Menstruation after Visanne: features of the restoration of the menstrual cycle

What is Visanne?

Visanne is a hormonal contraceptive drug that has a complex effect. These are round, white tablets with a smooth surface. The active component of the drug is dienogest, characterized by a high gestagenic effect. The substance inhibits the activity of sex hormones, which promote the growth of muscle tissue in the uterus and endometrium. In addition, under its influence a woman cannot become pregnant. Excipients include lactose, starch, talc, magnesium stearate and others.

It is important to observe the correct dosage of Visanne, due to which the medicine will act only on some receptors of the uterus, which will stop the development of pathology. In the end, the harmful cells will die, after which the patient will recover.

Contraindications for use

The drug Visanne has many contraindications. Moreover, some diseases may appear under the influence of the drug, so its use will need to be stopped immediately. The following conditions are contraindications to the use of Visanne:

• problems of the cardiovascular system that the patient may currently have or appear under the influence of the medication;
• diabetes mellitus, which resulted in vascular damage;
• serious liver diseases, malignant tumors in the organ;
• oncological diseases of the reproductive system (uterine tumor, breast cancer, etc.);
• frequent bleeding from the vagina, the causes of which are not clear;
• high sensitivity to the components that make up Visanne;
• lactose intolerance.

With caution, the doctor prescribes Visanne to patients with hypertension, heart failure, diabetes mellitus without vascular damage. In addition, the medicine is prohibited for women during pregnancy and breastfeeding. Dienogest passes into breast milk, so it will enter the baby’s body along with it. But the substance has a negative effect on children. Also, girls under 12 years of age should not take the drug.

Menstruation after Visanne withdrawal

After stopping the course of therapy, the functioning of the reproductive organs is not immediately restored. It takes 2-3 months for the body to normalize hormonal levels. But the recovery process is individual. The first menstruation after Visanne's withdrawal may differ in intensity, duration and character from the usual ones.

If endometriosis can be cured, then menstrual flow will become different. Indeed, with this disease, women complain of heavy, painful menstruation; they can last more than 7-8 days in a row. If the pills help, then the duration of menstruation will be reduced to 3-6 days, the discharge will become moderate, and the pain will decrease.

It is difficult to figure out on your own whether the condition has returned to normal. Recovery should take place under the supervision of a gynecologist who prescribed hormonal treatment. If all the doctor’s recommendations are followed, many women manage to normalize their condition without surgery or prevent the development of relapse of endometriosis after surgery.

After stopping treatment, ideally your periods should return within 2 or 3 months. If they begin immediately, it is advisable to consult a gynecologist; there is a possibility that a continuation of the course of therapy is required.

Some women do not start their periods 3 months after stopping the pills. This may be due to the formation of functional cysts on the ovaries, benign tumors in the uterus. Such patients require more time to restore reproductive functions.

A delay after withdrawal may occur under the influence of stress or depression, which may develop while taking Visanne. If your period does not start 3 months after the end of therapy, you should see a gynecologist.

In women who have completed the full course of treatment, the nature of their periods may change. With the gradual restoration of ovarian function and growth of the endometrium, they will be scanty in the first cycles. If after 2-3 cycles the volume of discharge does not increase, this may indicate a hormone deficiency.

Attention! It is impossible to independently assess how reproductive health is restored after stopping Visanne. The doctor may advise you to do an ultrasound and take hormone tests.

The appearance of spotting on the expected days of menstruation after discontinuation of the drug indicates that the ovaries have not begun to work normally and the endometrium has not grown. This condition is typical for hormonal imbalance, which sometimes occurs after artificial menopause. To eliminate it, the doctor may prescribe oral contraceptives.

When ovarian function is restored, the first menstruation that began after Visanne was discontinued may become heavy. When drug suppression of the process of estrogen production stops, the endometrium begins to actively grow. Therefore, the volume of discharge during menstruation increases.

But heavy discharge may be a sign of relapse of endometriosis or insufficient effectiveness of the drug. To clarify the condition, it is advisable to undergo a gynecological examination.

Possible side effects

Side effects usually occur in the first months of taking the medicine. Gradually their number decreases until they completely disappear. Most often, women taking Visanne experience bleeding from the vagina, swollen breasts, painful nipples, acne, and frequent mood changes. Moreover, vaginal discharge is not always bloody. They can be purulent, mucous, and most often have an unpleasant odor.

