal birth in such a clinical picture; It is important to ask your doctor how to save the life of an unborn baby. If menstruation appears during pregnancy, dangerous reasons may be as follows:

• detachment of the ovum;
• threat of early miscarriage and pathological birth in the 2nd and 3rd trimesters;
• heavy bleeding with progressive anemia;
• ectopic pregnancy;
• genetic disorders of the embryo;
• bad heredity;
• social and everyday factor.

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The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.