HRT Review

If you have been advised by the surgery to submit a HRT review, please use this form.

HRT Review

Section

Smoking status: *
Do you drink alcohol? *
Are you up to date with your cervical screening (smear)? *
Are you able to provide a recent blood pressure reading? *

Blood Pressure

Is your HRT controlling your symptoms well? *
Do you think you may need to discuss this with the doctor? *
Do you have any side effects from HRT that you wish to discuss? *
Do you suffer with vaginal or vulval dryness / itching or soreness? *
Do you have any concerns about vaginal bleeding? *
Do you need to consider contraception as well as HRT? *
Has anything changed in your own personal history or family history since your last review (e.g. blood clots, cancer, diabetes, thyroid or liver disease)? *
Are you happy to continue your current dose of HRT? *

The doctor may be able to update your review for the next 12 months. The doctor may contact you once we have received this information.