In addition, a woman may experience severe pain in the lower abdomen, which is accompanied by a decrease in appetite. A slight increase in weight is possible, and in some cases, on the contrary, body weight decreases. Often patients become less excitable, their sex drive decreases, and their libido decreases.

Use of the drug for uterine fibroids

If a woman is diagnosed with uterine fibroids or endometriosis, one of the first medications the doctor prescribes is Visanne. The drug leads to strengthening of the uterine mucosa. It must be taken only as prescribed by a doctor, as it can cause a number of side effects. In principle, the medication treatment regimen is standard, but the doctor can make adjustments to it. You should take the tablets once a day at the same time. They can be consumed both before and after meals. The main condition is to take the medicine with plenty of water.

The doctor cannot prescribe Visanne for other diseases, since it is effective only for endometriosis and uterine fibroids. True, in the first case, the effect of the drug is more pronounced and appears much faster.

The duration of treatment is 6 months, and the drug does not cause addiction in the patient. The drug should be taken continuously, so if the tablets run out, you need to urgently purchase a new pack. Even if a woman forgot to take her medicine one day, she must take it the next day. You should not take a double dose, even if you missed taking the pills, as this may cause an overdose. No special diet is required, but drinking alcohol is prohibited. Under the influence of ethanol, the likelihood of side effects increases.

Doctors, and even patients themselves, usually leave positive reviews regarding Visanne. They note the high effectiveness of the drug - in approximately 95% of all cases a positive effect is observed. If you comply with all the requirements of the treating gynecologist, there are practically no side effects, and an overdose is impossible.

The cost of Visanne is approximately 2,500 rubles per package. Considering that modern drugs are even more expensive, then the price of Visanne is not so high. Moreover, the medicine is very effective and allows you to quickly cure a gynecological disease.

Under no circumstances should you self-medicate. After all, failure to comply with the doctor’s requirements can lead to various complications. And subsequently, curing the disease will be much more difficult.

Today, Visanne is considered a fairly effective drug for uterine fibroids. The product does not pose any danger or harm to the body, and rarely provokes secondary effects. Despite this, the drug has a number of contraindications, and it is necessary to take it with special care, taking into account the treatment regimen determined by the doctor.

Visanne and menstruation during treatment

With such a fairly serious problem as endometriosis, the patient experiences intense menstruation, which is almost always accompanied by very severe pain. Practice shows that these are the main signs by which the above pathology is determined and diagnosed. Moreover, all therapeutic therapy is always aimed at reducing the resulting abnormal endometrial tissue.

Estrogens are produced in a woman’s body for the purpose of developing the intrauterine surface. An excess of these elements leads to the distribution of its tissues to that part of the body where they should not be located. The functional effect of the drug Visanne is aimed precisely at preventing the above process.

Experts note the fact that a single dose of the drug does not trigger the mechanism of its full action. This process occurs in order of gradual increase. For this reason, the presence of menstruation in the first few cycles of treatment with Visanne is considered the absolute norm. The reaction of each female body to this drug is formed completely individually and under the influence of many external factors.

When prescribing a course of treatment with dienogest tablets, the gynecologist must explain to the patient how they affect the body. A woman should be prepared for the fact that the nature of menstruation may change during the first 1-3 cycles, and with continued treatment they may disappear altogether.

Normally, during treatment with Visanne, menstruation should disappear; bloody or brownish discharge is allowed on the days of expected menstruation.

But the tablets do not begin to act instantly, so in the first 3 months of treatment with Visanne, menstruation occurs, although the volume and duration of discharge in many women is reduced.

The appearance of minor spotting during treatment is acceptable. Scanty, short periods with Visanne are normal. But if full menstruation begins, then a doctor’s consultation is necessary. This drug is not suitable for some patients, because the dose of hormones in it is designed for an average woman.

If there are complaints that menstruation continues while taking Visanne, the gynecologist should refer the patient for an ultrasound. If, based on the results of the examination, it is determined that the follicles are enlarging, the endometrium is growing, which means that it is necessary to increase the dose of hormones or change the drug.

Menstrual-like heavy discharge during a therapeutic course appears with complications. They can also occur in patients with reduced blood clotting or while taking blood-thinning drugs.

