A practical guide to the signals your body sends

A note before you begin

How to use this guide

The body rarely offers a complete explanation. More often, it gives us a small sign: a new ache, a change in bleeding, unusual fatigue, a swollen ankle, or one more trip to the bathroom at night.

A sign is a little like a footprint on a damp woodland path. It tells you that something has passed this way, but it does not reveal the whole journey. Rather than trying to guess the diagnosis, it is more useful to ask:

1. What has changed?
2. How quickly do I need help?
3. Which details should I record?
4. Which doctor is a sensible first contact?
5. What do I need to understand after the appointment?

This guide covers the services currently listed by OpenMedical:

• general practice;
• gynaecology;
• urology;
• vascular surgery;
• hormonal contraception consultations.

It is not intended to cover every area of medicine. Injuries, childhood illnesses, heart disease, neurological conditions, and digestive disorders are not discussed in depth. When a symptom does not clearly belong to one specialty, a general practitioner is often a useful first contact. A GP can assess the wider picture and refer you if specialist care is needed.

Guide to the chapters

1. General practice: common symptoms, respiratory infections, headaches, fatigue, diabetes, and blood pressure.
2. Gynaecology: cycle changes, bleeding, pain, discharge, menopause, and prevention.
3. Urology: infections, stones, blood in urine, urination, prostate health, and erectile function.
4. Vascular surgery: varicose veins, swelling, thrombosis, skin changes, and compression.
5. Hormonal contraception: choosing a method, side effects, risks, and missed pills.
6. Choosing where to seek care: a quick guide to symptoms and specialties.
7. Preparing for an appointment: documents, symptom records, and questions.
8. What the guide can and cannot do: where it can help and where its limits lie.
9. How OpenMedical helps: practical coordination around a medical visit.

You will find a short glossary and the medical sources at the end.

Three levels of urgency

Before searching for the name of a condition, it helps to decide how quickly care may be needed. The categories below are a general guide, not a formal triage system.

Get emergency help now

Call 155 or 112 if there may be an immediate threat to life or if the condition is worsening rapidly. Warning signs can include:

• severe shortness of breath or an inability to breathe normally;
• sudden or persistent pain or pressure in the chest;
• fainting, confusion, or a seizure;
• sudden weakness or numbness in the face, arm, or leg;
• a sudden, extremely severe headache, particularly with speech, vision, balance, or consciousness changes;
• severe abdominal or pelvic pain with fainting, marked weakness, or heavy bleeding;
• sudden pain and swelling in one leg together with chest pain or breathlessness;
• a painful, full bladder with a complete inability to pass urine;
• any rapidly worsening condition that feels dangerous.

This is not the moment to search for the perfect specialist. Emergency services can stabilise the situation first and investigate the cause afterwards.

Seek same-day or prompt medical advice

Some problems may not require an ambulance, but they should not wait for the next convenient appointment. Contact a doctor or a local urgent care service promptly if:

• a fever comes with breathlessness, pronounced weakness, dehydration, or deterioration after a period of improvement;
• you can see blood in your urine;
• painful urination occurs with fever, chills, nausea, or pain in the side or back;
• severe wave-like pain begins in the side or lower back;
• there is sudden pain on one side of the lower abdomen;
• unusual bleeding occurs when pregnancy is possible;
• one leg suddenly becomes larger, warmer, redder, or more painful than the other;
• bleeding is far heavier than usual and comes with dizziness, weakness, chest pain, or shortness of breath;
• a symptom is getting worse quickly, even if it does not yet appear life-threatening.

Arrange a routine appointment

A planned consultation is appropriate when a symptom is stable but keeps returning, interferes with daily life, or remains unexplained. Examples include:

• fatigue lasting several weeks;
• recurring headaches;
• periods that have become more painful, heavier, or less predictable;
• waking repeatedly at night to urinate;
• a weaker urine stream;
• legs that regularly swell or feel heavy by evening;
• varicose veins with pain, itching, or skin changes;
• contraception side effects that persist;
• questions about prevention, screening, testing, or changing contraceptive methods.

Routine does not mean unimportant. A recurring symptom deserves attention even when it is not an emergency.

Keep a small symptom record

It is surprisingly easy to forget details once you are in the consulting room: when the pain began, whether the fever came first, or what changed after taking a medicine. A few notes can give the doctor a clearer picture than trying to reconstruct everything from memory.

