Important Update: Online Triage Moving to Accurx

We are upgrading our online triage system to Accurx to make it easier and faster for you to contact us. The new forms launch on 14 January 2026. Find out how this change benefits you and read our FAQs.

Period Delay Medication Request

Please note that these requests can take up to a week to complete and that the pharmacy will then need 48 hours to process the prescription.

If you require your medication before this we recommend that you consider looking at undertaking an online assessment with a private provider who can provide the same medication for a charge.

Any medication can potentially have side effects. You need to be aware that the medication used to delay a period carries a small increased risk of blood clots. To help us know if the medication is appropriate for you we need some information.

Please answer the questions below.

You will need to give us a recent weight (in kg) and blood pressure reading- you can use the blood pressure machine at the DIY pod at the surgery if required.

Period Delay Request

Your Details

Enter Email
Please use format day/month/year e.g. 12/05/1979
I am the patient

Information about your period

Please use format day/month/year e.g. 12/05/1979
Are your periods regular?
For instance, what is the date that you want your period to start?
Please use format day/month/year e.g. 12/05/1979

Basic Health Data

e.g. 120 / 70
Please use format day/month/year e.g. 12/05/1979
Smoking Status

Medical History

Have you ever had bloods clots in your legs (DVT) or lungs (PE)?
Has anyone in your close family ever had clots in the legs or lungs?
Do you suffer from migraines?
Are you taking/using any contraception?
Have you ever had breast cancer?
Is there a chance you could be pregnant?

Confirmation

Important Information:

  • Medication to delay periods should be started three days before your period is due to be effective.
  • After stopping the medication you should experience a period bleed within 2 to 3 days, however this could be slightly longer.
  • This medication is not a form of contraception. You should continue to use other forms of contraception to avoid pregnancy.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.