Important! If menstruation with Vizanne goes without changes, then it is necessary to reconsider the treatment tactics.

The absence of menstrual flow while taking dienogest is normal. During therapy, the production of estrogen is suppressed, and endometriotic lesions atrophy. A delay in menstruation at the start of treatment is the expected effect of taking the pills, this means that the drug is working. It is worse if menstruation continues while taking Visanne, and the volume of discharge does not decrease.

Description

Visanne is a hormonal drug that prevents the conception of a child, which has a complex effect on the female body. These are rounded white tablets. The active component of the drug is considered to be dienogest, which is characterized by an increased gestagenic effect. The element inhibits the functionality of sex hormones that promote the growth of muscle tissue in the uterus and endometrium. In addition, under his influence a woman will not become pregnant.

It is important to adhere to the correct dosage of the drug, thanks to this the drug will affect only certain receptors of the uterus, and this will stop the formation of the disorder. As a result, the pathogenic cells will die and the woman will recover.

How does the reproductive system react to taking Visanne?

The essence of treatment with the drug is that the function of the ovaries is inhibited and thus the endometrium stops growing. Menstruation slows down when taking Visanne.

When using this remedy, ovulation is partially suppressed; as a result, menstruation is not observed, but spotting is possible. Under the influence of the progestin component, the endometrial layer does not grow. With a thin uterine mucosa, the possibility of bleeding is minimized. The most common reaction to taking this medication is brown spotting during expected menstruation (precisely brown, not bloody).

If uterine bleeding occurs while using the drug, you should consult a doctor. It is likely that it is necessary to increase the dosage of the drug until the discharge stops.

Although Visanne suppresses ovulation, it is not used as a contraceptive. Therefore, when taking this medication, you need to protect yourself with non-hormonal means, since the possibility of ovulation and subsequently pregnancy still exists. In order for the cycle to be restored correctly, you need to follow the doctor’s recommendations.

Composition and effect of the drug

The base of the drug is Dienogest. This biologically active component with progesterone influence has the following beneficial effects:

• Restoration of hormonal balance with a decrease in estrogenic influence on the reproductive organs;
• Stopping excessive thickening of the endometrium;
• Reducing the number of nerve endings in endometriotic sources, which guarantees a process of reducing pain;
• Inhibition of the growth and spread of other vessels that feed the sources of the disease;
• Effect on inflammation that occurs against the background of the disease;
• Inhibition of the production of prostaglandins (components that create conditions for pain).

The drug is released in cardboard packages. The inside of the tablet is white. One tablet contains dienogest in an amount of 2 mg.

Additional elements: lactose, potato starch, cellulose, talc, magnesium sterate.

One package contains 2 blisters of 14 tablets.

Instructions for use

Visanne is indicated for treatment of diseases of the genital area in women. The remedy is indicated when a woman has a proliferation of muscle tissue in the uterus and endometrium. For this reason, the drug is used in most situations for fibroids and endometriosis. For the treatment of other diseases, tablets are used extremely rarely.

Dienogest works well as part of a combination treatment, but it is possible to use Visanne to cure endometriosis without other medications. It is important to follow the prescribed recommendations exactly, using the treatment regimen determined by the doctor.

Therapy involves regular use of the drug, one tablet per day for at least six months. It is extremely important to maintain a 6-month treatment regimen in order to obtain a favorable result.

The instructions for use make it possible to take it from any day, regardless of your menstrual cycle, however, it is preferable to start therapy from the 1st day of menstruation, and subsequently it is possible to take tablets on an ongoing basis.

A specialist can prescribe this remedy after detecting endometriosis or stage 1-2 fibroids. Taking the drug for fibroids, endometriosis and adenomyosis is the same. During the period of taking the pills, menstruation may disappear completely or will be imperceptible.

Dosage

Reception is carried out continuously, at the same time, 1 tablet on any day of the menstrual cycle. You can drink any liquid in the required quantity. The tablets must be taken continuously, regardless of bleeding. When the packaging is finished, you should immediately start a new one without interruption.

If you miss taking a pill or vomit (if vomiting occurs 3 hours after taking the pill), then the effectiveness of the drug decreases significantly. If you miss a pill, you need to take it as soon as you remember. Subsequent appointments are carried out as usual.