A pain score from 0 to 10 can help, but the effect on everyday life is often more informative. Comments such as "It wakes me at night", "I cannot put weight on the leg", or "I have to stop working" give the number useful context.

Part I. General practice: understanding the wider picture

When fatigue, headaches, and several less specific changes appear together, it is not always obvious where to begin. A general practitioner can look at the symptoms as a whole rather than treating each one as a separate problem. This chapter explains which concerns a GP can usually assess first and when a specialist may be needed.

Fatigue can be related to sleep, infection, iron deficiency, thyroid function, blood sugar, medication, or mental health. Frequent urination may need urological assessment, but it can also be linked to diabetes. A GP will take a medical history, carry out an examination, choose appropriate tests, and help decide what should happen next.

Colds, flu, and other respiratory infections

A runny nose, sore throat, cough, fever, headache, aching muscles, and tiredness can occur with many respiratory infections. Symptoms alone do not always distinguish a cold from influenza, COVID-19, or another infection.

For a mild viral infection, rest, plenty of fluids, and monitoring how the illness develops are often important. Antibiotics do not treat viruses. A doctor will decide whether there is reason to suspect a bacterial infection and whether antibiotics are appropriate.

Contact a doctor sooner if:

• you may be at higher risk because of your age, pregnancy, reduced immunity, or a chronic condition;
• fever continues or returns after improvement;
• the cough becomes noticeably worse;
• drinking is difficult or dehydration develops;
• weakness is pronounced;
• breathing becomes difficult.

Severe breathlessness, persistent chest pain or pressure, confusion, seizures, difficulty waking or staying awake, marked weakness, or not passing urine require urgent assessment. The CDC overview of respiratory illnesses describes these warning signs.

Before the appointment, note your highest temperature, when the symptoms began, what the cough is like, any relevant chronic conditions, medicines already taken, known contact with someone who was unwell, and any home test results.

Headache: a familiar symptom with many patterns

Headaches may occur with infections, stress, poor sleep, dehydration, missed meals, eye strain, or migraine. Taking painkillers too often can itself contribute to recurring headaches.

Arrange a GP appointment when headaches:

• are becoming more frequent;
• have changed from their usual pattern;
• disrupt work or sleep;
• require frequent pain relief;
• come with nausea, sensitivity to light, or visual symptoms;
• are triggered by coughing, bending, or physical exertion.

These details make a recurring headache easier to discuss in a planned appointment. A separate group of symptoms, however, makes waiting at home unsafe.

Get urgent help for a headache that:

• comes on suddenly and is extremely severe;
• comes with a seizure;
• occurs with weakness or numbness;
• affects speech, walking, memory, or vision;
• begins after a head injury;
• is accompanied by high fever, neck stiffness, confusion, or an unusual rash.

The NHS headache guidance provides a fuller list of warning signs.

For two or three weeks, a headache diary can capture start time, duration, location, sensation, sleep, meals, fluids, caffeine, alcohol, menstrual cycle, medicines, and other symptoms. It does not provide a diagnosis, but it can reveal a pattern worth discussing.

Fatigue that does not lift with rest

Ordinary tiredness usually improves after sleep and a quieter day. Fatigue deserves medical attention when it lasts for weeks, affects everyday life, or is accompanied by other changes.

Possible explanations include:

• poor or insufficient sleep;
• stress, anxiety, or low mood;
• recovery after infection;
• anaemia;
• thyroid problems;
• diabetes;
• medicine side effects;
• sleep apnoea;
• hormonal changes, including menopause;
• other long-term conditions.

It is rarely useful to request a broad panel of tests without a clear clinical question. A GP can review the symptoms and risks first, then choose investigations that may genuinely help clarify the cause.

Mention unintentional weight loss, breathlessness, palpitations, pale skin, excessive thirst, frequent urination, loud snoring or choking during sleep, and changes in mood. The NHS guidance on tiredness and fatigue offers similar advice about when to seek help.

Thirst, frequent urination, and weight loss

Sometimes the water bottle empties faster than it used to, while night-time bathroom visits become routine. Strong thirst, frequent urination, blurred vision, fatigue, and unintentional weight loss can occur with diabetes.

These symptoms do not confirm diabetes. Diagnosis requires properly interpreted blood tests. Type 2 diabetes can develop gradually and remain unnoticed for a long time.

