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6) Period Delay

Norethisterone 5mg tablets can be used to delay menses. The medication should be commenced three days
prior to menstrual due date. Norethisterone 5mg should be taken three times per day orally for up to two weeks
until desired date. Menses usually occurs 2 to 3 days after stopping norethisterone, however this may be longer
in some cases.

The doctor should review the patient safety questionnaire and ensure the patient has no contraindication to
norethisterone.

Who shouldn’t be given norethisterone?
• Obesity BMI > 35kg/ m2

• Personal history of Venous Thromboembolism

• Strong family history of Venous Thromboembolism
• Immobile/wheelchair bound

• Carriers of thrombophilia

• Any other condition predisposing to Venous Thromboembolism

https://www.gpnotebook.co.uk/simplepage.cfm?ID=-294977482
https://patient.info/health/periods-and-period-problems/delaying-a-period

Once a doctor is satisfied the patient has no contraindication to norethisterone then a prescription for the above
duration can be issued.
If the doctor feels that another method for delaying menses may be more appropriate this should be brought to
the patient’s attention.

7) Weight management
The National Institute for Health and Care Excellence (NICE)1 recommends pharmacological treatment as an
option for the management of obesity for people who have not reached their target weight loss or have reached
a plateau following dietary, activity and behavioral changes, e.g. Orlistat therapy. Orlistat is a lipase inhibitor
which can also be used to maintain weight loss after achieving weight loss target, rather than to continue to lose
weight.
Prescribe Orlistat ONLY as part of a weight management plan (diet, activity and behavioural approaches) for
managing obesity in adults who are motivated to engage with a weight management plan and meet one of the
following criteria:
• BMI ≥28kg/m2 with comorbidities, e.g. type 2 diabetes, hypertension, sleep apnoea

• BMI ≥30kg/m2

Dose:
Orlistat (oral treatment) 120mg, TDS with meals.

The following Nutritional advice should be given to patients:

Recommend a low fat (30%) diet, e.g. 22g of fat per meal (based on a diet of 2000 calories and 3 meals per day)
• Take Orlistat with meals (immediately before, during or up to 1 hour after a meal)

• Distribute fat from the diet evenly over the 3 main meals

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