Not all women with PCOS will have all of the symptoms, and each symptom can vary from mild to severe.

Some women only experience menstrual problems or are unable to conceive, or both.

Common symptoms of PCOS include:

• irregular periods or no periods at all
• difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
• excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
• weight gain
• thinning hair and hair loss from the head
• oily skin or acne

You should talk to your GP if you have any of these symptoms and think you may have PCOS.

Fertility problems

PCOS is one of the most common causes of female infertility. Many women discover they have PCOS when they’re trying to get pregnant and are unsuccessful.

During each menstrual cycle, the ovaries release an egg (ovum) into the uterus (womb). This process is called ovulation and usually occurs once a month.

But women with PCOS often fail to ovulate or ovulate infrequently, which means they have irregular or absent periods and find it difficult to get pregnant.

Risks in later life

Having PCOS can increase your chances of developing other health problems in later life.

For example, women with PCOS are at increased risk of developing:

• type 2 diabetes – a lifelong condition that causes a person’s blood sugar level to become too high
• depression and mood swings – because the symptoms of PCOS can affect your confidence and self-esteem
• high blood pressure and high cholesterol – which can lead to heart disease and stroke
• sleep apnoea – overweight women may also develop sleep apnoea, a condition that causes interrupted breathing during sleep

Women who have had absent or very irregular periods (fewer than 3 or 4 periods a year) for many years have a higher than average risk of developing cancer of the womb lining (endometrial cancer).

But the chance of getting endometrial cancer is still small and can be minimised using treatments to regulate periods, such as the contraceptive pill or an intrauterine system (IUS).

Resistance to insulin

Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps to move glucose from blood into cells, where it’s broken down to produce energy.

Insulin resistance means the body’s tissues are resistant to the effects of insulin. The body therefore has to produce extra insulin to compensate.

High levels of insulin causes the ovaries to produce too much testosterone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation.

Insulin resistance can also lead to weight gain, which can make PCOS symptoms worse, as having excess fat causes the body to produce even more insulin.

Hormone imbalance

Many women with PCOS are found to have an imbalance in certain hormones, including:

• raised levels of testosterone – a hormone often thought of as a male hormone, although all women usually produce small amounts of it
• raised levels of luteinising hormone (LH) – this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
• low levels of sex hormone-binding globulin (SHBG) – a protein in the blood that binds to testosterone and reduces its effect
• raised levels of prolactin (only in some women with PCOS) – a hormone that stimulates the breast glands to produce milk in pregnancy

The exact reason why these hormonal changes occur is not known.

It’s been suggested that the problem may start in the ovary itself, in other glands that produce these hormones, or in the part of the brain that controls their production.

The changes may also be caused by the resistance to insulin.

Genetics

PCOS sometimes runs in families. If any relatives, such as your mother, sister or aunt, have PCOS, the risk of you developing it is often increased.

This suggests there may be a genetic link to PCOS, although specific genes associated with the condition have not yet been identified.

The GP will ask about your symptoms to help rule out other possible causes, and check your blood pressure.

They’ll also arrange for you to have a number of hormone tests to find out whether the excess hormone production is caused by PCOS or another hormone-related condition.

You may also need an ultrasound scan, which can show whether you have a high number of follicles in your ovaries (polycystic ovaries). The follicles are fluid-filled sacs in which eggs develop.

You may also need a blood test to measure your hormone levels and screen for diabetes or high cholesterol.

Diagnosis criteria

A diagnosis of PCOS can usually be made if other rare causes of the same symptoms have been ruled out and you meet at least 2 of the following 3 criteria:

• you have irregular periods or infrequent periods – this indicates that your ovaries do not regularly release eggs (ovulate)
• blood tests showing you have high levels of “male hormones”, such as testosterone (or sometimes just the signs of excess male hormones, even if the blood test is normal)
• scans showing you have polycystic ovaries

As only 2 of these need to be present to diagnose PCOS, you will not necessarily need to have an ultrasound scan before the condition can be confirmed.

Referral to a specialist

If you’re diagnosed with PCOS, you may be treated by your GP or referred to a specialist, either a gynaecologist (a specialist in treating conditions of the female reproductive system) or an endocrinologist (a specialist in treating hormone problems).

Your GP or specialist will discuss with you the best way to manage your symptoms. They’ll recommend lifestyle changes and start you on any necessary medicine.

Follow-up

Depending on factors like your age and weight, you may be offered annual checks of your blood pressure and screening for diabetes if you’re diagnosed with PCOS.

Treatment options can vary because someone with PCOS may experience a range of symptoms, or just 1.

The main treatment options are discussed in more detail below.

Lifestyle changes

In overweight women, the symptoms and overall risk of developing long-term health problems from PCOS can be greatly improved by losing excess weight.

Weight loss of just 5% can lead to a significant improvement in PCOS.

You can find out whether you’re a healthy weight by calculating your body mass index (BMI), which is a measurement of your weight in relation to your height.

A normal BMI is between 18.5 and 24.9. Use the BMI healthy weight calculator to work out whether your BMI is in the healthy range.

You can lose weight by exercising regularly and eating a healthy, balanced diet.

Your diet should include plenty of fruit and vegetables, (at least 5 portions a day), whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken.

Your GP may be able to refer you to a dietitian if you need specific dietary advice.

Read more about losing weight, healthy eating and exercise.

Medicines

A number of medicines are available to treat different symptoms associated with PCOS.

These are described below.

Irregular or absent periods

The contraceptive pill may be recommended to induce regular periods, or periods may be induced using an intermittent course of progestogen tablets (which are usually given every 3 to 4 months, but can be given monthly).

This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods.

Other hormonal methods of contraception, such as an intrauterine system (IUS), will also reduce this risk by keeping the womb lining thin, but they may not cause periods.

Fertility problems

With treatment, most women with PCOS are able to get pregnant.

The majority of women can be successfully treated with a short course of tablets taken at the beginning of each cycle for several cycles.

If these are not successful, you may be offered injections or IVF treatment. There’s an increased risk of a multiple pregnancy (rarely more than twins) with these treatments.

A medicine called clomifene is usually the first treatment recommended for women with PCOS who are trying to get pregnant.

Clomifene encourages the monthly release of an egg from the ovaries (ovulation).

If clomifene is unsuccessful in encouraging ovulation, another medicine called metformin may be recommended.

Metformin is often used to treat type 2 diabetes, but it can also lower insulin and blood sugar levels in women with PCOS.

As well as stimulating ovulation, encouraging regular monthly periods and lowering the risk of miscarriage, metformin can also have other long-term health benefits, such as lowering high cholesterol levels and reducing the risk of heart disease.

Metformin is not licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used “off-label” in certain circumstances to encourage fertility and control the symptoms of PCOS.

Possible side effects of metformin include nausea, vomiting, stomach pain, diarrhoea and loss of appetite.

As metformin can stimulate fertility, if you’re considering using it for PCOS and not trying to get pregnant, make sure you use suitable contraception if you’re sexually active.

The National Institute for Health and Care and Excellence (NICE) has more information about the use of metformin for treating PCOS in women who are not trying to get pregnant, including a summary of the possible benefits and harms.

Letrozole is sometimes used to stimulate ovulation instead of clomifene. This medicine can also be used for treating breast cancer.

Use of letrozole for fertility treatment is “off-label”. This means that the medicine’s manufacturer has not applied for a licence for it to be used to treat PCOS.

In other words, although letrozole is licensed for treating breast cancer, it does not have a license for treating PCOS.

Doctors sometimes use an unlicensed medicine if they think it’s likely to be effective and the benefits of treatment outweigh any associated risks.

Find out more about unlicensed and off-label use of medicines

If you’re unable to get pregnant despite taking oral medicines, a different type of medicine called gonadotrophins may be recommended.

These are given by injection. There’s a higher risk that they may overstimulate your ovaries and lead to multiple pregnancies.

Unwanted hair growth and hair loss

Medicines to control excessive hair growth (hirsutism) and hair loss (alopecia) include:

• particular types of combined oral contraceptive tablets (such as co-cyprindiol, Dianette, Marvelon and Yasmin)
• cyproterone acetate
• spironolactone
• flutamide
• finasteride

These medicines work by blocking the effects of “male hormones”, such as testosterone, and some also suppress production of these hormones by the ovaries.

A cream called eflornithine can also be used to slow down the growth of unwanted facial hair.

This cream does not remove hair or cure unwanted facial hair, so you may wish to use it alongside a hair removal product.

Improvement may be seen 4 to 8 weeks after treatment with this medicine.

But eflornithine cream is not always available on the NHS because some local NHS authorities have decided it’s not effective enough to justify NHS prescription.

If you have unwanted hair growth, you may also want to remove the excess hair by using methods such as plucking, shaving, threading, creams or laser removal.

Laser removal of facial hair may be available on the NHS in some parts of the UK.