Book a GP appointment if this combination persists. A borrowed home glucose meter or a single isolated reading is not enough to assess the situation safely. The doctor can choose and interpret the right laboratory tests. The WHO diabetes fact sheet summarises the main symptoms and the importance of diagnosis.

High blood pressure

Many people feel entirely well when a high blood-pressure reading first appears during a routine check or while measuring it for another reason. The number can be unsettling, especially when it is not clear what to do next.

High blood pressure often causes no obvious symptoms. A headache, anxiety, or a flushed face cannot tell you what your blood pressure is without a measurement.

One high reading does not always establish hypertension. Exercise, stress, pain, caffeine, cuff size, and measurement technique can all affect the result. Diagnosis generally depends on repeated measurements taken correctly.

Speak to a doctor if readings remain high, your usual pattern changes, medication causes side effects, you are pregnant or planning a pregnancy, or you have diabetes, kidney disease, or other cardiovascular risk factors.

Do not alter a prescribed dose after a single reading. Record the time, blood pressure, pulse, symptoms, and medication taken. The WHO hypertension fact sheet explains why measurement matters even when a person feels well.

What may happen at a GP appointment

Depending on the problem, the doctor may ask about symptoms, medicines, and family history; measure temperature, blood pressure, pulse, and oxygen saturation; examine relevant areas; request blood or urine tests; arrange imaging; or refer to another specialist.

Before leaving, ask when the results will be available, who will explain them, and what the next step might be depending on the findings.

Part II. Gynaecology: meaningful changes in the menstrual cycle

Many people only begin tracking their cycle closely after its familiar pattern changes. A period arrives early, is late or does not come at all, becomes more painful, or is suddenly much heavier. This chapter looks at how to describe those changes and distinguish a routine question from something that should be assessed sooner.

A menstrual cycle does not have to be identical every month. Age, stress, weight, sleep, medicines, contraception, pregnancy, illness, and the transition to menopause can all affect it. What matters is not matching someone else's idea of normal, but recognising a meaningful change in your own pattern.

Irregular periods

Irregularity can mean:

• cycle length varying substantially;
• bleeding between periods;
• bleeding after sex;
• missed periods;
• unusually frequent periods;
• a new change after a previously stable pattern.

Possible causes range from pregnancy and stress to weight changes, intensive exercise, hormonal contraception, polycystic ovary syndrome, thyroid disorders, perimenopause, and other conditions.

If a period is late and pregnancy is possible, take a test and tell the doctor the result. Do not assume stress is the explanation before other relevant causes have been considered.

Bring dates from recent cycles, duration and heaviness of bleeding, pain, bleeding between periods or after sex, changes in weight, skin or hair growth, medication, contraception, and the possibility of pregnancy.

Polycystic ovary syndrome can involve irregular or infrequent periods, disrupted ovulation, acne, and changes in hair growth. No single sign proves the diagnosis. See the WHO overview of polycystic ovary syndrome.

Heavy bleeding

Heavy periods should not be dismissed simply because they have happened for years. They can lead to iron deficiency, fatigue, and substantial disruption to everyday life.

Talk to a gynaecologist if:

• a pad or tampon needs changing every hour;
• bleeding lasts longer than a week;
• you need to use two menstrual products at once;
• there are large clots;
• bleeding wakes you at night;
• work, study, travel, or ordinary activities have to be cancelled;
• weakness, breathlessness, palpitations, or dizziness develop.

Possible causes include ovulation disorders, fibroids, polyps, adenomyosis, endometriosis, bleeding disorders, medicines, and other conditions. Assessment may include a blood test, pregnancy test, examination, ultrasound, or other investigations.

Very heavy bleeding together with chest pain, shortness of breath, marked dizziness, or weakness needs emergency assessment. ACOG guidance on abnormal uterine bleeding gives an emergency threshold of soaking through a pad or tampon every hour for more than two hours when these systemic symptoms are also present.

Painful periods and endometriosis

Mild cramping is common. Pain should not automatically be accepted as normal when it:

• prevents sleep, work, or study;
• becomes worse over time;
• continues beyond the first days of bleeding;
• occurs between periods;
• appears during sex;
• worsens with urination or bowel movements during the cycle;
• comes with heavy bleeding;
• remains uncontrolled despite the usual measures recommended by a doctor.

