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Hormone Replacement Therapy (HRT) review

HRT Review

If you are not currently prescribed HRT, please arrange a telephone consultation with a clinician (opens in same tab and ends the form) and do not continue with this form.

If you’ve indicated that you’re filling out this form for another person, please complete the rest of the form using the patient’s details and perspective.

Height and Weight

Only answer this question if you know your height. Please do not guess. If you are unsure, this can be checked at many pharmacies for free.
Only answer this question if you have weighed yourself. Please do not guess. If you are unsure, this can be checked at many pharmacies for free.

Blood Pressure

Please can you provide a recent blood pressure reading (optional)

Only answer this question if you have a recent blood pressure reading within the last 3 months. Please do not guess. If you are unsure, this can be checked at many pharmacies for free.

Smoking Status

Do you smoke? *
Would you like help to quit smoking? *

However long you have smoked and whatever your circumstances, Smokefree Norfolk can provide support. Please go to Smokefree Norfolk or call 0800 0854 113 to refer yourself directly.

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcoholAmount of different types of drink representing more than one unit of alcohol
How often do you have a drink containing alcohol? *
How many units of alcohol do you drink on a typical day when you are drinking? *
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? *

Medical History

Do you have or a does a family member have a history of breast, endometrial or ovarian cancer? *
Do you have or a does a family member have a history of blood clots, clotting disorders or hereditary thromboembolic disorders including deep vein thrombosis, pulmonary embolism, or severe varicose veins? *
Do you have a history of stroke? *
Do you suffer with migraines?
Have you had a hysterectomy? *
Do you have the Mirena coil fitted? *
For example, 12/4/2025

About Your HRT

Which oestrogen HRT are you currently using?
Which brand of HRT patches are you using?
Which brand of oestrogen-only HRT tablets are you using?
Which brand of sequential HRT tablets are you using?
Which brand of combined HRT tablets are you using?
Which brand of HRT gel or spray are you using?
Which strength Evorel patches are you using?
Which strength Femseven patches are you using?
Which strength Estradot patches are you using?
Which strength Estraderm MX patches are you using?
Which strength Progynova TS patches are you using?
Which strength Elleste Solo tablets are you using?
Which strength Progynova tablets are you using?
Which strength Zumenon tablets are you using?
Which strength Premarin tablets are you using?
Which strength Femoston tablets are you using?
Which strength Elleste Duet tablets are you using?
Which strength Femoston Conti tablets are you using?
Which strength Indivina tablets are you using?
Which strength Oestrogel are you using?
Which strength Sandrena are you using?
Which strength Lenzetto spray are you using?
How often do you apply your HRT patch?

Note: Patches should be applied to clean, dry, cool, hair-free skin below the waist, such as the thigh or buttock. Do not put the patch near the breast area.

You should wait at least 1 hour after putting on the patch before washing or performing any activity that can cause sweating. Your patch should stay on whilst bathing or showering but if it does fall off, replace it with a new patch.

Note: Evorel Sequi must be applied in the correct sequence. Please read the below information carefully and speak to your community pharmacy or the GP surgery if you have any questions.

Boxes of Evorel Sequi patches contain 4x Evorel 50 patches and 4x Evorel Conti patches.

You should apply one Evorel 50 patch twice a week for the first two weeks until all 4 patches are used. 3-4 days after applying the last Evorel 50 patch of the box, you should apply an Evorel Conti patch and continue to apply these twice weekly in the same fashion until they are all used. You will then switch to a new box an repeat the same process, starting with the Evorel 50 patches.

Confirmation

Patches should be applied to clean, dry, cool, hair-free skin below the waist, such as the thigh or buttock. Do not put the patch near the breast area.

You should wait at least 1 hour after putting on the patch before washing or performing any activity that can cause sweating. Your patch should stay on whilst bathing or showering but if it does fall off, replace it with a new patch.

How often do you take your oestrogen HRT tablet?

Note: Femoston 1/10 tablets must be taken in the correct sequence. Please read the below information carefully and speak to your community pharmacy or the GP surgery if you have any questions.

Boxes of Femoston 1/10 contain white tablets (oestrogen only) and grey tablets (oestrogen with progesterone).

You should take the white tablets for the first 14 days and then switch to take the grey tablets for the remaining 14 days without any break in-between. After this, a new 28-day cycle starting with the white tablets should start, without any break.

Confirmation

Note: Femoston 2/10 tablets must be taken in the correct sequence. Please read the below information carefully and speak to your community pharmacy or the GP surgery if you have any questions.

Boxes of Femoston 2/10 contain brick red tablets (oestrogen only) and yellow tablets (oestrogen with progesterone).

You should take the brick red tablets for the first 14 days and then switch to take the yellow tablets for the remaining 14 days without any break in-between. After this, a new 28-day cycle starting with the white tablets should start, without any break.

Confirmation

Note: Elleste Duet 1mg tablets must be taken in the correct sequence. Please read the below information carefully and speak to your community pharmacy or the GP surgery if you have any questions.

Boxes of Elleste Duet 1mg contain white tablets marked with “01” on one side (oestrogen only) and green tablets marked with “P1” on one side (oestrogen with progesterone).

