• Period Delay Patient Risk Assessment and Consent Form

    Please read this section carefully before completing the consent form

    Norethisterone 5mg tablets are used for adult females of 18 to 50 years to postpone menstruation (period delay This treatment is intended for non-regular use and only onesupply is allowed every 6 months. You should contact your GP if you required a more frequent treatment regimen.

  • Medicines and their possible side effects can affect individual people in different ways. The followingare

    some of the side effects that are known to be associated with Norethisterone.

    Just because a side effect is stated here does not mean that all people using this medicine willexperience that or any side effect.

    Patient / Applicants may experience a rise in blood pressure, jaundice (yellowing of the skin or whitesof the eyes), migraine-type headaches, signs of sever hypersensitivity (anaphylaxis): e.g. swelling of the mouth, tongue, face, throat, difficulty breathing, wheezing, severe skin rash, itch, redness, if you become pregnant unusually bad headache, sever itching (pruritus), other liver problems and signs .g.abdominal pain, nausea, vomiting, tiredness, dark brown urine, any sudden changes in eyesight, hearing or speech, any changes in sense of smell or touch. If you are concerned with the side effects, you may talk to the pharmacist who oversees this treatment or your GP for further information before proceeding with treatment.

    Drowsiness is rare with this medication, but may occur and interfere with performance ofskilled tasks e.g. driving Excess alcohol should be avoided when taking Norethisterone.

  • Applicant (or parent/guardian in the case of children/adolescents) must answer thefollowing questions comprising the applicant Risk Assessment Consent form.

     

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  • Clear
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    Pick a Date
  • I confirm and agree that any treatment prescribed for me is for my personal use only.

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  • Should be Empty: