Period Delay - Medical Assistment

If you have ordered this medication before, you can log in to fill up the questionnaire automatically.

About You

Are you female?

You must answer the question to continue.
Norethisterone is only for female patients.
Health

Are you breast feeding or pregnant or possibly pregnant?

You must answer the question to continue.
We are unable to supply you with norethisterone. Please consult your GP.
 

Do you have an allergy (hypersensitivity) to norethisterone?

You must answer the question to continue.
We are unable to supply you with norethisterone. Please consult your GP.
 

Do you or your family members have a history of deep vein thrombosis (DVT)?

You must answer the question to continue.
We are unable to supply you with norethisterone. Please consult your GP.
 

Have you been diagnosed with any of the following?

  • irregular vaginal bleeding of unknown cause
  • diabetes
  • depression
  • epilepsy, migraine, asthma, kidney or heart problems
  • myocardial infarction (heart attack)
  • High blood pressure
  • Angina
  • Any liver disease or disturbance of liver function
  • jaundice or herpes during pregnancy
  • severe itching
  • porphyria (a rare metabolic disorder)
  • Dubin-Johnson Syndrome (chronic jaundice (yellowing of the skin or eyes)) or Rotor Syndrome (jaundice in childhood)
  • an inherited disorder of the red blood pigment haemoglobin (porphyria)
  • cancer of the breast or genital tract
  • any serious medical condition which may require immediate hospitalisation
You must answer the question to continue.
We are unable to supply you with norethisterone. Please consult your GP.
Medication

Are you taking any type of hormonal contraceptives (e.g. oral or injections)?

You must answer the question to continue.
We are unable to supply you with norethisterone. Please consult your GP.
 

Are you currently taking any medication (including over the counter, prescription or recreational drugs)?

You must answer the question to continue.
 

Are you taking any of the following medications?

  • Medicines to treat epilepsy (e.g. phenytoin, carbamazepine)
  • Antibiotic medicines to treat an infection (e.g. tetracyclines, rifampicin, co-trimoxazole)
  • Antiviral medicines to treat HIV (e.g. ritonavir, nelfinavir)
  • Anticancer medicines
  • Herbal preparations containing St John's Wort (Hypericum perforatum)
  • Aminoglutethimide, sometimes used in Cushing's syndrome
  • Ciclosporin (for suppressing the immune system)
  • Non-steroidal inflammatory drugs (NSAIDs) for treating pain and inflammation
  • Medicines for high blood pressure
  • Rifamycin
  • Warfarin
  • Sex hormones
  • A statin for high cholesterol
  • griseofulvin
You must answer the question to continue.
We are unable to supply you with treatment. Please consult your GP.
Agreement

Do you understand that this medication should be only be used for delaying your period?

You must answer the question to continue.
We can only supply Norethisterone for period delay. If you would like to take this medication for any other reason, you must make an appointment to see your doctor as the treatment recommended may be different.
 

Do you agree to the following?

  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
You must answer the question to continue.
You must agree to this before continuing. If you need assistance contact customer support.
You must click on the terms and conditions to continue
01273 204 905

Have a question? call us now

hello@burwashmedsdirect.co.uk

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Mon – Fri 09:00 – 18:00

Saturday 09:00 – 13:00

Sunday Closed