Other symptoms

Medicines can also be used to treat some of the other problems associated with PCOS, including:

• weight-loss medicine, such as orlistat, if you’re overweight
• cholesterol-lowering medicine (statins) if you have high levels of cholesterol in your blood
• acne treatments

Surgery

A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOS that do not respond to medicine.

Under general anaesthetic, your doctor will make a small cut in your lower tummy and pass a long, thin microscope called a laparoscope through into your abdomen.

The ovaries will then be surgically treated using heat or a laser to destroy the tissue that’s producing androgens (male hormones).

LOD has been found to lower levels of testosterone and luteinising hormone (LH), and raise levels of follicle-stimulating hormone (FSH).

This corrects your hormone imbalance and can restore the normal function of your ovaries.

Pregnancy risks

If you have PCOS, you have a higher risk of pregnancy complications, such as high blood pressure (hypertension), pre-eclampsia, gestational diabetes and miscarriage.

These risks are particularly high if you’re obese. If you’re overweight or obese, you can lower your risk by losing weight before trying for a baby.

Risks of alcohol misuse

Short-Term

The short-term risks of alcohol misuse include:

• Accidents and injuries requiring hospital treatment, such as a head injury
• Violent behaviour and being a victim of violence
• Loss of personal possessions, such as wallets, keys or mobile phones
• Alcohol poisoning – this may lead to vomiting, fits (seizures) and falling unconscious
• Unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs)

People who binge drink (drink heavily over a short period of time) are more likely to behave recklessly and are at greater risk of being in an accident.

Long-Term

Persistent alcohol misuse increases your risk of serious health conditions, including:

As well as causing serious health problems, long-term alcohol misuse can lead to social problems for some people, such as unemployment, divorce, domestic abuse and homelessness.

If someone loses control over their drinking and has an excessive desire to drink, it’s known as dependent drinking (alcoholism).

Dependent drinking usually affects a person’s quality of life and relationships, but they may not always find it easy to see or accept this. Severely dependent drinkers are often able to tolerate very high levels of alcohol in amounts that would dangerously affect or even kill some people.

A dependent drinker usually experiences physical and psychological withdrawal symptoms if they suddenly cut down or stop drinking, including:

This often leads to “relief drinking” to avoid withdrawal symptoms.

Getting Help

You may need help if:

• You often feel the need to have a drink
• You get into trouble because of your drinking
• Other people warn you about how much you’re drinking
• You think your drinking is causing you problems

If you’re concerned about your drinking or someone else’s, a good first step is to see a GP. They’ll be able to discuss the services and treatments available.

Your alcohol intake may be assessed using tests such as the two below

As well as the NHS, there are a number of charities and support groups across the UK that provide support and advice for people with an alcohol misuse problem. For example, you may want to contact:

See a full list of alcohol charities and support groups

Treating alcohol misuse

How alcohol misuse is treated depends on how much alcohol a person is drinking. Treatment options include:

• Counselling – including self-help groups and talking therapies, such as cognitive behavioural therapy (CBT)
• Medicines
• Detoxification – this involves a nurse or doctor supporting you to safely stop drinking; this can be done by helping you slowly cut down over time or by giving you medicines to prevent withdrawal symptoms

There are 2 main types of medicines to help people stop drinking. The first is to help stop withdrawal symptoms and is given in reducing doses over a short period of time. The most common of these medicines is chlordiazapoxide (Librium). The second is a medicine to reduce any urge you may have to drink. The most common medicines used for this are acamprosate and naltrexone.

These are both given at a fixed dose, and you’ll usually be on them for 6 to 12 months.

Electronic prescriptions

Most prescriptions are now signed, sent and processed electronically.

You have 2 choices for how this works.

• You can choose a pharmacy or dispenser to dispense all your prescriptions. When you get a prescription, it will be sent electronically to the dispenser you have chosen. You can collect your medicines or appliances without having to hand in a paper prescription.
• You can decide each time you are issued a prescription where you would like it to be dispensed. When you are issued a prescription, you will be given a paper copy that you can take to any pharmacy or other dispenser in England. The paper copy will contain a unique barcode that will be scanned to download your prescription from the secure NHS database.

Choosing a pharmacy

If you get regular prescriptions or are already using a prescription collection service (where a pharmacy collects prescriptions from your GP practice for you) then choosing a pharmacy to dispense all your prescriptions may save you time by avoiding unnecessary trips to your GP.

You will still order your repeat prescriptions in the same way as you do now, but your prescriptions will be sent electronically to the pharmacy or dispenser of your choice.

You will not have to collect a paper repeat prescription from your GP practice.

Cancelling or changing your choice of pharmacist or dispenser

You can change or cancel your choice of dispenser at any time. Simply speak to your GP or pharmacist before you order your next prescription.

You should allow time for the update to take place to avoid your next prescription being sent to the wrong place.

Repeat prescriptions

Repeat prescriptions can be issued in 2 different ways:

1. You order the prescription to be approved by a GP each time you need a refill.
2. You order the prescription once and a GP approves a series of refills for you. They are sent to the pharmacy automatically, so you do not need to order them each time. This is called electronic repeat dispensing. The GP surgery or pharmacy will let you know when you need to re-order your prescription.

In both cases, you can:

• choose a specific pharmacy (nominated pharmacy) to collect your prescriptions from each time – call or contact the pharmacy online a few days before you run out of medicine to check your prescription is ready to collect
• decide each time you’re given a prescription where to collect it – you’ll be given a paper copy with a barcode to take to any pharmacy in England, or the pharmacy can find your prescription using your NHS number

As part of the repeat prescription service, the pharmacist will ask if you’re having any problems or side effects with your medicines and, where appropriate, they can discuss this with you and your GP.

Ordering repeat prescriptions online

If you receive medicine on repeat prescription, you can now use several apps and websites to order your repeats online. You can then collect your medicines from a pharmacy or have them delivered to your home (where available).

You can only order repeat prescriptions. You cannot order one-off, short-term prescriptions.

When you order a repeat prescription online, you can have your prescription sent electronically to a pharmacy or dispenser of your choice. This means you no longer need to collect a paper prescription from your GP surgery. For a full list of apps and websites you can use visit the NHS website

If you have not already chosen your regular pharmacy or dispenser (called a “nomination”), some apps and websites allow you to set one up. If they do not:

• contact the pharmacy or dispenser you want to nominate
• contact your GP surgery to set one up

You can order a repeat presctiption through the NHS website.

You need an NHS login to use this service. If you do not have an NHS login, you’ll be asked to set one up.

 

Quick links:

Find out about free prescriptions for :

You can get free NHS prescriptions if, at the time the prescription is dispensed, you:

• are 60 or over
• are under 16
• are 16 to 18 and in full-time education
• are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx)
• have a specified medical condition and have a valid medical exemption certificate (MedEx)
• have a continuing physical disability that prevents you going out without help from another person and have a valid medical exemption certificate (MedEx)
• hold a valid war pension exemption certificate and the prescription is for your accepted disability
• are an NHS inpatient

You’re also entitled to free prescriptions if you or your partner (including civil partner) receive, or you’re under the age of 20 and the dependant of someone receiving:

• Income Support
• income-based Jobseeker’s Allowance
• income-related Employment and Support Allowance
• Pension Credit Guarantee Credit
• Universal Credit and meet the criteria

If you’re entitled to or named on:

• a valid NHS tax credit exemption certificate – if you do not have a certificate, you can show your award notice. You qualify if you get Child Tax Credits, Working Tax Credits with a disability element (or both), and have income for tax credit purposes of £15,276 or less
• a valid NHS certificate for full help with health costs (HC2)

People named on an NHS certificate for partial help with health costs (HC3) may also get help.

Read more about who can get free NHS prescriptions.

Check if you’re eligible for free prescriptions

There’s a simple way to find out if you’re eligible for free NHS prescriptions and any help with other NHS costs.

Free prescriptions for certain medical conditions

People with certain medical conditions can get free NHS prescriptions.

Medical exemption certificates are credit-card-size cards. They are issued if you have:

• cancer, including the effects of cancer or the effects of current or previous cancer treatment
• a permanent fistula (for example, a laryngostomy, colostomy, ileostomy or some renal dialysis fistulas) requiring continuous surgical dressing or an appliance
• a form of hypoadrenalism (for example, Addison’s disease) for which specific substitution therapy is essential
• diabetes insipidus or other forms of hypopituitarism
• diabetes mellitus, except where treatment is by diet alone
• hypoparathyroidism
• myasthenia gravis
• myxoedema (hypothyroidism requiring thyroid hormone replacement)
• epilepsy requiring continuous anticonvulsive therapy
• a continuing physical disability that means you cannot go out without the help of another person (temporary disabilities do not count, even if they last for several months)

How to apply for a medical exemption certificate

Free prescriptions for pregnant women

If you’re pregnant or have had a baby in the past 12 months, you get free prescriptions if you have a valid maternity exemption certificate.

