Prescriptions: Starting HRT

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause.

The main benefit of HRT is that it can help relieve most of the menopausal symptoms, including: hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive.

Many of these symptoms pass after a few years, but they can be unpleasant and taking HRT can offer relief for many women.

Whilst the benefits of HRT often outweigh the risks, some types of HRT can increase your risk of breast cancer and blood clots. It is important to remain vigilant for signs of breast cancer & we encourage you to attend breast screening when invited.

To ensure your medication is prescribed safely and you are aware of all this information we review your prescription every 12 months.

If you are thinking of starting HRT please complete the form below (leave the section on current HRT regime blank but please do complete the information following this).

Information page on HRT

HRT & Risk of Breast Cancer

Infographic on the risks of HRT (EXTERNAL PDF LINK)

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Details

Full Name

Date of Birth (DD/MM/YYYY):

Contact Number (Preferably Mobile)

New to HRT?

If you are not currently using HRT but are thinking of starting please record what symptoms you are experiencing here:If you have researched HRT and think you may have an idea as to what would suit you then please also record this here

Have you had any problems finding it in stock?

Are you happy with your current HRT?

Current HRT regime

If you are currently taking HRT please provide us some details of your current regime. Whilst this will be on your medical records it can be important to clarify exactly what type of HRT you are using

Types of hormone

The following questions aim to give a brief overview of HRT to ensure you are prescribed the correct type

HRT can contain one hormone (oestrogen) or two hormones (oestrogen and progesterone)

The oestrogen is the hormone that aims to help your symptoms.

Progesterone prevent the wombs lining from thickening. If this were allowed to happen your risk of endometrial (womb) cancer would increase. Progesterone aims to largely eliminate this risk.

If you have had a hysterectomy you do not need to take the progesterone hormone because your womb has been removed. A Mirena coil also provides the progesterone needed as long as it has been inserted within the last 4 years.

Have you had a total hysterectomy?A total hysterectomy is where your uterus and cervix have been removed

Do you have a Mirena coil?

If you have a Mirena coil and know its insertion date please enter this here:

Cyclical vs continuous HRT

Once we know whether you need one of two hormones we think about how these hormones are given.

Oestrogen needs to be given every day to help improve symptoms.

Progesterone can be given every day (continuously) or for 2 weeks out of a 4 week period (cyclically).

A Mirena coil releases progesterone daily and for most women reduces vaginal bleeding.

If you do not have a Mirena coil we tend to use progesterone daily if your periods have stopped for >1 year as this should result in less irregular bleeding.

If you are still having a regular cycle we use it for 2 weeks out of a 4 weeks period. During the 2 weeks break from the progesterone you should have a period.

Do you know when your last period was? Please select the closest date possible

If you are having periods are they still fairly regular? If not, please describe what your cycle is like:If you are no longer having periods or you have a Mirena coil please indicate this here

Have you noticed any unusual or unexpected bleeding? If yes, please give detailsThis might include unusual bleeding in between regular periods, bleeding after sex or bleeding more than 12 months after your last period

Is your smear test up to date?

Risks of HRT

There are different ways of taking HRT. These can include tablets, patches and oestrogen also comes as a gel.

All methods of HRT have some risk, although some are safer than others. For example transdermal preparations (where oestogen is absorbed through this skin from a patch or cream) reduces the risk of blood clots when compared to oestrogen tablets.

Whilst for many the benefits of HRT outweigh the risks it is important that you are aware of them. This section aims to ensure that we are prescribing the most suitable type of HRT.

Have you a history of breast cancer or does it run in your family?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.

Do you have a personal or family history of ovarian cancer?A recent study found that for every 1,000 women taking HRT for 5 years, there will be 1 extra case of ovarian cancer

Is there any personal or family history of blood clots?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

Have you had a heart attack or stroke or do you have a first degree relative (parents, siblings or children) who has had a heart attack or stroke?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 have a personal or family history of any of the above conditions please give more details here:

What is your blood pressure?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.

Lifestyle

It is important to consider other lifestyle factors can increase your risk of breast cancer. Please complete the following questions:

Do you drink alcohol - if yes, how many units do you drink each week?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.

Do you smoke?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.

Do you know your height and weight? Please record them here in either metric or imperial unitsIf 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.

Do you exercise regularly?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.

Contraception

Menopause (when your periods stop permanently and you're no longer fertile) is usually diagnosed:

If you are over 50 and haven't had a period for more than 12 months

If you are under 50 and haven't had a period for more than two years

These rules do not apply if you're taking hormonal contraception.

Would you like to discuss contraception?Whilst a Mirena coil offers contraception other methods of HRT do not.

If we are able to directly issue your prescription which chemist would you like to collect it from (name & postcode)?

Thank you for completing all the information above.

If you would like to continue with your current method of HRT and it is safe to do so we will either issue the prescription or contact you if we need any further details.

If currently taking HRT are you happy with the current regime or would you like to make changes?

Thank you for completing all the information on this form. We hope it was also useful to provide you with more information.

If you would like to discuss your symptoms and/or starting HRT would you like us to contact you via text or telephone call (or either)?

Would you like to continue your current HRT regime?If you would like to change to a different regime we will call you to discuss this further

If you would like to change to a different HRT regime do you know what type you would like to change to? And would you like us to contact you via text or telephone call (or either)?

And finally...

I confirm that:

The information provided is accurate to the best of my knowledge

I understand the risks associated with HRT

I understand HRT is not a form of contraception (with the exception of the Mirena coil as long as it is within date)

Thank you for completing this form

Thinking of starting HRT?

Have you ever had a mammogram? If so please let us know the date and the outcome

I confirm I am happy to accept the risks associated with using HRT.

If you have any issues on HRT during the first 1-6 months please complete this quick form: https://www.clmp.org.uk/Forms/02bc7d60-c90e-4621-bc63-157a1742403d

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