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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)

There are not enough studies on whether pills are as effective in improving or eliminating symptoms as parenteral treatment

Coeliac disease damages the small intestinal mucosa, whilst Crohn's disease affecting the terminal ileum directly impairs the absorption site

When it is deficient, it can cause folic acid deficiency, which can lead to DNA synthesis obstacles and affect the development and maturation of red blood cells