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HRT Review

Please only complete the following questionnaire if requested by your GP practice as part of your routine review.

This questionnaire is for a routine review of your HRT. If you are experiencing any of the following ring your GP immediately: - Painful swelling of your leg. - Weakness or numbness of an arm or leg. - Sudden problems with your speech or sight. - Difficulty breathing. - Coughing up blood. - Pains in your chest, especially if it hurts to breathe in. - Unexpected vaginal bleeding - Persistent irregular vaginal bleeding - Breast lump, persistent breast pain, or nipple changes. - Abdominal pain, discomfort or bloating - Weight loss that is not intended
2. Have you had a hysterectomy(Required)
3. Have you had a Mirena coil (intrauterine system, IUS) fitted?(Required)
11. Have you been experiencing side effect since you started HRT?(Required)
13. Have you considered reducing or stopping your HRT?(Required)
14. Have you experienced any persistent unexpected bleeding, or increased bleeding?(Required)
15. Do you regularly self-check your breasts?(Required)
16. If applicable, are you up to date with your mammograms?(Required)
17. Have you ever had any blood clots? (e.g. Deep Vein Thrombosis or Pulmonary Embolism)(Required)
18. Have you ever had a heart attack or stroke?(Required)
19. Have you ever had breast cancer or endometrial cancer?(Required)
20. Have you ever had liver or gallbladder disease?(Required)
21. Do you have a family history of any of the following? Please select any that apply(Required)
22. Are you using contraception(Required)

Please see the following links for further information on the HRT that you may find useful:

Menopause Matters - https://www.menopausematters.co.uk/

NHS - https://www.nhs.uk/conditions/menopause/

Menopause - https://patient.info/womens-health/menopause

HRT - https://patient.info/womens-health/menopause/hormone-replacement-therapy-hrt

Alternatives to HRT - https://patient.info/womens-health/menopause/alternatives-to-hrt

Please see the following links for further information about HRT & Breast Cancer that you may find useful:

MHRA HRT & Breast Cancer - https://assets.publishing.service.gov.uk/media/5d68d0e340f0b607c6dcb697/HRT-patient-sheet-3008.pdf

After completing all of the above questionnaire, please click submit below. Your GP practice will then inform you if your HRT repeat prescription is ready for collection or if a further assessment is required.
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