Thinking of Starting HRT

 

Already on HRT, and need to complete a review? If so, please complete our HRT Review form here.

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HRT

Thinking of Starting HRT

What is HRT?

  • Hormone replacement therapy (HRT) is a treatment used to help menopause symptoms. It replaces the hormones oestrogen and progesterone, which fall to low levels as you approach the menopause.

Following your enquiry about HRT (hormone replacement therapy), please complete the following questionnaire and submit it ahead of your appointment.

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Personal Details
Please double check you've entered the correct email address
May be used to identify you
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HRT Assessment
Do you have a hormonal coil in place?: *
This is normally the Mirena coil.
Are you happy for us to add a note to your prescription for oestrogen flagging up the date that your coil change is due?: *
Do you need contraception?: *
HRT is not a contraceptive method. In general all women can stop contraception at the age of 55
Please ensure this is up to date
If you do not supply a recent reading, we will not be able to issue a prescription. We now have a blood pressure monitor in the surgery if you don't have access to a machine at home.
How many units of alcohol do you drink each week?: *
 
Do you smoke?: *
Do you have any new breast symptoms?: *
For example: a breast lump, skin changes or nipple discharge. Please note breast screening is offered to women every 3 years between the ages of 50-70
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Medical Background History
Have you had surgery to remove your womb (hysterectomy)?: *
Have you ever had breast cancer?: *
Have any of your parents or siblings been diagnosed with breast cancer?: *
Have you ever had any heart problems?: *
Have you ever had a stroke or mini stroke?: *
Have you ever had a blood clot?: *
For example a pulmonary embolism (PE) or a deep vein thrombosis (DVT)
Have any of your parents or siblings been diagnosed with a blood clot?: *
Please detail last period if there has been a long gap
Have you noticed any bleeding between periods or after sex?: *
Have you ever been told you have endometriosis?: *
Are you currently using any contraception or do you require ongoing contraception?: *

Contraception is recommended for all sexually active women under the age of 55 years unless periods have stopped for over a year off hormones.

Have any of your parents or siblings been diagnosed with heart disease or stroke?: *
Do you have migraines?: *
Do you have a history of liver disease?: *
Do you have a history of diabetes or prediabetes?: *
Are you up to date with your smear?: *
Do you have any medication or food allergies?: *
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Risks of HRT

To continue safely prescribing HRT, we need to ensure that you remain aware of the risks that may be present with HRT

Learn more about the risks and benefits

  • If you are unable to access this link or have any questions or concerns about the risks of HRT please contact the surgery to discuss further with a doctor

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