This pattern can occur with endometriosis, adenomyosis, fibroids, ovarian cysts, and other conditions. Endometriosis cannot be confirmed or excluded by one symptom or one ultrasound alone. The history of pain, examination, and suitable investigations all matter.

The WHO endometriosis fact sheet includes severe menstrual pain, heavy bleeding, chronic pelvic pain, pain during sex, and possible bowel or bladder symptoms.

Describe when the pain begins, how many days it lasts, whether it is one-sided or widespread, where it spreads, how it affects daily activities, and whether it is linked to sex, urination, or bowel movements.

Pelvic pain

Pelvic pain does not always begin in the reproductive organs. It may relate to the bladder, bowel, muscles, or nervous system. A gynaecological consultation can be the first step without necessarily being the last.

Book a planned appointment for pain that recurs, persists, follows the menstrual cycle, occurs during sex, affects urination or bowel movements, or comes with bloating, appetite changes, or weight loss.

Seek urgent help when pain is sudden, severe, or worsening, especially with fainting, dizziness, heavy bleeding, high fever, vomiting, breathing difficulty, a possible pregnancy, or shoulder pain with weakness.

Acute pain may be caused by an infection, a ruptured or twisted ovarian cyst, or, when pregnancy is possible, an ectopic pregnancy. These conditions cannot be distinguished safely at home. ACOG information on ectopic pregnancy explains why severe pelvic pain, shoulder pain, weakness, dizziness, or fainting can signal internal bleeding.

Fibroids and ovarian cysts

An ultrasound finding can sound alarming, although not every fibroid or cyst requires treatment.

Fibroids are non-cancerous growths arising from uterine muscle. They may cause no symptoms, or they may be associated with heavy or painful periods, bleeding between periods, pelvic pressure, or fertility concerns.

Ovarian cysts are common, and many functional cysts resolve without treatment. The next step depends on your age, symptoms, the size and appearance of the cyst, and any follow-up findings.

After an ultrasound, ask what was found, whether it explains the symptoms, whether follow-up is needed and when, which changes should prompt an earlier review, and whether the finding affects plans for pregnancy.

Read more in the ACOG guides to uterine fibroids and ovarian cysts.

Discharge, itching, and irritation

Normal vaginal discharge changes throughout the cycle. A marked change in colour, odour, amount, or texture, especially alongside itching, burning, pain, or irritation, may have several explanations.

These include thrush, bacterial vaginosis, sexually transmitted infections, irritation from hygiene products, hormonal changes, dryness during breastfeeding or menopause, and other inflammatory conditions.

Appearance alone does not reliably identify the cause. Using an antifungal treatment without assessment may delay the correct diagnosis when something else is responsible.

See a gynaecologist when symptoms are new, discharge changes substantially, there is a strong odour, itching or pain develops, urination or sex is painful, fever or pelvic pain appears, symptoms return after treatment, or a sexually transmitted infection is possible.

Avoid douching and fragranced products inside the vagina. The ACOG vaginitis guide explains why diagnosis depends on more than symptoms alone.

Perimenopause and menopause

The transition to menopause is gradual, more like a change of season than the flick of a switch. Periods may become irregular, lighter, or heavier. Hot flushes, night sweats, sleep disruption, mood changes, vaginal dryness, and urinary symptoms may also occur.

Not every change requires treatment, but symptoms are worth discussing when they interfere with daily life.

Contact a doctor about unusually heavy bleeding, bleeding between periods or after sex, persistent sleep disruption, recurrent urinary infections, vaginal dryness that causes pain, questions about hormone therapy, or bleeding after 12 months without a period.

Any bleeding after menopause should be assessed, even if it happens once and is slight. It does not automatically mean a serious illness, but it should not be ignored. The NHS menopause guide describes common changes and when to seek advice.

Cervical screening

Precancerous changes of the cervix often cause no symptoms. Screening therefore remains important when you feel well, even if you have been vaccinated against HPV.

The screening method and schedule depend on age, previous results, medical history, and the national programme. Do not assume that a schedule from another country also applies in Czechia.

Tell a doctor about bleeding after sex, bleeding between periods, unusual watery or blood-stained discharge, or recurring pelvic pain rather than waiting for the next screening date. The WHO cervical cancer fact sheet explains the role of HPV vaccination and screening.

