HRT Review (Oestrogen only) HRT Review (Oestrogen only) High Blood Pressure readings Advise review of BP and consideration of different contraception. Blood Clot Advise review with clinician and stop HRT Stroke or Heart Attack Advise review with clinician and stop HRT Breast Cancer Advise review with clinician and stop HRT Age >60 Advise review with clinician and stop HRT Coil > 5 years old Patient requires coil change. Advise GP to review form and patient notes. HRT to Topical Oestrogen Patient wishes to stop HRT and start topical oestrogen. Advise GP to review form and patient notes. Please complete this form to help us review your HRT. To ensure you are at low risk of problems, we need you to provide your HEIGHT, WEIGHT and BLOOD PRESSURE (unless done recently in the practice). If you are unable to measure these at home please arrange to have these done at the practice. 0131 333 3215 Coil or Hysterectomy? This review is only for women with a coil in their Womb or women who have had a Hysterectomy (Womb removal). Which applies to you? * I have a coil I have had a Hysterectomy I have been sent the wrong review Our sincere apologies, we don’t always get it right! Please phone the practice and we will send you the correct review. Your coil should be changed every 5 years if used with HRT * No problem – My coil is less that 5 years old My coil is older than 5 years old and will require CHANGED Your Details Patient Name * Date of Birth * Age * Mobile number * Email (If you’d like a copy of your review) Risks of HRT HRT provides physical and psychological benefits during the menopause but also comes with risks: Blood clots Stroke Endometrial Cancer Breast Cancer Ovarian Cancer Starting and continuing HRT is a decision made by you and your GP based on your individual case but a simple rule of thumb is: < 50 years old - we would recommend you continue HRT 50 – 60 years old – we would advise you consider the risks vs benefits and stop HRT if your symptoms allow > 60 years old – the risks are usually greater than the benefits and we would recommend you stop HRT Please confirm that you have considered the benefits vs risks of HRT * Yes Please confirm that you have considered alternatives to HRT * Yes If your flushing and sweats have stopped, you may wish to switch to a vaginal estrogen which comes with none of the risks of normal HRT Please STOP my HRT and prescribe me a vaginal oestrogen to help with vaginal dryness and pain Blood Pressure and weight (within the past 12 months) High/Top Number * Low/Bottom Number * OR Recently done in the practice and it was normal Weight Weight Units * Metric (kg) Imperial (Stones) Weight (kg) * Stones * and Pounds Weight conversion (stones to kg) * kg Do you smoke? * YES No Smoking is the most common cause of high BP, heart attacks and stokes. We STRONGLY advise stopping. There are NHS smoking clinics in Edinburgh and West Lothian to help you stop. Have you ever had a blood clot? * YES – The practice will contact you No Have you had a stroke or heart attack? * YES – The practice will contact you No Have you ever had breast cancer? * YES- The practice will contact you No How would you like to proceed? * I would like to CONTINUE my HRT for the next year I would like to STOP my HRT I would like to DISCUSS with a clinician This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our privacy policy to discover how we protect and manage your submitted data. Consent * I agree to the privacy policy © 2022 Kristian Turnbull CAPTCHA Submit If you are human, leave this field blank.