Maternity exemption certificates are credit-card-size cards.

To apply for a maternity exemption certificate, contact your doctor, midwife or health visitor.

The certificate will last until 12 months after the expected date of birth of your baby.

If your baby’s born early, you can continue to use your certificate until it expires.

If your baby is born late, you can apply for an extension.

If you apply after your baby is born, your certificate will last for 12 months from your baby’s birth.

Free prescriptions if you have a low income

If you have a low income, you may be eligible to receive financial help through the NHS Low Income Scheme.

To apply for an HC2 certificate, complete form HC1, which is available from Jobcentre Plus offices or most NHS hospitals. You might also be able to get an HC1 form from your doctor, dentist or optician.

You can also get an HC1 form by calling 0300 123 0849.

You qualify for a full help HC2 certificate (which includes free NHS prescriptions) if your income is less than or equal to your requirements, or your income is greater than your requirements by no more than half the current English prescription charge.

You qualify for a limited help HC3 certificate if your income is greater than your requirements by more than half the current English prescription charge.

The HC3 certificate shows how much you have to pay towards your health costs.

Certificates are usually valid for between 6 months and 5 years, depending on your circumstances.

How can I claim a refund on a prescription charge?

Ask the pharmacist, hospital or doctor for the refund form (FP57) when you pay for your prescription. You cannot get one later.

You must apply for a refund within 3 months of paying the prescription charge.

If you receive Universal Credit and meet all the criteria to be entitled to help with health costs but did not get a refund form (FP57), contact the NHS Business Services Authority. They’ll consider applications for refunds on a case-by-case basis.

Important numbers

A PPC covers all your NHS prescriptions, including NHS dental prescriptions, no matter how many items you need.

But it does not cover the cost of other health items, such as the provision of wigs and fabric supports, which are only provided through the hospital service.

There are 2 PPC options to choose from:

1. The 3-month PPC costs £30.25 and will save you money if you need more than 3 prescribed items in 3 months.
2. The 12-month PPC costs £108.10 and will save you money if you need more than 11 prescribed items in a year.

There are several payment options available. If you choose the 12-month PPC, you can pay for this upfront, or by 10 monthly direct debit instalments.

How much can I save?

If you need:

• 2 items each month –

you can save £116.30 with a 12-month PPC

• 3 items each month –

you can save £228.50 with a 12-month PPC

• 4 items each month –

you can save £340.70 with a 12-month PPC

How to apply for a PPC

Check if you’re entitled to free prescriptions before you apply for a PPC.

It’s quickest to buy a PPC online. The PPC will start from the day you submit your application, unless you request a different start date, but the start date must be within 1 month before or after the date of your application.

If you prefer talking to someone, you can call the PPC order line on 0300 330 1341. Your certificate will be valid from the day you make the phone call, unless you request otherwise.

Make sure you have your bank details or credit or debit card details ready.

You can receive your certificate details by email if you provide an email address, print them at the end of your online application, or receive the details by post.

Although a PPC is valid from the day of your application (unless otherwise requested), it may take a couple of days to receive the details of your certificate by post. If you pay prescription charges while you’re waiting for the details to arrive, you can get a refund, as long as you get an NHS refund form (FP57) when you pay.

Some pharmacies may be able to sell you a PPC. You will not be able to pay by direct debit if you buy a PPC at a pharmacy.

Useful tips

• Remember to apply for a new PPC in plenty of time, otherwise you’ll have to pay full prescription charges if it expires.
• It’s important that you do not use your certificate after it expires. The NHSBSA checks that patients who claim for free NHS prescriptions are entitled to the exemption they have declared.
• Check that your certificate is valid before claiming free NHS prescriptions
• If you have to pay for prescriptions while you’re waiting for details about a new PPC and need to apply for a refund, ask the pharmacist for an NHS receipt (FP57) so you can claim back the cost. Your PPC must cover the date you paid the prescription charge.
• You can claim for the refund of prescription charges up to 3 months after paying. The FP57 explains what to do.
• If you buy a 12-month PPC by direct debit, you are entering into a commitment to pay all the instalments.

 

If you have a prescription:

If you already have a prescription and urgently need the medicine, try the following steps:

• If your local pharmacy is closed, you can get your medicine from any pharmacy as long as they have it in stock. Use the NHS pharmacy service search to find other nearby pharmacies and their opening hours – some are open until midnight or later, even on public holidays.
• If you’d like to speak to someone first, call NHS 111 free of charge by dialling 111 on your mobile or landline. The person you speak to can look up an out-of-hours pharmacy or another NHS service in your area.
• You can also use the NHS walk-in centre service search to find your nearest walk-in centre. These can sometimes dispense medicines after a consultation.
• If it’s urgent, you can call your GP surgery. They should have details of their out-of-hours service recorded on their answering machine. This is the service your GP runs outside their usual opening hours and on public holidays – do not use this routinely. You can use the NHS GP service finder to find your GP surgery’s phone number.
• If it’s an emergency and you’ve tried all of the above unsuccessfully, use the service search to find your nearest A&E.

If you do not have a prescription

If you run out of prescription medicine and do not have a prescription with you, you can get an emergency supply from a pharmacy without a prescription.

Take an old prescription or the medicine’s packaging with you, if you have it.

Pharmacies

You’ll be assessed by the pharmacist to find out:

• if you need the medicine immediately
• who previously prescribed the medicine (to make sure they’re a trusted source)
• what dose of the medicine would be appropriate for you to take

The pharmacist needs to know the answers to all of these questions before they can supply a prescription-only medicine without a prescription in an emergency. They will keep a record of your details, the medicine they provide and the nature of the emergency.

If the pharmacist is not satisfied that the medicine and dose is appropriate for you, they may not supply the medicine.

Only a limited range of controlled medicines can be prescribed in an emergency, such as those for epilepsy (phenobarbital). Many commonly used controlled medicines, such as morphine or diamorphine, cannot be supplied without a prescription by a pharmacist in an emergency.

You may need to pay for this service and medicine, even if you do not normally, because they’re being provided without a prescription. This may vary between pharmacies.

GPs and walk-in centres

If you run out of medicine while you’re away from home, you may be able to have a consultation with a local GP and get a prescription for a limited supply of medicines. You’ll then need to find a pharmacy that’s open.

You can also go to an NHS walk-in centre. They may be able to organise a GP consultation. Sometimes, they can give you medicine after you’ve seen a nurse.

These services staffed by expert advisers provide a range of proven methods to help you quit. They’ll give you accurate information and advice, as well as professional support, during the first few months you stop smoking. They also make it easy and affordable for you to get stop smoking treatments, such as:

• Varenicline (Champix)
• Bupropion (Zyban)
• Nicotine replacement therapy, such as patches and gum

One-to-one and group stop smoking services

You’ll normally be offered a one-to-one appointment with an adviser, but many areas also offer group and drop-in services as well. Depending on where you live, the venue could be a local GP surgery, pharmacy, high-street shop, or even a mobile bus clinic.

Jennifer Percival, who trains stop smoking advisers, says that using both treatment and specialist support is proven to give you the best chance of stopping smoking.

“The majority of people who see an adviser will get through the first month after quitting without smoking a cigarette.

“Overall, you’re up to 4 times more likely to stop smoking for good if you use a combination of stop smoking treatment and receive support from an NHS Stop Smoking Service.” she says.

How to contact a stop smoking adviser

Your GP can refer you, or you can phone your local stop smoking service to make an appointment with an adviser.

What happens at the first stop smoking session?

At your first meeting with an adviser, you’ll talk about why you smoke and why you want to quit, as well as any attempts you’ve made to quit in the past. You’ll also be able to decide on a quit date.

You’ll be offered a breath test, which shows the level of carbon monoxide – a poisonous gas in cigarette smoke – in your body.

“You don’t need to be sure you want to quit or have a quit plan in mind before this meeting,” says Jennifer.

“You can use the time to talk your situation through with the adviser without making a commitment. If you do decide to quit, the adviser can help you form an action plan and set a quit date, usually in a week or so.”

Stop smoking aids

At your first session, you’ll also discuss NHS-endorsed stop smoking treatments available to help you. These are nicotine replacement products (including patches, gum, lozenges, inhalators and mouth and nasal sprays) and the stop smoking tablets Champix (varenicline) and Zyban (bupropion).

“No one is forced to use treatment,” says Jennifer, “but we’ll encourage it because the results are better. We can help you decide which type of treatment is right for you and how to use it.

“In some cases, we can directly supply you with the treatment before you leave, or we can arrange for you to receive a prescription or a voucher for it.

“In the case of nicotine replacement therapy, it often works out at least a third cheaper than buying it from a pharmacy.”

There’s evidence that e-cigarettes can help people stop smoking. E-cigarettes aren’t currently available as medicines so they can’t be supplied by stop smoking services or prescribed on the NHS but, if you want to use an e-cigarette to help you quit, you can still get advice and support from a stop smoking adviser to give you the best chance of success.

