Hormone Replacement Therapy (HRT)

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HRT

Hormone Replacement Therapy (HRT) 

This online form is for patients who are thinking of starting hormone replacement therapy (HRT)

You will need a current blood pressure reading.

  • We have a blood pressure station for patient use in the main reception area at Frome Medical Centre, if you do not have a home blood pressure machine.
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All questions marked with a * are mandatory

Personal Details
If you are changing your name, this would be the name we current have for you
Please double check you've entered the correct email address and you have used your current email address
May be used to identify you
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Health Questions
Do you have a history of deep vein thrombosis (DVT) or pulmonary embolus (PE)?: *
Is there a family history of deep vein thrombosis (DVT) or pulmonary embolus (PE)?: *
Do you have a history of breast cancer?: *
Is there a family history of breast cancer?: *
Do you have any other circulation issues such as previous heart attack, uncontrolled blood pressure or angina?: *
Do you have any metabolic problems with liver issues, diabetes, thyroid problems or bowel issues?: *
Have you ever smoked?: *
Do you smoke now?: *
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Blood Pressure

What is your current blood pressure (BP)?

  • We have a blood pressure station for patient use in our main reception at the practice if you do not have a home blood pressure machine. 
Top Reading
Bottom Reading

Understanding your blood pressure reading

Blood pressure is measured in millimetres of mercury (mmHg) and is given as two figures:

  • Systolic pressure (Top Reading) – the pressure when your heart pushes blood out
  • Diastolic pressure (Bottom Reading) – the pressure when your heart rests between beats

For example, if your blood pressure is "140 over 90" or 140/90mmHg, it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.

As a general guide

  • Normal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
  • High blood pressure is considered to be 140/90mmHg or higher
  • Low blood pressure is considered to be 90/60mmHg or lower

A blood pressure reading between 120/80mmHg and 140/90mmHg could mean you're at risk of developing high blood pressure if you don't take steps to keep your blood pressure under control.

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Additional Health Questions
Have you had a hysterectomy to remove your uterus?: *
Are you still having periods?: *

You need to keep using contraception for 12 months after your last menstrual period if you are aged over 50; or 24 months after your last period if you are aged under 50.

  • If you do not have periods due to your current contraception or HRT, then a blood test for FSH can help you and your doctor to know when it is safe to stop your contraception.
  • HRT is not a contraceptive, however a Mirena coil can be used as both contraception and endometrial protection in HRT. You can use contraception such as the Progesterone Only Pill alongside HRT if you need to.
  • In general, contraception can be stopped at the age of 55 as the chance of becoming pregnant naturally after this age is extremely low.
Do you have a Mirena coil fitted in the last 5 years and still in place?: *

Please note that the licence for use of the Mirena coil (levonorgestrel-releasing IUS) for the progestogen part of HRT is 4 years, but it is 5 years when used just for contraception.

  • However, the Faculty of Sexual and Reproductive Health support the use of Mirena coil for up to 5 years, but this is off-licence.
Do you have any vaginal bleeding between your periods or after intercourse?: *
Are you up to date with breast and cervical screening checks?: *
Is there anything that might increase your risk of osteoporosis (thinning of the bones)?: *
taking steroid tablets, overactive thyroid, underweight for a period of time, previous excess alcohol use, smoking or having smoked heavily for many years or a family history of hip fractures
Are you having menopausal symptoms?: *
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