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info@profarmadirect.com
07425 899611

Period Delay Consultation

There are many reasons why you may choose to delay your period. Maybe you have a wedding or holiday planned and you want to delay your period until after the event. Likewise, you may wish to avoid the stress or discomfort of a period during a house move, job change or another stressful event such as exams. If you have a big event planned, consider taking period delay tablets, also known as Utovlan or Norethisterone, and you could delay your period by up to 17 days.

1. About your Health

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Please state your gender

This refers to your biological gender

Male

Female

What is your date of birth?

Use the calendar to select your date of birth.

Please add your height (in cms)

Your height is important for the prescribers decision.

Please add your current weight (in kgs)

Please make sure to add your current weight. This may affect the prescriber's decision.

Do you have any recent or past medical history of note?

If so, please provide more information

Yes

No

Do you suffer from any allergies?

If so, please provide more information

Yes

No

Do you currently take any medication whatsoever?

Please list all your current prescription medication including any medication you buy over the counter.

Yes

No

Is there a history of medical disorder's within your family?

If so, please provide more information

Yes

No

Are there any other health/medical details you feel we should know?

If so, please provide more information

Yes

No

2. About your Condition

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Is this a repeat prescription?

Yes

No

Are you female?

Yes

No

Are you breast feeding or pregnant or possibly pregnant?

Yes

No

Do you have an allergy (hypersensitivity) to norethisterone?

Yes

No

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

Yes

No

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

Yes

No

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

Yes

No

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

If so, please list the medications

Yes

No

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

Yes

No

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

Yes

No

Is there anything else which you feel we should know about prior to you taking this medication?

Yes

No

3. The Agreement and Consent

Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

0%

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.

Yes

No

I agree to the Terms and Conditions and I confirm that I am over 18.
Terms and Conditions

Yes

No

About Us

Profarma Direct is a cutting-edge online pharmacy that specialises in lifestyle medicine and personalised prescriptions.

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom
07425 899611
For Sales & Orders:
info@profarmadirect.com
For General Enquiry:
info@profarmadirect.com

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How to check GPhC Registration

You can check our pharmacy details and registration status here. You can also see details of any Fitness to Practise decisions relating to a registrant.

GPhC Registration Number:

2076639

GPhC Registered Owner:

Profarma Direct Ltd

Superintendent Pharmacist:

Zakaria Jalgaonkar

GPhC Pharmacy Details:

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom

Copyright © 2024 Profarma Direct. All Rights Reserved.

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