Read more about using e-cigarettes to stop smoking

Jennifer points out that NHS stop smoking advisers only provide evidence-based support. “We won’t suggest or recommend hypnosis or acupuncture as there’s not enough evidence they help you stop smoking.”

Talk to your GP

Many people don’t realise that their GP can help them quit smoking. Your doctor can do a lot, such as enrolling you in a “stop smoking” clinic, and prescribing nicotine replacement therapy, such as patches and gum, or stop smoking medication such as Champix.

10 self-help tips to stop smoking

Join your local stop smoking service

Did you know that you’re up to 4 times more likely to quit successfully with the help of your local stop smoking service?

Services staffed by trained stop smoking advisers are available all over the country. You can join a local group that meets once a week, or have one-to-one support if you prefer. You usually go for a few weeks and work towards a quit date.

Find your nearest NHS Stop Smoking Service, or call the Smokefree National Helpline on 0300 123 1044 to speak to a trained adviser.

Find online support

For online support including apps, communities and motivational emails, visit Better Health.

Have an emergency phone number to hand

Keep an emergency number, perhaps for your local stop smoking service or the national helpline.

“We’re here on 0300 123 1044 from Monday to Friday 9am to 8pm, and Saturday and Sunday 11am to 4pm answering calls from people who are about to have a cigarette and want help not lighting up,” says Chris, one of the helpline advisers. “We can talk about why you want to smoke and how to deal with your cravings.”

Read more about how to cope with cravings

Consider using a nicotine-containing product

Cigarettes are addictive, and self-control alone might not be enough for you to stop entirely. Give yourself a better chance of success by using nicotine replacement therapy (NRT). This is available on prescription from your GP, from your local stop smoking service or from a pharmacist.

You could also consider trying e-cigarettes. While they’re not risk-free, they are much safer than cigarettes and can help people stop smoking.

Read more about using e-cigarettes to stop smoking

Find your nearest NHS stop smoking service, or call 0300 123 1044

If you relapse after quitting, the key is to learn from what went wrong so you’re more likely to succeed next time.

If you’re tempted to start smoking again, call the free NHS Smokefree helpline on 0300 123 1044 to get support from a trained adviser.

When you quit smoking, it’s important to be positive and really believe that you’ll be successful. You shouldn’t expect to start smoking again. A slip-up shouldn’t mean that you’ll return to smoking the way you did before. It’s an opportunity to learn a bit about yourself and what will help you to be more successful in the future.

If you do relapse, don’t worry. It can take a few tries to quit smoking for good.

It can be helpful to commit yourself to the “not a single drag” rule. Promise to yourself and others that you’ll not even have a single drag on a cigarette. By sticking to this simple rule, you can guarantee that you won’t start smoking again.

Preventing slip-ups

Why is it that some people who have stopped return to smoking? The main reason is giving in to cravings. These are powerful urges to smoke, often triggered by stress, seeing other people smoking, getting drunk, or emotional events like arguments.

The best way to withstand cravings is a combination of stop smoking medicines and behavioural changes. It’s also important to stay away from people who smoke. Most people who relapse do so because they’re with other people who are smoking, and this is usually after having asked one of them for a cigarette.

Get practical advice on how to relieve cravings

Help to prevent relapse

The risk of relapse is highest in the first few weeks after stopping. But some people can relapse several months, or even years, after stopping smoking.

Avoiding a relapse is best, but if you do give in to temptation, don’t despair. Really think about what went wrong and plan how you’ll deal with a similar situation in the future.

If you have had a cigarette or two:

• Don’t give up – you can still avoid a full relapse. Commit to the “not a single drag” rule and get back on with it.
• Remind yourself why you want to quit. Then take control again.
• Get support – call the free NHS Smokefree helpline on 0300 123 1014 to speak to a trained adviser. Lines are open Monday to Friday, 9am to 8pm and Saturday and Sunday, 11am to 5pm.
• Make it hard to smoke – avoid places where you can easily ask someone for a cigarette. And don’t buy a packet.
• Stay strong – if you’re tempted to smoke again, force yourself to wait 2 hours. Then decide if you really need the cigarette.
• Keep taking any prescribed stop smoking medicine or using nicotine replacement therapy, unless you go back to regular smoking. It can help you get back on track.

If you have relapsed and are back to regular smoking:

• Don’t become despondent – set a new quit date, maybe in a week or so.
• Learn from your mistakes – what caused you to slip up? Think of ways you could have avoided smoking. Work on your coping skills so you’re prepared next time you’re in the same situation.
• Talk to your doctor or local stop smoking service if you need more help to cope with cravings in your next quit attempt.
• Stay positive – making mistakes or slipping up can be a useful experience if you’re prepared to learn from it. Remember, you’ll be stronger next time because you’ll know what to look out for.

More information

Read the answers to common questions about stopping smoking, including:

• Why should I stop smoking if I’m pregnant?
• Who can use nicotine replacement therapy?
• Where can I get help to stop smoking?

The most effective way to tackle cravings is a combination of stop smoking medicines and behavioural changes.

Going cold turkey may be appealing and works for some, but research suggests that willpower alone isn’t the best method to stop smoking. In fact, only 3 in every 100 smokers manage to stop permanently this way.

Using nicotine replacement therapy (NRT) and other stop smoking medicines can double your chances of quitting successfully compared with willpower alone. This is because untreated cravings often result in lapses.

Read more about stop smoking treatments available on the NHS and privately.

Types of cravings

Cravings happen because your body misses its regular hits of nicotine.

There are 2 types of craving.

The steady and constant background craving for a cigarette decreases in intensity over several weeks after quitting.

Sudden bursts of an intense desire or urge to smoke are often triggered by a cue, such as having a few drinks, feeling very happy or sad, having an argument, feeling stressed, or even having a cup of coffee. These urges to smoke tend to get less frequent over time, but their intensity can remain strong even after many months of quitting.

Tackling Cravings

There are 3 tried and tested ways to tame cravings:

• Nicotine Replacement Therapy
• Prescription stop-smoking medicines
• Behavour changes

Nicotine replacement therapy

Nicotine replacement therapy (NRT) gives your body the nicotine it craves without the toxic chemicals that you get in cigarettes, so it doesn’t cause cancer. It helps you stop smoking without having unpleasant withdrawal symptoms.

NRT won’t give you the same “hit” or pleasure you would expect from a cigarette, but it does help reduce cravings.

NRT is available as gum, patches, lozenges, microtabs, inhalator, nasal spray, mouth spray and oral strips.

It’s important to use the right NRT product for your lifestyle. Some products, like the patch, release nicotine into your system slowly and steadily, so they’re ideal for relieving background cravings. Others, such as the nasal spray and mouth spray, release nicotine quickly in short bursts, so they’re better suited to sudden intense cravings. A good strategy is to use the nicotine patch to manage the steady and constant background cravings, and carry a fast-working product with you to deal with the sudden intense cravings.

Discuss the NRT products available over the counter with your pharmacist, or talk to your local NHS stop smoking adviser or GP about receiving NRT on prescription.

Stop smoking medicicnes

The prescription tablets Zyban (bupropion) and Champix (varenicline) are an alternative to NRT in helping you stop smoking. They don’t contain nicotine, but work on your brain to dampen cravings.

As they take a few days to work fully, you need to start these medicines for a week or two before you stop smoking. Ask your doctor or a local stop smoking adviser whether prescription medicines may help you.

Read more about prescription stop smoking medicines

Change your behaviour

NRT and stop smoking medicines can help curb cravings, but they can’t completely eradicate them. There are some additional things that can help.

Avoid triggers

For you, some events or times of the day may have a strong association with smoking: after food, with a coffee, after putting the kids to bed, when chatting to a friend, or having an alcoholic drink.

Try doing something different at these times. You don’t have to make this change forever, just until you have broken the association with smoking.

Stay strong

Expect your cravings to be at their worst in the first few weeks after quitting. The good news is that they’ll pass, and the quickest way to achieve this is to commit to the “not a single drag” rule.When you’re ready to stop for good, promise yourself “I won’t even have a single drag on a cigarette”.

If you feel like smoking, remember “not a single drag” to help the feeling pass.

Exercise

Physical activity may help reduce your nicotine cravings and relieve some withdrawal symptoms. It may also help you reduce stress and keep your weight down.

When you have the urge to smoke, do something active instead. Going to the gym or local swimming pool are good, as is a little gentle exercise like a short walk, or something useful like doing the housework or gardening.

Find out how to do more exercise

Be prepared

Expect cravings at special events like holidays, funerals or weddings.

You may have never experienced these before as a non-smoker, so you’ll associate them strongly with smoking. Have some fast-acting NRT with you just in case.