Part III. Urology: ordinary medical questions, even when they feel private

People often put off discussing urinary or sexual concerns because they feel awkward. For a urologist, these are everyday clinical problems. A calm, precise description makes it easier to decide which examination or tests are needed.

Urological problems can affect both women and men. The specialty covers the kidneys, urinary tract, bladder and urethra, the prostate, and aspects of male sexual and reproductive health.

Burning and frequent urges

A bladder infection may cause burning or pain when urinating, urgent or frequent trips to the toilet, small amounts of urine, lower abdominal discomfort, and cloudy, strong-smelling, or occasionally blood-stained urine.

From symptoms alone, it is not always possible to distinguish an infection from irritation, a stone, a sexually transmitted infection, or another cause.

Seek prompt help if you are pregnant, or if the symptoms are accompanied by fever, chills, pain in the side or back, nausea, vomiting, pronounced weakness, difficulty drinking, or a general deterioration in your health. The infection may have reached the kidneys. The NIDDK guide to bladder infection lists these warning signs.

Do not use antibiotics left over from an earlier illness. The drug, dose, and duration depend on the individual situation, and similar symptoms can have a different cause.

Side pain and kidney stones

A stone in the urinary tract may cause severe pain in the back, side, lower abdomen, or groin. The pain may come in waves and may be accompanied by nausea, vomiting, blood in the urine, painful urination, frequent urges, or difficulty passing urine.

Other conditions can produce similar pain. Urine and blood tests or imaging may be needed.

Seek urgent care if pain comes with fever, chills, inability to urinate, marked weakness, or vomiting that prevents drinking. The NIDDK information on kidney stones describes the usual symptoms.

Do not try to force a stone out by drinking excessive water when pain is severe, vomiting continues, or urine flow is obstructed. Medical assessment comes first.

Blood in urine

Even a small amount of blood can make urine look pink, red, or brown. Sometimes it is detected only in a urine test.

Possible causes include infection, stones, inflammation, kidney disease, prostate enlargement, injury, certain medicines, strenuous exercise, a tumour of the urinary tract or prostate, and other conditions.

Blood in the urine should be assessed even if it happened only once, caused no pain, involved only a small amount, has since disappeared, or occurred while you were taking blood-thinning medicine.

Food and medicines can also change the colour of urine, but only a urine test can confirm whether blood is present. The NIDDK overview of haematuria explains its forms and possible causes.

Frequent urination

Frequent trips to the toilet do not always mean a bladder disorder. Fluid intake, caffeine, alcohol, diuretic medicines, infection, an overactive bladder, incomplete emptying, prostate enlargement, pregnancy, diabetes, neurological causes, anxiety, and sleep disturbance may all play a role.

For a few days, record when and approximately how much you drink, when you urinate, any night-time trips to the bathroom, urgency, leakage, pain, medicines, caffeine, and alcohol. This helps a doctor distinguish frequent, small-volume urination from a genuinely high volume of urine.

A weak stream, night waking, and the prostate

Benign prostate enlargement can cause difficulty starting to urinate, a weak or interrupted stream, dribbling, a feeling that the bladder has not emptied fully, urgency, frequent urination, and waking at night to pass urine.

Similar symptoms can occur with infection, prostate inflammation, bladder disease, urethral narrowing, and other conditions. Prostate size does not always match symptom severity.

Tell the doctor when the change began, how often you wake at night, whether you have pain, fever, or blood in the urine, which medicines you take, and whether you have had surgery or have diabetes or a neurological condition. Some cold and allergy medicines can make urination more difficult for people with prostate problems. Do not stop any prescribed medicine without advice, but bring a complete list.

The NIDDK guide to benign prostate enlargement provides more detail.

A painful, full bladder with a complete inability to urinate may be acute urinary retention. It requires immediate medical care, as explained by NIDDK.

Erectile dysfunction

Occasional difficulty getting or keeping an erection can follow tiredness, stress, alcohol, or performance anxiety. A recurring problem is worth discussing with a doctor.

Erectile dysfunction may be linked to problems with circulation, diabetes, high blood pressure, kidney disease, hormonal disorders, medicine side effects, smoking, alcohol, depression, anxiety, relationship stress, or urological conditions.

It is not only about sexual performance. Sometimes it is an early sign of another health problem that is worth investigating.

Avoid medicines and supplements from unverified sellers. Some products interact dangerously with heart or blood pressure medicines. A doctor can investigate possible causes and discuss safer options. The NIDDK guide to erectile dysfunction explains why other health conditions may be relevant.

