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Adding Norethisterone on top of the combined pill is not appropriate, both contain progestogens, and stacking them increases the risk of side effects such as breakthrough bleeding, mood changes, and a small but real raised risk of venous thromboembolism (VTE)
If the solution turns cloudy, develops visible particles, changes color, or develops an unusual odor, it has degraded and should be discarded
no serious adverse events were reported
For example, those with severe B12 deficiency or nerve damage might need more
W.et al
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