Get more self-help tips to stop smoking

Delay

When the urge to smoke strikes, remember that although it may be intense, it’ll be shortlived and will probably pass within a few minutes. Each time you resist a craving, you’re 1 step closer to stopping smoking.

Why eye checks are important

The sooner any eye problem is found, the sooner you and your child will be able to get any treatment and support needed.

Children may not realise they have a vision problem so, without routine tests, there’s a risk a problem may not be spotted. This may affect their development and education.

If you have any concerns about your child’s vision see a GP or go to an opticians.

When will my child’s eyes be checked?

Your child’s eyes may be checked a number of times throughout the first hours, weeks and years of their life.

• Within 72 hours of birth

  Your child’s eyes will be checked for any obvious physical problems as part of the newborn physical examination.

• Between 6 and 8 weeks old

  This is a follow-up physical examination to check for any obvious problems that were not picked up soon after birth.

• Around 1 year, or between 2 and 2-and-a-half years

  You may be asked if you have any concerns about your child’s eyesight as part of your child’s health and development reviews. Eye tests can be arranged if necessary.

• Around 4 or 5 years old

  Your child’s eyes may be examined soon after they start school. This is called vision screening and it checks for reduced vision in one or both eyes. The aim is to detect any problems early so that treatment can be given if needed.

  Vision screening is usually carried out in your child’s school. However, this does not happen in all areas. If your child’s vision is not checked at school, take them to your local opticians for an eye examination.

Speak to a GP or go to an opticians if you have any concerns about your child’s vision at any stage.

What tests may be carried out?

A number of tests may be carried out to check for vision or eye problems in babies and children.

Attention to visual objects

Causes of eye problems in babies and children

There are a number of different eye problems that can be detected during eye tests, including:

• childhood cataracts – cloudy patches in the lens of the eye that are present from birth
• lazy eye (amblyopia) – where the vision in one eye does not develop properly
• squint (strabismus) – where the eyes look in different directions
• short-sightedness (myopia) – where distant objects appear blurred, while close objects can be seen clearly
• long-sightedness (hyperopia) – where you can see distant objects clearly but nearby objects are out of focus
• astigmatism – where the transparent layer at the front of the eye (cornea) is not perfectly curved
• colour vision deficiency (colour blindness) – difficulty seeing colours or distinguishing between different colours; this is more common in boys than girls

Spotting signs of an eye problem

Although your child should have regular eye tests as they grow up, it’s still important to look out for signs of any problems and get advice if you have any concerns.

For babies, the checklist in your baby’s personal child health record (red book) can be used to help you check if your child’s vision is developing normally.

In older children, signs of a possible eye problem can include:

• the eyes not pointing in the same direction
• complaining of headaches or eye strain
• problems reading – for example, they may need to hold books close to their face and they may lose their place regularly
• problems with hand-eye co-ordination – for example, they may struggle to play ball games
• being unusually clumsy
• regularly rubbing their eyes
• sitting too close to the TV

The GP surgery can refuse registration for reasons such as they are not taking new patients or it’s too far away from your home and you need home visits.

How to register with a GP practice outside your area

When you’ve chosen a GP surgery, ask if they’re accepting registrations outside of the area and ask for a registration form.

Find out more about how to register with a GP surgery

The surgery will decide if they can accept you as a regular patient or accept you without home visits.

Because of the distance to your home, the GP surgery might not be able to offer home visits.

If you are not well enough to go to the GP surgery, other arrangements might be made.

Registering with a practice further away from home can affect decisions about referrals for hospital tests and treatment, or access to community health services. Speak to the GP about your options.

How to book, change or cancel an appointment

You should be able to book or change an appointment at your GP surgery:

• online, find out more about how to start using online services
• by phone
• in person, by going into the surgery and talking to the receptionist

In some GP surgeries, you may also be able to have a consultation online or over the phone. Speak to your GP surgery for more information about online and phone consultations.

Call your GP surgery if you need an urgent appointment. If your GP surgery is closed, a recorded message will tell you who to contact.

Booking, changing and cancelling appointments online

If you are registered with a GP surgery, you can use their online services to book, check or cancel appointments with a GP, nurse, or other healthcare professional.

If you have already signed up to online services, log in to your usual service provider and book one of the available appointments.

To change an appointment online, you will need to cancel the appointment you already have and book a new one.

Read more about how to start using online services, if you are not signed up to them already.

Evening and weekend appointments

You can now see a GP or nurse on:

• weekday evenings between 6.30pm and 8pm
• Saturdays and Sundays

Call your GP surgery or use their online services to book evening and weekend appointments. You may be able to get an appointment on the same day.

You may be offered an appointment at:

• your GP surgery
• another local GP surgery
• another local NHS service

If you’re not registered with a GP

You can call any GP surgery to get emergency treatment for up to 14 days if you are not registered with a GP or are away from home.

If your treatment will last longer than 14 days, you’ll have to register as a temporary or permanent resident. Read more about:

• how to register as a temporary resident with a GP
• how to register with a GP surgery

Other services

Before you make an appointment to see your GP, think about what other services might be able to help.

• Go to a pharmacy for advice and treatment for minor conditions that do not need a prescription. Read about services you can get from a pharmacist.
• Call NHS 111 if you have an urgent medical problem, but you’re not sure what to do.
• Visit 111.nhs.uk for urgent medical advice for people aged 5 and over only.
• Visit a sexual health service for testing for sexually transmitted infections and contraception advice.

You do not have to make an appointment or register for these services.

Paracetamol is a common painkiller used to treat aches and pain. It can also be used to reduce a high temperature.

It’s available combined with other painkillers and anti-sickness medicines. It’s also an ingredient in a wide range of cold and flu remedies.

Paracetamol is widely available as tablets and capsules.

For people who find it difficult to swallow tablets or capsules, paracetamol is also available as a syrup or as soluble tablets that dissolve in water to make a drink.

Key facts:

• Paracetamol takes up to an hour to work.
• The usual dose of paracetamol is one or two 500mg tablets at a time.
• Do not take paracetamol with other medicines containing paracetamol.
• Paracetamol is safe to take in pregnancy and while breastfeeding, at recommended doses.
• Brand names include Disprol, Hedex, Medinol and Panadol.

Most people can take paracetamol safely, including pregnant and breastfeeding women.

However, some people need to take extra care with paracetamol.

Paracetamol and pregnancy

How and when to take it

Paracetamol can be taken with or without food.

Adults can take a maximum of 4 doses (up to eight 500mg tablets in total) in 24 hours. Wait at least 4 hours between doses.

Overdosing on paracetamol can cause serious side effects. Do not be tempted to increase the dose or to take a double dose if your pain is very bad.

What if I take too much?

Taking 1 or 2 extra tablets by accident is unlikely to be harmful, as long as you do not take more than 8 tablets in 24 hours.

Wait at least 24 hours before taking any more paracetamol.

Get help from 111 now if you take:

What if I forget to take it?

If you take paracetamol regularly and miss a dose, take it as soon as you remember. However, skip the missed dose if it’s nearly time for your next dose.

Never take double doses of paracetamol. Do not take an extra dose to make up for a missed one.

Taking paracetamol with other painkillers

It’s safe to take paracetamol with other types of painkiller that don’t contain paracetamol, such as ibuprofen, aspirin and codeine.

Do not take paracetamol alongside other medicines that contain paracetamol. If you take 2 different medicines that contain paracetamol, there’s a risk of overdose.

Before taking any other medicines, check the label to see whether they contain paracetamol.

Side effects

Paracetamol very rarely causes side effects if you take it at the right dosage.

For a full list of possible side effects, see the leaflet inside your medicines packet.

If you’re worried about a side effect or notice anything unusual, talk to your pharmacist or doctor.

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to paracetamol.

Call 999 or go to A&E if:

Cautions with other medicines

It’s safe to take paracetamol with most prescription medicines, including antibiotics.

Paracetamol isn’t suitable for some people. Talk to your doctor if you are unsure.

Check with your doctor or pharmacist if you’re taking St John’s wort (a herbal remedy taken for depression) as you may need to reduce your paracetamol dose.

Otherwise, paracetamol isn’t generally affected by also taking herbal remedies or supplements.

For safety, tell your doctor or pharmacist if you’re taking any other medicines, including herbal remedies, vitamins or supplements.

Ibuprofen is an everyday painkiller for a range of aches and pains, including back pain, period pain and toothache. It also treats inflammation such as sprains and strains, and pain from arthritis.

It’s available as tablets, capsules, granules and as a liquid that you swallow. It also comes as a gel, mousse and spray that you rub into your skin.

Ibuprofen is combined with other painkillers in some products. It’s an ingredient in some cold and flu remedies, such as Nurofen Cold and Flu.

You can buy most types of ibuprofen from pharmacies and supermarkets. Some types are only available on prescription.

