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Small amounts of carnitine are obtained from foods, such as meat and dairy products, but to get an abundant supply, supplementation is necessary

doi: 10.15212/AMM-2022-0005

These might include: Pregnancy test : Essential first step for any woman of reproductive age with menstrual changes Blood tests : To assess hormone levels (FSH, LH, oestradiol, prolactin, thyroid function) and full blood count if bleeding is heavy STI screening : Particularly for unexplained intermenstrual or postcoital bleeding Pelvic ultrasound : If structural causes need to be excluded Review of medication : To ensure no drug interactions or other contributing factors Keep a menstrual diary noting cycle length, flow heaviness, and any associated symptoms

- Use appropriate reaction conditions and reducing agents (such as triethylamine-trimercaptopropane) to promote the formation of disulfide bonds between cysteine and other amino acids