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Domperidone (10 mg up to three times daily) is an alternative prokinetic agent but has MHRA restrictions due to cardiac risks (QT prolongation) and interactions with CYP3A4 inhibitors

Anxiety can also hamper sleep

Metformin is believed to cause substantial changes in the composition and operation of the intestinal microbiome, as stated by several studies (Forslund et al., 2015

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Circulating levels of anxiolytic steroids in the luteal phase in women with premenstrual syndrome and in control subjects