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Seek immediate medical attention (attend A&E or call 999) if you experience: Large volumes of blood in the stool or blood clots Melaena black, tarry, foul-smelling stools suggesting upper gastrointestinal bleeding Dizziness, light-headedness, or fainting , which may indicate significant blood loss and haemodynamic compromise Rapid heart rate, pallor, or shortness of breath signs of anaemia or shock Severe, persistent abdominal pain or distension Vomiting blood (haematemesis) or coffee-ground material Arrange an urgent GP appointment if: You notice persistent or recurrent small amounts of bright red blood on toilet paper or mixed with stool You have unexplained weight loss, change in bowel habit, or persistent abdominal discomfort You are aged over 40 years and experiencing new-onset rectal bleeding You have a family history of colorectal cancer or inflammatory bowel disease According to NICE guidance (NG12) , patients should be referred on an urgent suspected cancer pathway (within two weeks) in several scenarios, including: adults aged 50 and over with unexplained rectal bleeding

23 In addition, high insulin levels resulting from insulin resistance can further increase hyperandrogenism and worsen hormone imbalance

Rare genetic diseases Transthyretin amyloidosis (ATTR) is a rare systemic disease characterized by the progressive deposition of misfolded TTR protein in the heart and peripheral nerves, leading to transthyretin amyloid polyneuropathy (ATTR-PN) and transthyretin amyloid cardiomyopathy (ATTR-CM)

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