Part IV. Veins and vascular surgery: from varicose veins to urgent symptoms

Legs may feel tired after a day spent standing, sitting at a desk, or out in hot weather. Recurrent swelling, pain, skin changes, and enlarged veins deserve closer attention.

A vascular surgeon can examine the legs and, when appropriate, arrange an ultrasound. Duplex ultrasound evaluates blood flow, valve function, reflux, and other venous problems.

Varicose veins

Varicose veins become enlarged and twisted when vein walls or valves no longer work effectively. Blood has more difficulty travelling back towards the heart and can pool in the veins.

Symptoms can include visible blue or purple veins, heaviness, aching, swelling, itching, burning, night cramps, worsening after long periods of sitting or standing, and improvement after elevating the legs.

Seek an assessment when symptoms interfere with normal activity, are getting worse, or are accompanied by skin changes. Small spider veins do not reveal the severity of venous disease, and appearance alone cannot show how well blood is flowing.

The NHLBI guide to varicose veins describes symptoms, causes, and the role of duplex ultrasound.

One swollen leg or two

Swelling in both legs may be related to prolonged sitting, heat, medicines, venous insufficiency, or a wider health problem. A GP may be the right first contact when the cause is unclear.

Sudden swelling in one leg needs prompt assessment, particularly when the leg is painful, tender, warm, red, or noticeably larger than the other, or when the swelling follows surgery, injury, prolonged immobility, or long-distance travel.

This may be a deep vein thrombosis. Do not massage a painful swollen leg or try to "get the blood moving" yourself.

Deep vein thrombosis and pulmonary embolism

Deep vein thrombosis, or DVT, is a blood clot in a deep vein. Part of the clot can travel to the lungs, causing a pulmonary embolism, which can be life-threatening.

Possible DVT signs include one-sided swelling, pain or tenderness, redness, and warmth. Possible pulmonary embolism signs include sudden shortness of breath, chest pain that worsens with breathing or coughing, a fast heartbeat, coughing up blood, dizziness, or fainting.

If you develop breathlessness, chest pain, cough up blood, or faint, call 155 or 112. Do not drive yourself. The NHLBI information on venous thromboembolism describes these symptoms.

The risk may be higher after surgery, a major injury, or prolonged immobility; during pregnancy and after childbirth; with cancer or a previous clot; and with some oestrogen-containing medicines. A risk factor does not mean that you will develop a clot. It means that the doctor needs to know about it.

Skin changes, ulcers, and bleeding

Long-term problems with venous return can lead to darker skin, dryness, itching, hardened tissue, inflammation, or a slow-healing wound near the ankle.

Do not wait for a small wound to get worse. A venous ulcer needs professional wound care and an assessment of circulation.

If a varicose vein bleeds, apply firm pressure with a clean cloth, raise the leg, and seek prompt help. Call 155 or 112 for severe bleeding or bleeding that does not stop.

Compression and movement

Walking and using the calf muscles help blood return through the veins. A clinician may also recommend compression hosiery. The compression level and size should be chosen after an assessment, especially if you have arterial disease, diabetes, reduced sensation, or pronounced swelling.

Compression can reduce symptoms, but it does not explain their cause. Do not choose high-strength compression based only on your usual clothing size or a friend's recommendation.

Useful questions for a vascular surgeon include whether an ultrasound is needed, whether venous reflux is present and explains the symptoms, what level of compression is suitable, which treatments may be appropriate, and which changes should prompt urgent care.

Part V. Hormonal contraception: choice, safety, and tolerability

A suitable contraceptive method needs to be safe and workable in ordinary life. Questions can arise before the first prescription or much later because of side effects, a missed pill, a new medicine, or changing plans. This chapter will help you prepare for a more informed and useful conversation with a doctor.

Contraception is not only about preventing pregnancy. Your health history, daily routine, plans for pregnancy, comfort, side effects, and ability to use a method consistently all matter.

There are combined methods containing oestrogen and progestogen, as well as methods containing progestogen alone. Hormonal options include pills, patches, vaginal rings, injections, implants, and hormonal intrauterine systems. Each is used differently and has its own benefits, side effects, and contraindications.

Condoms can reduce the likelihood of pregnancy and also lower the risk of sexually transmitted infections. Hormonal contraception does not provide protection from these infections. The WHO contraception fact sheet explains the distinction.

