This form is ONLY for those completing their 3 month review (+/- a few months)
This may include medications bought over the internet, those that have been stopped or dose changed by anyone apart from ourselves
Please note that if your mental health is currently significantly impact and you are concerned for your well-being you must contact the crisis team on 0300 200 0011 and select option 1 or 999.
If you are struggling with your mental health please contact the practice or if out of hours or in an emergency call the CRISIS team: 0300 200 0011 and select option 1.
If you would like to change to a different regime we will call you to discuss this further
Please note those aged 25 to 49 should have a smear test every 3 years. For those aged 50 to 64 it is every 5 years. While those over 65 will only need one if 1 of your last 3 tests was abnormal.
If you are no longer having periods please indicate this here. You may notice some vaginal bleeding in the first 3 months of starting or changing HRT, but if you experience any bleeding after 3 months then you should see your healthcare professional straight away.
If no type 'NO'. Otherwise, please give us details.
Whilst a Mirena coil offers contraception other methods of HRT do not.
A total hysterectomy is where your uterus and cervix have been removed
You may notice some vaginal bleeding in the first 3 months of starting or changing HRT, but if you experience any bleeding after 3 months, or heavy/unusual bleeding then you should see your healthcare professional straight away.
A recent study found that for every 1,000 women taking HRT for 5 years, there will be 1 extra case of ovarian cancer
It is thought that the risk of developing a blood clot is 2 to 4 times higher than normal for women taking HRT tablets. But as the risk of menopausal women developing blood clots is usually very low, the overall risk from taking HRT tablets is still small. It is estimated that for every 1,000 women taking HRT tablets for 7.5 years, fewer than 2 will develop a blood clot. Please note that there is no increased risk of blood clots when using HRT patches or gels
Out of 1,000 women taking HRT between the ages of 50-59, there will be an extra 4 cases of breast cancer diagnosed every 5 years. If you use oestrogen only HRT there are 4 fewer cases diagnosed.
The evidence shows that HRT does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age. Oestrogen-only HRT is associated with no, or reduced, risk of heart disease. Combined HRT is associated with little or no increase in the risk of heart disease. Taking oestrogen tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small
If you do at least 2.5 hours of moderate exercise each week, out of 1,000 women aged 50-59 there will be 7 FEWER cases of breast cancer diagnosed every 5 years.
If you are a current smoker, out of 1,000 women aged 50-59 there will be an additional 3 cases of breast cancer diagnosed every 5 years.
If you drink more than 2 units of alcohol each day, out of 1,000 women aged 50-59 there will be an additional 5 cases of breast cancer diagnosed every 5 years.
If you are overweight or obese (your BMI is equal or greater than 30) out of 1,000 women aged 50-59 there will be an additional 24 cases of breast cancer diagnosed every 5 years.
Your blood pressure should be checked every 12 months whilst you are taking HRT. Please record it here. Blood pressure machines can be bought from pharmacies, online retailers and most supermarkets. If you are not able to check it yourself please arrange an appointment with one of our health care assistants.
If so please let us know the date and the outcome
To view the risks associated with HRT please use the links at the top of this form.