HRT Review

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We perform annual reviews for women taking HRT in order to ensure the medicine is still meeting your needs and that it is still safe to prescribe. This form is designed only for patients who have already been prescribed HRT for menopause symptoms and not experiencing any issues, are happy with it and would like to re-order it.

You’ll need a recent blood pressure reading to complete this form – you can use a home monitoring machine.

A clinician will review your form and – if safe to do so – will re-prescribe your HRT medication for 6 months with a further 6 months available on repeat prescription. You’ll need to complete this review form every time you’d like us to re-prescribe HRT.

If after reviewing your form we need to have a further discussion with you before re-prescribing your HRT, we will contact you to book an appointment. If we don’t need anything further, we will send your prescription to your nominated pharmacy within one week

If you are having any problems with your HRT, would like to switch to a different type of HRT or have any questions please do not use this form and contact the surgery to arrange an appointment

In order to provide you with another prescription of your HRT we need to ask you a number of questions.

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Personal Details
Please double check you've entered the correct email address
Are you currently prescribed Mounjaro ( Tirzepatide ) or Wegovy (Semaglutide) privately for weight loss?: *
May be used to identify you
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HRT Review
For example tablets, patch or gel.
Do you have a hormonal coil in place?: *
This is normally the Mirena coil.
Do you have periods or bleeding with your HRT?: *
Is this: *
Has your bleeding changed?: *
Does your HRT help your perimenopausal/menopausal symptoms?: *
Please ensure this is up to date
Blood Pressure

If you do not supply a recent reading, we will not be able to issue a prescription. If you are not able to find a way of measuring your blood pressure in the community, please contact the surgery and arrange an appointment with one of our HCA’s.

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
Do you regularly check your breasts?:
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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?: *
Do you suffer from migraines?: *
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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
Do you feel that for you the benefits of taking HRT outweigh the risks?: *

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Contact

Strathesk Medical Practice
Bonnyrigg Health Centre
109/111 High Street
Bonnyrigg
Midlothian
EH19 2ET

Telephone: 0131 322 9333

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