Our doctors would now like to check your suitability for this product

Important

This questionnaire forms the basis of your online consultation. Please be honest and if you are unsure about any of your answers, please verify the information with your GP before using the service:

I am 18 years old or above.
I am using this service on my own behalf and of my own free will. Any treatment or advice is for my sole use only.

I confirm the above statements are true

We'd like to share some more information about our period delay treatment. Norethisterone:

Needs to be started three days before your period is due
Does not work for everyone
Does not act as a contraceptive
Should not be used if you're pregnant or breastfeeding
Should not be taken if you're currently using the combined contraceptive pill, patch or ring. Depending on the type, you might be able to use your combined contraceptive without a break, to delay your period
Side effects include changes to your periods, breast pain, nausea, headaches and changes in your mood and sex drive
Can worsen migraine, epilepsy, asthma, heart and kidney problems. The risk is small as you'll only be using it for a short period, but it's important you know
Can increase your blood pressure (BP) and risk of stroke, heart attack and blood clots which can be life threatening

We'll need you to have a BP check before we can make sure it’s safe for you to have Norethisterone. You can take this using a home BP monitor or at your GP surgery. Your local pharmacy might be able to check this for you, but please give them a call before you attend to make sure they can.

Please confirm that you understand this

Periods

Your Periods

Why do you wish to delay your period?

Do you experience any abnormal or undiagnosed vaginal bleeding (that is bleeding other than your period, such as bleeding in between periods or bleeding after sex)?

Yes

Can you predict when your periods are due?

Yes

Measurements

Your height and weight

Please enter your height and weight.

Metric (e.g. 160cm/60kg)

Imperial (e.g. 5ft 7in/13st 7lb)

What is your blood pressure?

Less than 140/90 (normal)

More than 140/90 (high)

I don't know

Please have your blood pressure (BP) checked before completing your consultation. You can do this using a home BP monitor or at your GP surgery. Your local pharmacy might be able to check this for you, but please give them a call before you attend to make sure they can.

Consent

Informed consent

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact the Online Doctor before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
I have read, understand and agree to the latest terms and conditions and privacy policy.

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact Lloyds Online Doctor before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
I have read, understand and agree to the latest terms and conditions and privacy policy.

I have responded honestly and provided complete and accurate information that reflects my up to date medical history and information, so that the doctor can safely assess and advise me.
I fully understand all the questions and information provided. If I am unsure about any aspect of the service I will contact the Online Doctor before proceeding.
I understand the side effects, effectiveness and alternatives to the treatment I am requesting.
I understand this consultation will form part of my Online Doctor medical record and will be kept in line with the relevant retention period.
I have read, understand and agree to the latest terms and conditions and privacy policy.