Key facts

• Ibuprofen works by reducing hormones that cause pain and swelling in the body.
• It takes 20 to 30 minutes to work if you take it by mouth, and 1 to 2 days to work if you put it on your skin.
• Ibuprofen is typically used for period pain or toothache. Some people find ibuprofen better than paracetamol for back pain.
• Always take ibuprofen tablets, capsules, granules and liquid with food or a drink of milk to reduce the chance of an upset stomach. Do not take it on an empty stomach.
• If you’re taking tablets, capsules, granules or liquid, take the lowest dose to control your pain for the shortest possible time. Do not take it for more than 10 days (or 3 days if you’re under 18) unless you’ve spoken to your doctor. Do not use the gel, mousse or spray for more than 2 weeks without talking to your doctor.

Who may not be able to take ibuprofen?

Do not take ibuprofen by mouth or apply it to your skin if you:

• have ever had an allergic reaction or symptoms like wheezing, runny nose or skin reactions after taking aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen
• are pregnant

Tablets, capsules, granules and liquids

To make sure ibuprofen tablets, capsules, granules or liquid is safe for you, tell your doctor or pharmacist if you:

• have ever had bleeding in your stomach or a hole (perforation) in your stomach caused by an NSAID
• have had a hole (perforation) in your stomach, bleeding in your stomach or a stomach ulcer more than once
• have a health problem that means you have an increased chance of bleeding
• have severe heart failure, severe kidney failure or severe liver failure
• are trying to get pregnant
• have high blood pressure that’s not under control
• have heart disease or mild to moderate heart failure, or have ever had a stroke
• have kidney or liver problems
• have asthma, hay fever or allergies
• have Crohn’s disease or ulcerative colitis
• have chickenpox or shingles – taking ibuprofen can increase the chance of certain infections and skin reactions

If you’re over 65, ibuprofen can make you more likely to get stomach ulcers. Your doctor will prescribe you a medicine to protect your stomach if you’re taking ibuprofen for a long-term condition.

Always follow your doctor or pharmacist’s advice, and the instructions that come with your medicine.

Dosage

• Each ibuprofen tablet or capsule contains 200mg, 400mg or 600mg of ibuprofen. Slow-release tablets and capsules contain 200mg, 300mg or 800mg of ibuprofen.

• Each sachet of granules contains 600mg of ibuprofen.

• If you’re taking ibuprofen as a liquid, 10ml contains either 200mg or 400mg. Always check the label.

• The usual dose for adults is one or two 200mg tablets or capsules 3 times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take 4 times a day if needed. This should only happen under supervision of a doctor.

• If you’re taking granules, the usual dose for adults is one sachet 2 or 3 times a day. Some people might need to take it 4 times a day.

• If you take ibuprofen 3 times a day, leave at least 6 hours between doses. If you take it 4 times a day, leave at least 4 hours between doses.

• If you have pain all the time, your doctor may recommend slow-release ibuprofen tablets or capsules. You’ll usually take these once a day in the evening or twice a day. Leave a gap of 10 to 12 hours between doses if you’re taking ibuprofen twice a day.

How to take tablets, capsules, granules and liquid

• Swallow ibuprofen tablets or capsules whole with a drink of water, milk or juice. Do not chew, break, crush or suck them as this could irritate your mouth or throat.

• For people who find it difficult to swallow tablets or capsules, ibuprofen is available as a tablet that melts in your mouth, granules that you mix with a glass of water to make a drink, and as a liquid.

• If you’re taking the tablet that melts in your mouth, put it on your tongue, let it dissolve and then swallow. You do not need to drink any water.

• Take ibuprofen granules by emptying the contents of the sachet into a glass full of water to make an orange flavoured fizzy drink, stir and drink straight away.

• If you’re taking liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

• Take ibuprofen tablets, capsules, granules or liquid with a meal or snack, or with a drink of milk. It will be less likely to upset your stomach. If you take it just after food, ibuprofen may take longer to start working.

How long to take it for

If you’re taking ibuprofen for a short-lived pain like toothache or period pain, you may only need to take it for a day or two.

You may need to take ibuprofen for longer if you have a long-term health problem, such as rheumatoid arthritis.

If you need to take ibuprofen for more than 6 months, your doctor may prescribe a medicine to protect your stomach from any side effects.

If you forget to take ibuprofen tablets, capsules, granules or liquid

If you are prescribed ibuprofen as a regular medicine and forget to take a dose, take the missed dose as soon as you remember, unless it’s almost time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Never take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much ibuprofen tablets, capsules, granules or liquid

Taking too much ibuprofen by mouth can be dangerous. It can cause side effects such as:

• feeling and being sick (nausea and vomiting)
• stomach pain
• feeling tired or sleepy
• black poo and blood in your vomit – a sign of bleeding in your stomach
• ringing in your ears (tinnitus)
• difficulty breathing or changes in your heart rate (slower or faster)

Urgent advice: Contact 111 for advice now if

Common side effects of tablets, capsules, granules and liquid

These common side effects of ibuprofen taken by mouth happen in more than 1 in 100 people. There are things you can do to help cope with them:

• Headaches

  Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. It’s important not to take any other medicines for pain to help with headaches. Talk to your doctor if the headaches last longer than a week or are severe.

• Feeling dizzy

  If ibuprofen makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better. Avoid coffee, cigarettes and alcohol. If the dizziness does not get better within a couple of days, speak to your pharmacist or doctor. Do not drive or ride a bike while you’re feeling dizzy.

• Feeling sick (nausea)

  Stick to simple meals. Do not eat rich or spicy food. Always take ibuprofen tablets, capsules, granules or liquid with a meal or snack or with a drink of milk.

• Being sick (vomiting)

  Have small, frequent sips of water to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.

  If you take contraceptive pills and you’re being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

• Wind

  Try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly. There are pharmacy medicines that can also help, such as charcoal tablets or simeticone.

• Indigestion

  If you get repeated indigestion stop taking ibuprofen and see your doctor as soon as possible. If you need something to ease the discomfort, try taking an antacid, but do not put off going to the doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Ibuprofen gel, mousse or spray

To make sure ibuprofen applied to the skin is safe for you, tell your doctor or pharmacist if you have:

• kidney problems
• asthma, hay fever or allergies
• a stomach ulcer

Always follow your doctor or pharmacist’s advice, and the instructions that come with your medicine.

Dosage

The amount of ibuprofen you put on your skin depends on the product you’re using. Check the package leaflet carefully for how much to use.

How to use ibuprofen gel, mousse or spray

Gently massage the ibuprofen into the painful area 3 or 4 times a day. Leave at least 4 hours between applications.

Most products must not be used more than 4 times in 24 hours. Check the instructions that come with the medicine to see how many times a day you can use it.

Never use ibuprofen gel, mousse or spray on your eyes, mouth, lips, nose or genital area. It may make them sore. Do not put it on sore or broken skin.

Do not put plasters or dressings over skin you’ve applied ibuprofen to.

Wash your hands after using it, unless you are treating your hands.

Do not smoke or go near naked flames as clothes that have been in contact with ibuprofen gel, mousse or spray burn more easily, even if they have been washed.

If you forget to put it on

Do not worry if you occasionally forget to use ibuprofen gel, mousse or spray, just carry on using it when you remember.

If you put on too much ibuprofen gel, mousse or spray

Putting too much ibuprofen on your skin is unlikely to cause problems.

If you swallow the gel, mousse or spray

If you swallow ibuprofen gel, mousse or spray, you may get symptoms including:

• headaches
• being sick (vomiting)
• feeling sleepy or dizzy

Urgent advice: Contact 111 for advice now if

Common side effects of gel, mousse and spray

You’re less likely to have side effects when you apply ibuprofen to your skin than with tablets, capsules, granules or liquid because less gets into your body. But you may still get the same side effects, especially if you use a lot on a large area of skin.

Applying ibuprofen to your skin can sometimes cause your skin to become more sensitive than normal to sunlight. Speak to your doctor if this is a problem.

Immediate action required: Call 999 or go to A&E now if:

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to ibuprofen.

Immediate action required: Call 999 or go to A&E now if:

Long term side effects

Ibuprofen can cause ulcers in your stomach or gut, especially if you take it by mouth for a long time or in big doses. If you need to take it for a long time your doctor may also prescribe a medicine to help protect your stomach.

Other side effects

These are not all the side effects of ibuprofen tablets, capsules and syrup. For a full list see the leaflet inside your medicines packet.

For more information on taking ibuprofen alongside herbal supplements, visit the NHS website.

Paracetamol is a common painkiller for children. It’s often used to treat headaches, stomach ache, earache, and cold symptoms. It can also be used to bring down a high temperature (fever).

Paracetamol tablets (including soluble tablets), syrup and suppositories are available on prescription and to buy from shops and pharmacies.

Who can and cannot take paracetamol

Children can take paracetamol as:

• a liquid syrup – from the age of 2 months
• suppositories – from the age of 2 months
• tablets (including soluble tablets) – from the age of 6 years
• Calpol Fast Melts – from the age of 6 years

Do not give paracetamol to babies younger than 2 months old, unless it is prescribed by a doctor.

