Hormone Replacement Therapy Review

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

Please select the practice location most relevant to this Online Form submission:

Further Questions

I have the following questions that I would like to raise about HRT with my Nurse or Doctor:

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/

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

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

Patient.info 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

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Riverside Surgery • Le Molay-Littry Way, Bovey Tracey, Devon, TQ13 9QP.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.