What a doctor needs to know

Before prescribing, a doctor may ask about:

• migraine, especially migraine with aura;
• smoking;
• high blood pressure;
• a personal or family history of blood clots;
• surgery and prolonged immobility;
• heart, liver, or kidney disease;
• diabetes;
• cancer;
• pregnancy, childbirth, and breastfeeding;
• all medicines and supplements;
• menstrual patterns;
• previous experiences with contraception;
• plans for pregnancy.

These questions help the doctor identify the safest suitable options.

Changes during the first months

After starting hormonal contraception, some people experience spotting, changes in bleeding, breast tenderness, nausea, headaches, skin changes, mood changes, or a change in libido. These symptoms may settle during the first few months.

You do not need to put up with a problem that is severe, persistent, or affecting daily life. A different preparation or method may suit you better, but the change should be discussed with a clinician. The NHS guide to side effects and risks notes that reported side effects often improve within about three months.

Seek urgent assessment for sudden shortness of breath, chest pain, coughing blood, a new painful swelling in one leg, a severe new headache with neurological symptoms, changes in vision, speech, or movement, fainting, severe pelvic pain, heavy bleeding, or a positive pregnancy test with pain or bleeding.

These symptoms do not automatically mean that contraception caused a complication. They do mean that a dangerous cause should be ruled out.

Oestrogen and clot risk

Combined hormonal methods are associated with a small increase in the risk of blood clots. The absolute risk remains low for most people for whom these methods are suitable, but personal factors can change it.

It is particularly important to discuss a previous clot, migraine with aura, smoking after age 35, high blood pressure, several cardiovascular risk factors, the period after childbirth, upcoming surgery, and prolonged immobility. ACOG guidance on combined hormonal contraception explains the main benefits and restrictions.

Do not stop a prescribed method simply because a general list of risks has caused concern. Discuss your individual situation with a clinician. Symptoms of a possible clot or another acute condition are the exception and require urgent help.

If a pill is missed

The right action depends on the type of pill, the number of missed doses, how much time has passed, where you are in the pack, whether you have had sex without backup contraception, other medicines, vomiting, and diarrhoea.

That is why "take two pills" is not a safe universal instruction. Check the leaflet for your specific product and contact a doctor or pharmacist promptly. Use additional barrier protection if the instructions advise it.

If you have had sex without additional protection or think the method may have failed, ask about emergency contraception as soon as possible. The WHO emergency contraception guidance states that emergency methods can be used within five days, while pills are more effective the sooner they are taken.

Hormonal intrauterine systems

A hormonal intrauterine system is a long-acting method. Cramping and changes in bleeding can occur after insertion. The clinician should explain what to expect while your body adjusts, what follow-up is needed, and how to check the device.

Contact a doctor promptly if you have severe or increasing pain, a high fever, unpleasant-smelling discharge, very heavy bleeding, fainting, a positive pregnancy test, or reason to think the device has moved. Do not attempt to reposition or remove it yourself.

Some hormonal methods can also make periods less painful or heavy. This benefit should not delay an assessment if pain is new, severe, or getting worse.

When a method simply does not suit you

You do not need to wait for an emergency before discussing change. Persistent bleeding, headaches, mood concerns, libido changes, an impractical routine, anxiety about missed pills, plans for pregnancy, a new illness or medicine, or changing priorities are all valid reasons for another consultation.

An effective method needs to work not only on paper, but in the everyday life of the person using it.

Part VI. Choosing where to seek care

A new symptom can make it clear that you need a doctor without making it clear which doctor to choose. That uncertainty can delay booking or lead to a confusing search through different specialties. This chapter offers a practical starting point, not a replacement for clinical triage.

If your situation seems to fit more than one row, you do not need to identify the exact specialty yourself. A GP or another available medical service can direct you when the problem is stable. If warning signs are present, choose the more urgent option.

Part VII. Preparing for the appointment

Time moves quickly in a consulting room, and an important date or medicine name can suddenly be difficult to remember. A little preparation leaves more of the appointment for the problem itself. You do not need a suitcase of paperwork, only the relevant records in a clear order.

Bring identification, insurance details, a list of medicines and supplements with doses, a list of allergies, previous medical reports, test results, imaging reports or images, hospital discharge letters, and relevant pregnancy or childbirth information. Menstrual dates, or a diary of urination, pain, headaches, blood pressure, or swelling, can also be useful when they relate to the problem.