You should take the white “01” tablets for the first 16 days and then switch to take the green “P1” tablets for the remaining 12 days without any break in-between. After this, a new 28-day cycle starting with the white “01” tablets should start, without any break.

Confirmation

Note: Elleste Duet 2mg tablets must be taken in the correct sequence. Please read the below information carefully and speak to your community pharmacy or the GP surgery if you have any questions.

Boxes of Elleste Duet 2mg contain orange tablets marked with “02” on one side (oestrogen only) and grey tablets marked with “P2” on one side (oestrogen with progesterone).

You should take the orange “02” tablets for the first 16 days and then switch to take the grey “P2” tablets for the remaining 12 days without any break in-between. After this, a new 28-day cycle starting with the orange “02” tablets should start, without any break.

Confirmation

Note: Novofem tablets must be taken in the correct sequence. Please read the below information carefully and speak to your community pharmacy or the GP surgery if you have any questions.

Boxes of Novofem contain red tablets (oestrogen only) and white tablets (oestrogen with progesterone).

You should take the red tablets for the first 16 days and then switch to take the white tablets for the remaining 12 days without any break in-between. After this, a new 28-day cycle starting with the red tablets should start, without any break.

Confirmation
How often do you take your oestrogen HRT tablet?
How many pumps of Oestrogel do you use?
How many sachets of Sandrena do you use?
How many sprays of Lenzetto do you use?
For example, do you use it every day or do you take it for 21 days with a 7 day break? If you use patches, how often do you change these?
Do you use a separate progesterone?
Do you use testosterone?
HRT does not act as contraception so does not protect you against pregnancy. Would you like further information on contraception?

About Your Symptoms

Do you have any vaginal bleeding? *
Please mark yes even if this is very infrequent or is spotting type or non-heavy bleeding.
How would you describe your bleeding?

Note: Vaginal bleeding whilst on HRT, especially if it’s persistent, heavy or occurs after 3 months of starting or changing HRT should be reported to the surgery

Do you bleed after having sex?
Do you experience any of the following?
Are you experiencing any potential side effects from your HRT?
Are these side effects tolerable for you?

Extra important information

If you need to have an operation or have a period of prolonged immobilisation (e.g leg in a cast) then you may need to change or stop your HRT. If this applies to you whilst taking HRT, please let the surgery know.

Operation or have a period of prolonged immobilisation confirmation

Unscheduled vaginal bleeding can be common within the first 3 months of starting or changing HRT treatment. If this continues after 3 months it rarely could be a sign of endometrial cancer. Please ensure any bleeding experienced after this 3 month period is reported promptly to the surgery for further investigation. This includes spotting, light, irregular, heavy or regular bleeding.

Vaginal bleeding after a hysterectomy (after the initial healing phase) is unusual and rarely could be a sign of vaginal cancer. Please ensure any bleeding experienced is reported promptly to the surgery for further investigation. This includes spotting, light, irregular, heavy or regular bleeding.

Vaginal bleeding confirmation

Some HRT schedules are associated with a small increased risk of breast cancer. Generally, the risk increases the longer you are on HRT. Because of this it is important to check your breasts regularly of any abnormal lumps or bumps and to keep up to date with any breast screening (mammogram) appointments.

Information on how to check your breasts can be found here: Touch Look Check | Breast Cancer Now

Female patients will be invited for NHS breast screening every 3 years between the ages of 50 and 71. More information on breast screening can be found here: When you’ll be invited for breast screening and who should go – NHS

Breast cancer confirmation

Some HRT schedules are associated with a small increased risk of blood clots. The risk is greater with oral forms of HRT. Because of this it is important to understand and be able to identify the symptoms of a blood clot.

Symptoms of a blood clot in the lungs:

  • Sudden, severe chest pain
  • Sudden shortness of breath
  • Coughing up blood

Symptoms of a blood clot in the brain (stroke):

  • Unusually severe or long headache
  • Sudden problems with your sight
  • You find it difficult to speak
  • You collapse or faint
  • Any part of your body feels weak or numb

Symptoms of a deep-vein thrombosis (DVT):

  • Severe pain, tenderness or swelling of the calf, ankle or foot
  • Purple discolouration of the skin of the leg
  • Skin of the leg becomes red or hot to touch

If you get any of these symptoms, you should stop taking HRT and seek urgent medical attention.

Blood cot confirmation

Lifestyle measures should be used alongside HRT to help reduce menopausal symptoms. Please see the table below on how to reduce common symptoms:

Symptom Lifestyle change
Hot flushes and night sweats Regular exercise, weight loss (if applicable), wearing light clothing, keeping rooms cool, reducing stress, avoiding spicy food, avoiding caffeine, avoiding alcohol, stopping smoking
Sleep disturbances Maintaining good sleep hygiene and regular bedtime routine
Low mood and anxiety Getting enough sleep, regular physical activity, relaxation exercises and mindfulness
Cognitive symptoms (e.g. “brain fog”) Regular physical activity and good sleep hygiene
Lifestyle measures confirmation
Please indicate the outcome you would prefer from this review: