Treatment Questions – Reach Online Pharmacy

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Are you a female (from birth) aged between 18 and 50 years old? *

Yes

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What is the duration you intend to delay your period? *

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Are you currently pregnant? *

Yes

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Do you have a regular cycle, and are your periods predictable? *

Yes

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Do you have any known allergy or allergy or any hypersensitivity to Norethisterone or any excipients in Norethisterone?(See Patient Information Leaflet Section 4 for further information) *

Excipients:

Lactose
Maize starch
Magnesium stearate

Yes

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Can you provide your height, weight and BMI?

Height *

Feet/Inches

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Weight *

Stone/Pound

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BMI *

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Do you suffer from any of the following? *

Haematological Conditions:

Undiagnosed abnormal vaginal bleeding with an active blood clot in a vein of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism), or a history of these types of blood clot when the cause was not known.
if you or a member of your family have ever had a problem with blood clots, including deep vein thrombosis (DVT)
Disorders that increase the risk of blood clots in the veins, e.g. antiphospholipid syndrome, antithrombin deficiency or factor V Leiden.
Previous idiopathic or current venous thromboembolism (deep vein thrombosis, pulmonary embolism).
Active or recent arterial thromboembolic disease (e.g. angina, myocardial infarction).

Hepatical Conditions:

Current and past history of jaundice.
Active liver disease or a history of severe liver disease if liver function has not returned to normal, including a liver tumour.

Cardiological Conditions:

Current and past history of angina, heart attack, stroke or mini-stroke (TIA).

Respiratory Conditions:

Asthma

Neurological Conditions:

Epilepsy
Migraine
Current and past history of depression

Other Conditions:

Kidney impairment
Current and past history of hormone-dependent breast cancer or genital cancer or active cancer
Systemic Lupus Erythematosus (SLE)
Rare, inherited metabolic disorders called porphyria.
Hypersensitivity to the active substance or any of the ingredients and excipients listed on eMC SPC.
Rare hereditary disorders of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.

Yes

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Do you suffer from any of the following that could increase chances of blood clot? *

Systemic lupus erythematosus (immune system attacks healthy tissues, typically causing symptoms such as painful joints and muscles, tiredness, fever and rashes)
Have had a blood clot in the veins or lungs before
Have relatives who have had blood clots
Are unable to move for long periods of time (e.g. after an operation)
Have a serious injury or have major surgery
Have a history of repeated miscarriage
Smoke

Yes

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Do you have any medical conditions that you believe we should be aware of? *

Yes

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

Yes

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Are you taking any of the following medications? *

Anticonvulsants (e.g., phenobarbital, phenytoin, carbamazepine).
Anti-infectives (e.g., rifampicin, rifabutin, nevirapine, efavirenz, tetracyclines, ampicillin, oxacillin and cotrimoxazole).
Ritonavir and Nelfinavir.
Steroid Hormone.
St John\'s Wort.
Aminoglutethimide.
Cyclosporin.
Non-Steroid Anti-inflammatory Drug (NSAID).
Aprepitant.
Barbiturates.
Bosentan.
Carbamazepine.
Cobicistat.
Crizotinib.
Dabrafenib.
Eslicarbazepine.
Efavirenz.
Fosaprepitant.
Fosphenytoin.
Griseofulvin.
Nevirapine.
Oxcarbazepine.
Perampanel.
Phenytoin.
Primidone.
Topiramate.
Rufinamide.
Topiramate.
Vemurafenib.
Ciclosporin.
Selegiline.
Vasodilators.

Yes

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Do you suffer from irregular or abnormal bleeding or spotting between your periods? *

Yes

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Are you currently using any regular contraception in form of tablet, mini pill, patches, implant or injection? *

Yes

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I understand that this treatment is intended for occasional use, with only one supply permitted every six months. If I require more frequent treatment, I should consult my GP. *

Yes

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I understand I would need to start taking the medication 3 days prior to the day that I expect my period to start. *

Yes

This field is required No

I understand Norethisterone is not use as a contraceptive. *

Yes

This field is required No

I understand that taking Norethisterone while flying, along with using the mini pill, contraceptive implant, or contraceptive injection, may increase my risk of blood clots, and it is not recommended to use Norethisterone together with these forms of contraception. *

Yes

This field is required No

I understand that if I am using regular pills or patches for contraception, it would be a more effective way to delay my period is by taking my combined pill packs or contraceptive patches continuously without a break. It is not recommended to take Norethisterone alongside with combined contraception. *

Yes

This field is required No

I understand that Norethisterone carries a risk of blood clots, and I should stop taking the tablets and seek medical advice immediately if I experience any of the following symptoms: *

Symptoms of a blood clot in the lungs:

Sudden, severe, sharp pain in your chest
Coughing up blood
You suddenly become short of breath
Your heart beats more rapidly

Symptoms of a blood clot in the brain (‘a stroke’):

You have an unusually severe or long headache
Your sight is affected in any way
You find it difficult to breathe
Any part of your body feels weak or numb

Symptoms of a deep-vein thrombosis (DVT):

You have severe pain, tenderness or swelling in your calf, ankle or foot
You have purple discolouration of skin of the leg or the skin becomes red and warm to touch

Yes

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I understand that Norethisterone may worsen migraine, epilepsy, and asthma, and if this occurs, I will consult my doctor. *

Yes

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I understand that Norethisterone can affect certain laboratory tests, and I am responsible for informing my doctor if I am undergoing any blood tests or hospital investigations. *

Yes

This field is required No

I understand Norethisterone have been associated with lowering of mood, if experiencing depression, thoughts of self-harm or other menta health issues should seek medical advice. *

Yes

This field is required No

I understand that if my period does not resume within 5 days after finishing a course of Norethisterone tablets, I should contact my doctor to exclude the possibility of pregnancy. *

Yes

This field is required No

Can we share this information with your General practitioner? Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to contact your regular prescriber if there is a need for that. We advise you share this treatment with your doctor for him/her to update your medical records. *

Yes

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To ensure your medication is prescribed safely, our clinical team may need to: *

Access your medical records (including your Summary Care Record, where applicable)
Invite you to take part in a follow-up phone or video consultation for further clarification

By submitting your responses, you consent to this where clinically appropriate, and agree to upload a summary health record from your prescriber or pharmacist if required.

Yes

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Do you agree to the following? *

You have answered truthfully to all the questions and you are aware that any incorrect information you provided can present a potential danger to your health
You understand prescribing decisions will be based on the answers from your consultation and incorrect information can cause harm to your health. Orders may be rejected if not clinically suitable
You will inform your doctor about any unusual side effects
The treatment is solely for your own use
You will read the patient information leaflet supplied with your medication
You will not exceed the maximum daily dose of this medication
You confirm you have the capacity to make decisions about my own health