Check with your doctor or pharmacist before giving your child paracetamol if they:

• are small for their age, as a lower dose may be better
• have had liver or kidney problems
• take medicine for epilepsy
• take medicine for tuberculosis (TB)
• take warfarin (a blood-thinning medicine)

Dosage and how often to give it

Paracetamol tablets, syrup and suppositories come in a range of strengths. Children need to take a lower dose than adults, depending on their age.

Ask your doctor or a pharmacist for advice if your child is small or big for their age and you’re not sure how much to give.

Syrup dosages for children

Infant syrup (sometimes called “junior syrup”) is for children under 6 years old. A 5ml dose contains 120mg of paracetamol.

Infant syrup: 120mg/5ml

Age	How much?	How often?
3 to 6 months	2.5ml	Max 4 times in 24 hours
6 to 24 months	5ml	Max 4 times in 24 hours
2 to 4 years	7.5ml	Max 4 times in 24 hours
4 to 6 years	10ml	Max 4 times in 24 hours

Six plus syrup is for children aged 6 years and older. A 5ml dose contains 250mg of paracetamol.

Six plus syrup: 250mg/5ml

Age	How much?	How often?
6 to 8 years	5ml	Max 4 times in 24 hours
8 to 10 years	7.5ml	Max 4 times in 24 hours
10 to 12 years	10ml	Max 4 times in 24 hours

Do not give your child more than 4 doses of paracetamol in 24 hours. Wait at least 4 hours between doses.

Dosage instructions are different for babies over the age of 2 months (see Giving paracetamol to babies from 2 months).

Tablet dosages for children

Tablets usually come as 500mg. For lower doses break up the tablet to give your child a smaller amount.

Do not give your child more than 4 doses of paracetamol in 24 hours. Wait at least 4 hours between doses.

How often to give paracetamol

If your child needs help with pain day and night for several days (usually up to 3 days), give a dose of paracetamol every 6 hours. This will help to relieve the pain safely without the risk of giving too much paracetamol.

If your child has pain that comes and goes, give a dose of paracetamol when they first complain of pain. Wait at least 4 hours before giving another dose.

What if they take too much?

If you give your child 1 extra dose of paracetamol by mistake, wait at least 24 hours before giving them any more.

Get help from 111 now if:

When to use 111

How to give paracetamol to your child

Paracetamol can be taken with or without food.

How to give syrup

How to give tablets

How to use suppositories

Find out more information about giving paracetamol to babies from 2 months including treating a high temperature after vaccinations

Giving paracetamol with other painkillers

Ibuprofen is the only safe painkiller to give children alongside paracetamol. However, do not give paracetamol and ibuprofen at the same time.

You need to give these medicines 1 at a time (unless your child’s doctor or nurse gives you different instructions).

For high temperature

For pain (including teething)

Other medicines containing paracetamol

Do not give your child another medicine with paracetamol in it. If they take 2 different medicines that contain paracetamol, there’s a risk of overdose.

Paracetamol is an ingredient in lots of medicines that you can buy from the pharmacy or supermarket. These include some cough and cold medicines, so check the ingredients carefully.

Side effects in children

Paracetamol rarely causes side effects if you give it in the right doses.

If you’re worried about a side effect or notice anything unusual, talk to your pharmacist or doctor.

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to paracetamol.

Call 999 or go to A&E if:

You can report any suspected side effect using the Yellow Card safety scheme.

Cautions with other medicines

In general, paracetamol doesn’t interfere with prescription medicines, including antibiotics.

However, paracetamol isn’t suitable for some children.

Check with a doctor or pharmacist before giving any herbal remedies or supplements to your child.

Ibuprofen is a common painkiller for children. It’s often used to treat cold symptoms, teething and toothache.

Ibuprofen also treats inflammation, such as aches and pains after an injury like a sprain, or because of a health problem like childhood arthritis. It can also be used to bring down a high temperature (fever).

For children aged 3 months to 12 years, ibuprofen comes as a liquid syrup.

For children aged 7 years or older, ibuprofen is available as tablets, capsules and granules that you dissolve in water to make a drink.

You can buy most types of ibuprofen from pharmacies and supermarkets. Some types, such as ibuprofen granules, are only available on prescription.

Key facts

• Ibuprofen works by reducing hormones that cause pain and swelling in the body.
• It takes 20 to 30 minutes to work if you take it by mouth, and 1 to 2 days to work if you put it on your skin.
• Ibuprofen is typically used for period pain or toothache. Some people find ibuprofen better than paracetamol for back pain.
• Always take ibuprofen tablets, capsules, granules and liquid with food or a drink of milk to reduce the chance of an upset stomach. Do not take it on an empty stomach.
• If you’re taking tablets, capsules, granules or liquid, take the lowest dose to control your pain for the shortest possible time. Do not take it for more than 10 days (or 3 days if you’re under 18) unless you’ve spoken to your doctor. Do not use the gel, mousse or spray for more than 2 weeks without talking to your doctor.

Who can and can’t take ibuprofen

Children can take ibuprofen as:

• a liquid syrup – from the age of 3 months
• tablets and capsules – from the age of 7 years
• chewable tablets – from the age of 7 years
• granules – from the age of 12 years

Ibuprofen is not suitable for some children. Check with your pharmacist or doctor if your child:

• has had an allergic reaction to ibuprofen or any other medicines in the past
• has asthma
• has liver or kidney problems
• has a health problem that means they have an increased risk of bleeding
• has an inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
• is small or big for their age, as a lower or higher dose may be better

Do not give ibuprofen for chickenpox unless it has been recommended by a doctor – it can cause a serious skin reaction.

Dosage and how often to give it

Ibuprofen is usually given to children 3 or 4 times a day. Your pharmacist or doctor will tell you how often to give it.

If you’re not sure how much to give a child, ask your pharmacist or doctor.

If you give it:

• 3 times in 24 hours, leave at least 6 hours between doses
• 4 times in 24 hours, leave at least 4 hours between doses

Ibuprofen syrup dosages for children

Ibuprofen tablet dosages for children

If your child has pain all the time, your doctor may prescribe slow-release tablets or capsules. These are given once or twice a day.

What if I forget to give it?

Give the missed dose as soon as you remember. If it’s nearly time for their next dose, skip the missed dose and give their next dose as the usual time.

Never give a double dose to make up for a forgotten one.

What if they take too much?

If you give your child 1 extra dose of ibuprofen by mistake, wait at least 12 hours before giving them any more.

Urgent advice: Get help from 111 now if:

If you need to take your child to hospital, take the ibuprofen packaging or leaflet plus any remaining medicine with you.

How to give ibuprofen to your child

It’s best to give ibuprofen to children with food or milk so they do not get an upset tummy.

Syrup

Shake the bottle well and measure out the right amount using a plastic syringe or spoon. These come in the medicine packet. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.

To hide the taste of the syrup, you can give the child a drink of milk or fruit juice straight after the medicine. But do not mix ibuprofen syrup with juice or milk as it may mean they do not get the right dose if they do not finish the drink.

Tablets and capsules

Tablets and capsules should be swallowed whole with a glass of water or juice. Tell your child not to chew, break, crush or suck them as this could irritate their mouth or throat.

Children taking chewable tablets should chew them before swallowing.

Granules

Sprinkle or stir the granules into a small amount of soft food (such as yoghurt) or a small drink, or you can mix them with a spoonful of cold water. Do not mix the granules with warm food or liquid.

Your child should then swallow the food or drink it straight away without chewing. Make sure they take it all. Do not keep the granule/food mixture to give later.

Giving ibuprofen with other painkillers

Paracetamol is the only safe painkiller to give children alongside ibuprofen. However, do not give ibuprofen and paracetamol at the same time.

You need to give these medicines 1 at a time (unless your child’s doctor or nurse gives you different instructions).

For high temperature

If you’ve given your child ibuprofen and they still have a high temperature after 1 hour, you could try paracetamol instead.

If this helps bring down their temperature, carry on giving them paracetamol only (following the instructions that come with the medicine).

Call your doctor if you’ve tried both paracetamol and ibuprofen and they have not helped.

Do not alternate between paracetamol and ibuprofen to treat a high temperature without advice from a doctor or nurse.

Do not give more than the maximum daily dose of either medicine.

For pain (including teething)

If you’ve given your child ibuprofen and they’re still in pain 2 hours later, you could try giving paracetamol as well.

If this works, you can alternate paracetamol and ibuprofen, giving only 1 medicine at a time.

Do not give more than the maximum daily dose of either medicine.

See your doctor if you’ve tried alternating paracetamol and ibuprofen and they have not helped. Also see your doctor if you don’t know what is causing your child’s pain.

Never give aspirin to a child under the age of 16, unless their doctor prescribes it.