Begin with one sentence that describes your main aim:

• "I want to understand why this pain keeps returning."
• "I want to check why my periods have changed."
• "I want to have the blood in my urine checked."
• "I want to know whether my current contraception is safe for me."
• "I want to understand the swelling in my leg."
• "I want to know whether persistent fatigue needs testing."

The sentence does not need to include every detail. It simply gives the consultation a clear starting point before you discuss the fuller history.

Before leaving, ask:

1. What explanations are being considered?
2. Which tests are needed and what will they answer?
3. When will the results be ready?
4. Who will explain them?
5. Which changes mean I should seek help sooner or urgently?

If treatment is prescribed, also ask how to use it, what to do after a missed dose, which side effects are expected, which require medical advice, and when to review whether the treatment is working.

Part VIII. What this guide can and cannot do

A long health guide is useful only when its limits are clear. This chapter distinguishes between general guidance and decisions that still require an examination and individual medical judgement.

This guide can help someone describe a symptom, choose a likely first contact, recognise a warning sign, prepare for a consultation, and know what to ask about results and follow-up.

It cannot diagnose, exclude an emergency, choose medication, replace an examination, interpret a test without context, promise that a symptom is harmless, or guarantee a particular treatment.

Clear writing must not create false certainty. A simple explanation can make the next step easier to see, but an answer may still require an examination, a laboratory test, an ultrasound, or observation over time.

Part IX. How OpenMedical supports the care journey

Choosing a specialty does not end the practical work. Appointments, records, language, and follow-up still need to fit together. This final part explains the difference between the doctor's clinical role and the coordination support provided by OpenMedical.

Clinical decisions are made by doctors at partner clinics. OpenMedical helps organise the practical steps around care:

• finding an appropriate type of consultation;
• coordinating an appointment;
• sharing available documents through an agreed channel;
• supporting communication in an agreed language;
• making the next step clear;
• coordinating follow-up or referral when needed.

OpenMedical is not an emergency service and does not replace a doctor. For urgent or life-threatening symptoms, call 155 or 112.

Short glossary

Medical history: information about symptoms, previous illnesses, surgery, medicines, and relevant family history.

Screening: testing people without symptoms to detect certain changes earlier.

Ultrasound: an examination using sound waves to show organs, tissues, or blood flow.

Haematuria: blood in urine.

Venous reflux: backward blood flow in a vein because its valves are not working properly.

Deep vein thrombosis: a blood clot in a deep vein, usually in a leg.

Pulmonary embolism: a blood clot that travels to blood vessels in the lungs.

Perimenopause: the transition leading up to menopause.

Menopause: the point reached after 12 months without a period, provided the absence of bleeding is not explained by another cause.

Fibroid: a usually non-cancerous growth arising from the muscle of the uterus.

Ovarian cyst: a sac containing fluid or other tissue in or on an ovary.

Combined hormonal contraception: contraception containing oestrogen and progestogen.

Progestogen-only contraception: a hormonal method without oestrogen.

Sources and editorial basis

Sources checked on 2026-07-25.

Emergency care and general symptoms

• Government of Czechia: emergency numbers
• CDC: respiratory illnesses and warning signs
• NHS: headaches
• NHS: tiredness and fatigue
• WHO: diabetes
• WHO: hypertension

Gynaecology

• ACOG: abnormal uterine bleeding
• WHO: endometriosis
• WHO: polycystic ovary syndrome
• ACOG: chronic pelvic pain
• ACOG: ectopic pregnancy
• ACOG: vaginitis
• ACOG: uterine fibroids
• ACOG: ovarian cysts
• NHS: menopause and perimenopause
• WHO: cervical cancer and prevention

Urology

• NIDDK: bladder infection
• NIDDK: kidney stones
• NIDDK: blood in urine
• NIDDK: benign prostate enlargement
• NIDDK: urinary retention
• NIDDK: erectile dysfunction

Veins and vascular surgery

• NHLBI: varicose veins
• NHLBI: venous thromboembolism symptoms
• NHLBI: pulmonary embolism

Hormonal contraception

• WHO: contraception methods
• WHO: emergency contraception
• ACOG: combined hormonal contraception
• NHS: hormonal contraception side effects and risks