Overdose

Serious cases of drug overdose have not been recorded. Signs that may be noted in case of overdose:

Indications for use in adenomyosis

In the official instructions for the drug, endometriosis is stated as the only indication. In practice, Visanne is prescribed in the following clinical situations:

• Internal endometriosis – adenomyosis;
• External endometriosis – damage to the ovaries, fallopian tubes, peritoneum, vagina;
• Detection of internal and external endometriosis;
• Combination of adenomyosis with uterine fibroids and endometrial hyperplasia.

Visanne can be prescribed for all types of endometriosis, regardless of the location of its foci.

The drug can be used as an independent means of conservative therapy, or in the complex treatment of endometriosis. The use of dienogest before surgery reduces the size of the lesion and reduces blood loss. After surgery, Visanne is prescribed to prevent relapse of the disease.

On a note

There are no complete analogues of Visanne. Other agents can be used to treat adenomyosis: gonadotropin-releasing hormone agonists, COCs, Mirena intrauterine device. It is impossible to say unequivocally which treatment option is more effective and which is better. Each drug has its own scope, contraindications and limitations.

It is also useful to read: Internal endometriosis (adenomyosis)

Contraindications

Visanne is not recommended for use in the presence of any of the list of contraindications, some of which apply to any products that contain a progestogen element. If any of these conditions begin to progress, then use of the product should be stopped immediately:

• Acute thrombophlebitis and any diseases associated with thrombophlebitis;
• Diseases of the cardiovascular system, which are based on vascular lesions of an atherosclerotic nature (including ischemic heart disease, stroke, heart attack) in the current period or in the medical history;
• Diabetes with vascular complications;
• History of serious liver disease;
• History of benign and malignant liver tumors;
• Manifested or suspected cancerous tumors, including a malignant breast tumor;
• Vaginal bleeding of unknown origin;
• Galactose intolerance, lactose deficiency;
• Children under 18 years of age;
• Hypersensitivity to the active ingredients or to any of the additional elements of the drug.

The drug should be taken with extreme caution in case of: depressive conditions, medical history of ectopic pregnancy, arterial hypertension, chronic heart failure, hyperlipidemia, deep vein thrombophlebitis.

Side effects

Quite rare, but the following side effects may occur:

1. Headache, migraine.
2. Acne on the skin.
3. Swelling and pain in the chest.
4. Changes in emotional state.
5. Dyspnea.
6. Feeling of “dry” eyes.
7. Tinnitus.
8. Minor bleeding between periods.

Which side effects are more likely to occur:

• Weight gain;
• Anxiety, attention disorder, insomnia;
• Disorder of the intestinal tract;
• Exacerbation of thrush;
• Swelling of the face, arms and legs.

Doctor's opinion

Doctors, as a rule, leave favorable prognoses about the treatment of uterine fibroids with Visanne. They highlight the increased effectiveness of the drug - in approximately 95% of treatments the outcome is positive. If you adhere to all the requirements from a specialist, then there are practically no side effects, and there cannot be an overdose. It turns out that the drug is generally safe.

Alla Borisovna, obstetrician-gynecologist:

I categorically do not support those people who decide to self-treat with this remedy. It's thoughtless. Failure to comply with and ignore the requirements of a specialist can lead to various complications. When they occur, it will be much more difficult to treat the disease. The effectiveness of the drug against fibroids and endometriosis is high. This makes it possible to quickly recover from the disease.

Questions

Hello! I am 23 years old, I have not given birth. I had a hydatidiform mole, after two curettages, I was diagnosed with endometriosis, there is tingling in the abdomen. The doctor prescribed the drug Visanne, they are very expensive and rare. Is it worth taking them? Thank you!

If you are diagnosed with endometriosis, treatment is necessary, because... the presence of this disease leads to secondary infertility. If this drug is not affordable for you, it is recommended to re-consult with a gynecologist to replace the drug with the most optimal one for you. Read more about this disease and diagnostic methods, as well as treatment tactics, in the section of the same name by clicking on the link: Endometriosis as a cause of infertility.

Thank you! but I would like to know about the drug VISANNE itself, it’s not about the price at all, you need to know whether the drug is of high quality or not. and is it true that it causes artificial menopause, is it dangerous?

Thank you very much!

This drug has proven itself in the treatment of endometriosis. The basic rule for the treatment of endometriosis is the absence of menstrual flow, so hormonal drugs are used continuously, i.e. menopause is artificially induced. After discontinuation of the drug and recovery from this disease, ovarian function is restored within 1-3 months. Read more about this disease and diagnostic methods, as well as treatment tactics, in the section of the same name by clicking on the link: Endometriosis as a cause of infertility.

hello, I’m 21, I got married as a virgin, after marriage I began to notice severe pain during menstruation, after half a year I couldn’t conceive and decided to go to the gynecologist and discovered endometriosis through an ultrasound and told me that before prescribing me hormonal pills, I should donate blood. , FSH, testosterone, and prolactin, please tell me how long this treatment will last?

Treatment of endometriosis is long-term, can last from 6-9 months. The duration of therapy is determined by a specialist doctor depending on the level of hormonal levels. The basic rule for the treatment of endometriosis is the absence of menstrual flow for 6-9 months, therefore hormonal drugs are used continuously, i.e. menopause is artificially induced. After discontinuation of the drug and recovery from this disease, ovarian function is restored within 1-3 months. Read more about this disease and diagnostic methods, as well as treatment tactics, in the section of the same name by clicking on the link: Endometriosis as a cause of infertility.

Hello, tell me, did you write me an answer that they can prescribe hormonal pills that will prevent me from having periods for 6 months???? how is this? is it safe? Because I have internal endometriosis inside the uterus.

This method of treatment, continuous use of a contraceptive drug, is one of the methods of treating endometriosis, if you doubt the correctness of the treatment, it is recommended to re-consult with a gynecologist to select another optimal treatment for you, if this treatment regimen doesn't suit you. Read more about this disease and diagnostic methods, as well as treatment tactics, in the section of the same name by clicking on the link: Endometriosis as a cause of infertility.

Hello! I recently had my blood tested for hormones; LH, FSH, TESTESTERONE AND PROLACTIN. My prolatin hormone is elevated, but the rest are normal, the doctor sent me for an X-ray of the brain, and in one day I had sexual intercourse, can the level increase for this reason? prolactina? And so I have a diagnosis of internal endometriosis, so the gynecologist signed Hyperprolatemia! Of course, I’m not bothered by a headache at all, rarely, only painful periods and an irregular cycle! Thank you in advance!

In order for the level of prolactin in the blood to be determined correctly, the day before blood sampling you need to abstain from sexual intercourse. Also, before taking blood for analysis, it is necessary to avoid physical activity. Only in this case, the results will correspond to reality. It is advisable to retake the prolactin test. You can read more about prolactin and its functions in the body in our thematic section of the same name: Prolactin.

Good afternoon! Please tell me that I was prescribed the drug Visanne for the treatment of endometriosis, but after reading the instructions I still don’t understand whether to drink them during menstruation only? Or, when menstruation began, should I start drinking them without a break, regardless of the cycle? Thanks in advance!

Visanne is taken daily, regardless of the period of the menstrual cycle and the presence or absence of menstrual bleeding. The duration of treatment is determined individually by the attending gynecologist. You can read more about the causes of endometriosis, its clinical manifestations, as well as methods for diagnosing and treating this disease in our medical information section dedicated to this disease: Endometriosis.

Hello, on September 1, 2012, I had a laparoscopy and the endometriosis of the left ovary was removed, there were no adhesions and the tubes were passable, on September 11, on the first day of my period, as prescribed by the doctor, I started drinking Visanne, I’m already finishing half of the second box, I haven’t had any more periods, not even spotting, this is normal while taking Visanne? The doctor prescribed me to drink for 3 months, after 3 months of taking Visanne, will my periods go normally next month or what? and how soon can I plan my pregnancy? thanks in advance

The drug Visanne is usually prescribed for a long course - for six months. This drug blocks the functioning of the ovaries, therefore, during the period of its use, menstruation is absent. After three months of treatment, you will need to undergo a re-examination and examination by the treating gynecologist, based on the results of which, your doctor will be able to give further recommendations on treatment and, if possible, pregnancy planning in your particular case. You can read more about the treatment of endometriosis in our section: Endometriosis.

Good afternoon please tell me I was diagnosed with endometriosis, prescribed Visanne epigallate and indinol, I’ve been taking indinol for the second month now, no periods, just spotting, is this normal? I recently took an anti-Mullerian hormone test and the result was 0.08 (normal range is 1-2.56). Is this a normal result when taking Visanne? Thank you in advance!!!

When treating endometriosis, there should be no menstrual flow as such; this is what the treatment is based on. These drugs block the functioning of the ovaries, which is why during the period of use of these drugs there is no menstrual flow and foci of endometriosis decrease. Treatment can be prescribed for 3 to 9 months, it all depends on the stage of endometriosis. You need to undergo examination and examination by a gynecologist during the treatment period to determine the effectiveness of the therapy. With the use of these drugs, the hormone level is within acceptable values.

Read more about this disease, methods of diagnosis and treatment by clicking on the link: Endometriosis.

AFTER 1.5 MONTHS WHEN TAKING VISANNE I DID AN ULTRASOUND AND THEY SAID THAT VISANNE DID NOT GIVE ANY EFFECTS! PLEASE TELL ME MEDICINES SHOULD NOT TAKE AN ACTIVE IMMEDIATELY? THANK YOU IN ADVANCE!!

Sometimes the drug is not suitable, i.e. does not have an effect on the foci of endometriosis, or the duration of use of the drug is short and the therapeutic effect has not yet been achieved, in this case, the specialist doctor, after conducting a follow-up examination, must decide on the need to discontinue this drug and select a different treatment regimen. It may be necessary to take this drug for a longer period of time. All these issues are decided by your attending physician.

Read more about this disease, methods of diagnosis and treatment in a series of articles by clicking on the link: Endometriosis.

I have been diagnosed with adenomyosis. Uterine fibroids are intramural. The drug Visanne was prescribed for 3 months. and begin planning when discontinuing the drug. Started using it on day 2 of the cycle. My period passed, but there was spotting for another 8 days, which is normal. On the 14th day of the drug, my ear began to clog. Could this be a side effect of using the drug? Thank you

In the first month of taking Visanne, prolonged spotting is possible. On the part of the hearing organ, when taking this medication, there may be a side effect such as ringing in the ears. I recommend that you personally visit a gynecologist if this symptom persists for a long time. You can get more information on this issue in the thematic section of our website: Uterine fibroids

I have 4 fibroids, one is growing in the uterine area (submucosal growth), a polyp in the endometrial wall, an endometrioid cyst on the left ovary, I was prescribed the drug Visanne, I’ve been taking it since the 1st day of my cycle, it’s not even a month yet, surgery is coming soon, hysteroscopy, laparoscopy, I have irritability, I’m not in the mood, I’m lashing out at everything I can, like I’m on vacation in the Czech Republic, recovering before the operation... but I read the instructions for Visanne and I think that’s how the drug affects me, before I was calmer!

This drug, indeed, among the side effects, has such as irritability, depression, sleep disturbances, and bad mood. If these signs are significantly expressed, I recommend that you personally consult with your doctor to prescribe another drug. You can get more information about the treatment of fibroids in the thematic section of our website by clicking on the link: Uterine fibroids

Thanks for the answer! May I ask if the drug can help in reducing fibroids and the cyst can resolve? at least for a little bit?

The drug Visanne is used to treat endometriosis. If you have been diagnosed with endometriosis, this medication should have a good therapeutic effect. Unfortunately, its effect on uterine fibroids is not reported in official sources. You can get more information about the treatment of uterine fibroids in the section of our website: Uterine fibroids

I've been taking Visanne for 14 months now. Ultrasound shows positive changes. All was good. But for the last 2 months I have been bleeding constantly during sexual intercourse. What to do? The doctor extended the treatment for another year. Maybe you need to take a break?

The drug Visanne can be taken for a long time - from 6 months or more, depending on the clinical condition of the patient and the dynamics of treatment. If there is currently bleeding, I recommend that you do a blood test for sex hormones, a smear, an ultrasound of the pelvic organs, and then personally visit your gynecologist to determine further treatment tactics. You can get more information on this issue in the thematic section of our website by clicking on the link: Bloody discharge in gynecology

Good afternoon On September 23, 2014, the endometrioma of the left ovary was removed and Visanne was prescribed for 4 months. Tell me, is conception possible, do I need additional protection?

In this situation, the possibility of pregnancy cannot be excluded, since Visanne is a progestin and does not have a contraceptive effect. During the period of use of this medication, barrier methods of contraception should be additionally used, which will eliminate the possibility of pregnancy.

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