Side effects in children

Ibuprofen can cause side effects. To reduce the chance of side effects, give your child the lowest dose for the shortest time to control their symptoms.

Common side effects

The common side effects of ibuprofen, which happen in more than 1 in 100 children, are:

• indigestion, heartburn or feeling or being sick (nausea or vomiting) – you can reduce this by giving ibuprofen with food

If these symptoms carry on or get worse, they may be signs of irritation of the gut or stomach. Talk to your doctor or pharmacist if these side effects bother your child or do not go away.

Serious side effects

Contact a doctor straight away if your child:

• gets severe stomach pains, vomits blood, or their poo is very dark or black – these may be signs of a stomach ulcer
• stops peeing or there’s blood in their pee – there may be a problem with their kidneys
• hears ringing in their ears

Ibuprofen may make asthma worse in some children, but this is uncommon. Talk to your doctor if you’re worried.

In rare cases, it’s possible for your child to have a serious allergic reaction (anaphylaxis) to ibuprofen.

Immediate action required: Call 999 or take your child to A&E if:

These are not all the side effects of ibuprofen. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect using the Yellow Card safety scheme.

Ibuprofen does not mix well with some prescription medicines.

Tell your doctor or pharmacist if your child is taking any other medicine, including herbal remedies, vitamins or supplements.

Antihistamines are medicines often used to relieve symptoms of allergies, such as hay fever, hives, conjunctivitis and reactions to insect bites or stings.

They’re also sometimes used to prevent motion sickness and as a short-term treatment for insomnia.

Types of antihistamine

There are many types of antihistamine.

They’re usually divided into 2 groups:

• antihistamines that make you feel sleepy – such as acrivastine, chlorphenamine (Piriton), hydroxyzine and promethazine
• non-drowsy antihistamines that are less likely to make you feel sleepy – such as cetirizine, cinnarizine, diphenhydramine, fexofenadine and loratadine

They also come in several different forms – including tablets, capsules, liquids, syrups, creams, lotions, gels, eyedrops and nasal sprays.

Which type is best?

There’s not much evidence to suggest any particular antihistamine is better than any other at relieving allergy symptoms.

Some people find certain types work well for them and others do not. You may need to try several types to find one that works for you.

Non-drowsy antihistamines are generally the best option, as they’re less likely to make you feel sleepy. But types that make you feel sleepy may be better if your symptoms stop you sleeping.

Ask a pharmacist for advice if you’re unsure which medicine to try as not all antihistamines are suitable for everyone.

Who can take antihistamines

Most people can safely take antihistamines.

But speak to a pharmacist or GP for advice if you:

• are pregnant or breastfeeding
• are looking for a medicine for a young child
• are taking other medicines
• have an underlying health condition, such as heart disease, liver disease, kidney disease or epilepsy

Some antihistamines may not be suitable in these cases. A pharmacist or doctor can recommend one that’s best for you.

Loratadine is usually recommended if you need to take an antihistamine in pregnancy. Loratadine or cetirizine are usually OK to take while breastfeeding.

How to take antihistamines

Take your medicine as advised by the pharmacist or doctor, or as described in the leaflet that comes with it.

The advice varies depending on the exact medicine you’re taking. If you’re not sure how to take your medicine, ask a pharmacist.

Side effects of antihistamines

Like all medicines, antihistamines can cause side effects.

Side effects of antihistamines that make you drowsy can include:

• sleepiness (drowsiness) and reduced co-ordination, reaction speed and judgement – do not drive or use machinery after taking these antihistamines
• dry mouth
• blurred vision
• difficulty peeing

Side effects of non-drowsy antihistamines can include:

• headache
• dry mouth
• feeling sick
• drowsiness – although this is less common than with older types of antihistamines

Check the leaflet that comes with your medicine for a full list of possible side effects and advice about when to get medical help.

Taking antihistamines with other medicines, food or alcohol

Speak to a pharmacist or GP before taking antihistamines if you’re already taking other medicines.

There may be a risk the medicines do not mix, which could stop either from working properly or increase the risk of side effects.

Examples of medicines that could cause problems if taken with antihistamines include some types of:

• antidepressants
• stomach ulcer or indigestion medicines
• cough and cold remedies that also contain an antihistamine

Try not to drink alcohol while taking an antihistamine, particularly if it’s a type that makes you drowsy, as it can increase the chances of it making you feel sleepy.

Food and other drinks do not affect most antihistamines, but check the leaflet that comes with your medicine to make sure.

The leaflet that comes in the packet with your medicine will have detailed information about it, including how to take it and what side effects you might get.

You may also find information on individual antihistamines on the Medicines and Healthcare products Regulatory Agency (MHRA): patient information leaflets website.

Aspirin is an everyday painkiller for aches and pains such as headache, toothache and period pain. It can also be used to treat colds and flu-like symptoms, and to bring down a high temperature.

Aspirin is known as an acetylsalicylic acid. It also belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).

Aspirin combined with other ingredients is also available in some cold and flu remedies.

You can buy most types of aspirin from pharmacies, shops and supermarkets. Some types are only available on prescription.

Aspirin comes as tablets or suppositories – medicine that you push gently into your anus (bottom). It also comes as a gel for mouth ulcers and cold sores.

If you’ve had a stroke or heart attack, or are at high risk of a heart attack, your doctor may recommend that you take a daily low-dose aspirin. Some women may also be prescribed low-dose aspirin while they’re pregnant.

This is different to taking aspirin for pain relief. Only take low-dose aspirin if your doctor recommends it.

Key facts

• It’s best to take aspirin with food. That way, you’ll be less likely to get an upset stomach or stomach ache.
• Never give aspirin to children under the age of 16 (unless their doctor prescribes it). It can make children more likely to develop a very rare but serious condition called Reye’s syndrome.
• You should start to feel better 20 to 30 minutes after taking aspirin.
• Aspirin is an ingredient in combined medicines such as Anadin Original, Anadin Extra, Alka-Seltzer Original, Alka-Seltzer XS and Beechams Powders.
• Aspirin as a mouth gel has the brand name Bonjela. Like other aspirin products, it’s only for people aged 16 and over. Bonjela Teething Gel and Bonjela Junior Gel do not contain aspirin, so you can give them to children under 16.

Who can and cannot take aspirin

Most people aged 16 and over can safely take aspirin.

Aspirin is not suitable for some people.

To make sure aspirin as a painkiller (including mouth gel) is safe for you, tell your doctor or pharmacist if you:

• have ever had an allergy to aspirin or similar painkillers such as ibuprofen
• have ever had a stomach ulcer
• have recently had a stroke (although depending on the kind of stroke you’ve had, your doctor may recommend that you take low-dose aspirin to prevent another one)
• have high blood pressure (hypertension)
• have indigestion
• have asthma or lung disease
• have ever had a blood clotting problem
• have liver or kidney problems
• have gout – it can get worse for some people who take aspirin
• have heavy periods – they can get heavier with aspirin
• are pregnant, trying to get pregnant or breastfeeding

Taking aspirin for pain

The dose of aspirin that’s right for you depends on the kind of aspirin you’re taking, why you’re taking it and how well it helps your symptoms.

Aspirin tablets

Different aspirin tablets and how to take them

Dosage and strength of aspirin tablets

Aspirin suppositories

How to use aspirin suppositories

Dosage and strength of aspirin suppositories

Apsirin mouth gel

How to use aspirin mouth gel

How long to take it for

If you’re taking aspirin for a short-lived pain, like toothache or period pain, you may only need to take it for 1 or 2 days.

If you’ve bought it from a shop, supermarket or pharmacy and need to use aspirin for more than 3 days, ask your doctor or pharmacist for advice.

If your doctor has prescribed your aspirin, take it for as long as they recommend.

If you take too much

Taking or using 1 or 2 extra tablets or suppositories is unlikely to be harmful.

The amount of aspirin that can lead to overdose varies from person to person.

Contact 111 for advice now if:

Side effects

Like all medicines, aspirin can cause side effects although not everyone gets them.

It’s best to take the lowest dose that works for you for the shortest possible time. That way, there’s less chance that you’ll get unwanted side effects.

For a full list see the leaflet inside your medicines packet.

Common side effects

These common side effects of aspirin for pain relief happen in more than 1 in 100 people. There are things you can do to help cope with them.

• Mild indigestion

  Take your aspirin with food to prevent this. If you still get indigestion or it does not go away, it could be a sign that the aspirin has caused a stomach ulcer. Talk to your doctor as they may prescribe something to protect your stomach or switch you to a different medicine.

• Bleeding more easily than normal

  Be careful when doing activities that might cause an injury or a cut. It might be best to stop doing contact sports such as football, rugby and hockey, while you’re taking aspirin. Wear gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you’re worried about any bleeding.

Talk to your doctor or pharmacist if the side effects bother you or do not go away.

Serious side effects

It happens rarely, but some people have serious side effects after taking aspirin.

Call your doctor or contact 111 now if: