Period Delay - WePrescribe

Period Delay Consultation

Are your menstrual cycles regular and are you able to approximately estimate when your periods are due?

Have you suffered with vaginal bleeding when you are not menstruating? (e.g. bleeding between your cycles)

Why do you wish to delay your period?

Other

Religious festival

Going on holiday

Sporting event

Are you currently pregnant, planning a pregnancy or breastfeeding?

Have you ever previously suffered with any blood clots or Deep vein thrombosis (DVT) in the past?

Have you ever previously been advised not to use any contraceptives by any healthcare professional?

Are you over 35 years of age and a smoker?

Have you ever been diagnosed with any other medical conditions?

This can include: -Immune system conditions such as HIV -Liver or kidney issues

Please provide more details

Do you suffer with any allergies?

If so, please provide more information

Please provide more details

Do you currently take any medication? This includes herbal remedies and over the counter medication.

If so, please provide more information

Please provide more details

Is there any other information you would like to share with our prescribing team?

If so, please provide more information

Please provide more details

We strongly recommend that you inform your GP of any treatment you receive. Would you like WePrescribe to do this on your behalf?

I have read and understood the Terms and Conditions.

Please see our terms and conditions here

Period Delay Consultation