Treatment Questions | Pharma Aesthetics

Answer medical questions to order

Have you read the medical information for period delay?

Yes No

Are you allergic or sensitive to Provera or norethisterone?

Yes No

Are you pregnant, possibly pregnant, or breastfeeding?

Yes No

Provera and norethisterone not recommended in pregnancy or when breastfeeding.

Are you using any hormonal contraception?

Yes No

Hormonal contraception includes: Contraceptive pills Contraceptive patches Contraceptive vaginal ring Contraceptive implant Contraceptive injection (depot) Hormone releasing coil (IUS)

Are you in a high risk group for thrombosis, sometimes called DVT or blood clots?

Yes No

Very overweight Previous blood clot in the veins or lungs Relatives who have had blood clots Immobility for long periods of time, e.eg after an operation or during a long haul flight (6+ hours) After serious injury or have major surgery History of repeated miscarriage

Are you over 35 AND a smoker?

Yes No

Do you have undiagnosed irregular vaginal bleeding?

Yes No

Are you taking any medication listed below?

Yes No

These medications can interact with norethisterone and Provera: Medicines to treat epilepsy (e.g. phenytoin, carbamazepine) Antiviral medicines to treat HIV (e.g. ritonavir, nelfinavir, nevirapine, efavirenz) Blood thinning medication (e.g. warfarin) Herbal preparations containing St John's Wort (Hypericum perforatum) Antibiotics for tuberculosis (e.g. rifampicin, rifabutin) Other antibiotic medicines (e.g. doxycycline, lymecycline, other tetracyclines, co-trimoxazole) Anticancer medicines Ciclosporin (for suppressing the immune system) Non-steroidal inflammatory drugs (NSAIDs) for treating pain and inflammation Medicines for high blood pressure

Have you ever been diagnosed with any of the following?

Yes No

Angina (heart pain) Myocardial infarction (heart attack) High blood pressure Liver disease Jaundice in pregnancy Severe itching or a severe blistering rash in pregnancy (rare) Porphyria (rare metabolic disorder) Genital or breast cancer or liver tumours

Are you aware Provera or norethisterone need to be started at least 3 days before your period is due?

Yes No

If Provera or norethisterone is not started at least 3 days before a period, it may not work to delay the period Period bleeding usually starts 2-3 days after Provera or norethisterone is stopped, but it can sometimes begin sooner or later after stopping the tablets.

If ordering Provera, do you agree to Provera being supplied to you 'off label'?

Yes No

If ordering norethisterone answer 'Yes' and continue. If a medicine is used for an 'off label' (unlicensed) purpose the manufacturer is not liable in case of adverse events. Doctors take the responsibility for the prescribing. The dose regime for Provera for period delay is not mentioned in the manufacturer's patient leaflet insert - please follow the dosage instructions on the label affixed to the packet.

Do you have any further medical information or questions?

Yes No

Is there anything you do not understand or do you need further help?

Do the following apply to you?

Yes No

The medication is for my own use to delay my period and I will not share with anyone else I will read the information leaflet supplied with the tablets I am over 18 and I agree to identity verification checks I have completed this questionnaire myself and fully understand all the information My responses are honest and accurate, and I understand that this is necessary for a safe medical assessment I agree to the terms & conditions, privacy policy, data sharing policy & consent to cookies

Email:

Online Doctor now available

Period delay

Answer medical questions to order

Pharmacy

Aesthetics

About