Reception: HRT review

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause.

The main benefit of HRT is that it can help relieve most of the menopausal symptoms, including: hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive.

Many of these symptoms pass after a few years, but they can be unpleasant and taking HRT can offer relief for many women.

Whilst the benefits of HRT often outweigh the risks, some types of HRT can increase your risk of breast cancer and blood clots. It is important to remain vigilant for signs of breast cancer & we encourage you to attend breast screening when invited

To ensure your medication is prescribed safely and you are aware of all this information we review your prescription every 12 months. 

If your review is now due please complete the following form and fill in as much information as possible. Some of this information will already be included in your medical records but this is a good opportunity to update any changes.

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 331401. We will start to process your form by the next working day but it will take up to 3 working days to complete. Please DO NOT call before 3 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.

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Details
Current HRT regime
Types of hormone

The following questions aim to give a brief overview of HRT to ensure you are taking the correct type.

HRT can contain one hormone (oestrogen) or two hormones (oestrogen and progesterone)

The oestrogen is the hormone that aims to help your symptoms.

Progesterone prevent the wombs lining from thickening. If this were allowed to happen your risk of endometrial (womb) cancer would increase. Progesterone aims to largely eliminate this risk.

If you have had a hysterectomy you do not need to take the progesterone hormone because your womb has been removed. A Mirena coil also provides the progesterone needed as long as it has been inserted within the last 4 years.

A total hysterectomy is where your uterus and cervix have been removed
Cyclical vs continuous HRT

Once we know whether you need one of two hormones we think about how these hormones are given.

Oestrogen needs to be given every day to help improve symptoms.

Progesterone can be given every day (continuously) or for 2 weeks out of a 4 week period (cyclically).

A Mirena coil releases progesterone daily and for most women reduces vaginal bleeding.

If you do not have a Mirena coil we tend to use progesterone daily if your periods have stopped for >1 year as this should result in less irregular bleeding.

If you are still having a regular cycle we use it for 2 weeks out of a 4 weeks period. During the 2 weeks break from the progesterone you should have a period.

If you are no longer having periods or you have a Mirena coil please indicate this here
This might include unusual bleeding in between regular periods, bleeding after sex or bleeding more than 12 months after your last period
Risks of HRT

There are different ways of taking HRT. These can include tablets, patches and oestrogen also comes as a gel.

All methods of HRT have some risk, although some are safer than others. For example transdermal preparations (where oestogen is absorbed through this skin from a patch or cream) reduces the risk of blood clots when compared to oestrogen tablets.

Whilst for many the benefits of HRT outweigh the risks it is important that you are aware of them. This section aims to ensure that we are prescribing the most suitable type of HRT.

Out of 1,000 women taking HRT between the ages of 50-59, there will be an extra 4 cases of breast cancer diagnosed every 5 years. If you use oestrogen only HRT there are 4 fewer cases diagnosed.
A recent study found that for every 1,000 women taking HRT for 5 years, there will be 1 extra case of ovarian cancer
It is thought that the risk of developing a blood clot is 2 to 4 times higher than normal for women taking HRT tablets. But as the risk of menopausal women developing blood clots is usually very low, the overall risk from taking HRT tablets is still small. It is estimated that for every 1,000 women taking HRT tablets for 7.5 years, fewer than 2 will develop a blood clot. Please note that there is no increased risk of blood clots when using HRT patches or gels
The evidence shows that HRT does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age. Oestrogen-only HRT is associated with no, or reduced, risk of heart disease. Combined HRT is associated with little or no increase in the risk of heart disease. Taking oestrogen tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small
Your blood pressure should be checked every 12 months whilst you are taking HRT. Please record it here. Blood pressure machines can be bought from pharmacies, online retailers and most supermarkets. If you are not able to check it yourself please arrange an appointment with one of our health care assistants.
Lifestyle

It is important to consider other lifestyle factors can increase your risk of breast cancer. Please complete the following questions:

If you drink more than 2 units of alcohol each day, out of 1,000 women aged 50-59 there will be an additional 5 cases of breast cancer diagnosed every 5 years.
If you are a current smoker, out of 1,000 women aged 50-59 there will be an additional 3 cases of breast cancer diagnosed every 5 years.
If you are overweight or obese (your BMI is equal or greater than 30) out of 1,000 women aged 50-59 there will be an additional 24 cases of breast cancer diagnosed every 5 years.
If you do at least 2.5 hours of moderate exercise each week, out of 1,000 women aged 50-59 there will be 7 FEWER cases of breast cancer diagnosed every 5 years.
Contraception

Menopause (when your periods stop permanently and you're no longer fertile) is usually diagnosed:

If you are over 50 and haven't had a period for more than 12 months

If you are under 50 and haven't had a period for more than two years

These rules do not apply if you're taking hormonal contraception.

Whilst a Mirena coil offers contraception other methods of HRT do not.
Are you happy with your HRT?

Thank you for completing all the information above.

If you would like to continue with your current method of HRT and it is safe to do so we will either issue the prescription or call you if we need any further details

If you would like to change to a different regime we will call you to discuss this further

Thank you for completing this form


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