Period Delay Treatment

A licensed doctor reviews your answers before recommending this treatment.

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01Details

Treatment

Period Delay Treatment

€25 — reviewed by a licensed doctor before your treatment is confirmed.

Patientenangaben

Vollständiger Name des PatientenE-MailTelefon

Geburtsdatum

Enter a date up to 21/10/2026.

PPS number (optional)

Wird für medizinische Dokumente in Ihrem Land benötigt. Kann auch später im Profil ergänzt werden.

Bevorzugte Apotheke (optional)

Geben Sie mindestens 2 Zeichen ein, um zu suchen.

Meine Apotheke ist nicht aufgeführt

IE · Period delay · Full

This form is used to assess your suitability for period-delay medication. It is reviewed by an Irish-registered doctor before any prescription is issued — this is not a live consultation, so please answer every question fully and honestly. Both medications used for period delay require the doctor to make the final decision on which is most suitable for you; this may not match your own preference if your answers indicate a different option is safer.

Your request

When is your period due? (expected start date)

How many days would you like to delay it by, and why? (e.g. holiday, exam, wedding)

Do you have a preference between the two available medications, or would you like the doctor to choose the most suitable one for you?

Your health

Is there any chance you could be pregnant, or are you currently trying to conceive?

Are you currently breastfeeding?

Have you ever been diagnosed with a blood clot (DVT or pulmonary embolism) or a clotting disorder?

Has a first-degree relative (parent or sibling) had a blood clot?

Have you ever had a stroke, heart attack, or angina?

Height (cm)

Weight (kg)

Do you have liver disease, a liver tumour, or a history of jaundice during a previous pregnancy?

Do you have, or have you ever had, breast cancer or any other hormone-sensitive cancer?

Do you have any abnormal or unexplained vaginal bleeding that hasn't yet been investigated by a doctor?

Do you have high blood pressure?

Do you get migraines?

Do you have any of the following conditions? (select all that apply)

Lupus (SLE)EpilepsyDiabetesNone of the above

Do you currently smoke?

Have you had any major surgery, or a period of significantly reduced mobility (bed rest, a long-haul flight, or an immobilised limb) in the last 4 weeks?

Are you currently taking any other medications, including blood thinners?We fill this in from your medical profile when we have it. Write "None" if you take none.

Is there anything else you think the doctor should know before making a decision?

Adresse des Patienten

Erforderlich für medizinische Dokumente und physische Materialien.

Straße und HausnummerWohnung / Einheit (optional)StadtEircode (optional)

Einwilligung zur Datenweitergabe (DSGVO)

Ich bestätige, dass die obigen Angaben korrekt sind und stimme einer Videokonsultation mit dem ausgewählten Arzt zu.Ich stimme zu, dass meine persönlichen und medizinischen Daten von Global Health verarbeitet und mit den behandelnden Kliniken und dem medizinischen Netzwerk geteilt werden — einschließlich Kliniken in anderen Ländern — zum Zweck meiner Behandlung, Serviceverbesserung und Sicherheit. DatenschutzerklärungIch möchte Terminaktualisierungen per WhatsApp erhalten (optional)