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HRT starter questionnaire

HRT Starter Questionnaire

Section

Have you noticed any bleeding between periods or after sex?
Have you had a hysterectomy?
Do you have a Mirena coil in place?
Are you currently using any contraception or do you require ongoing contraception? (contraception is recommended for all sexually active women under the age of 55 years unless periods have stopped for over a year off hormones)
Have you ever been told you have endometriosis?
Smoking status:
Do you have parents or siblings or children who have had heart disease or a stroke?
Do you have parents or siblings or children who have had a blood clot (sometimes called a deep vein thrombosis or pulmonary embolus)?
Have you ever had a blood clot?
Do you have any known blood clotting abnormalities?
Do you have a family history of breast cancer under the age of 50?
Do you have migraines?
Do you have a history of heart disease?
Do you have a history of liver disease?
Do you have a history of diabetes/pre-diabetes?
Do you have a past history of breast cancer?
Systolic “Top Number” / Diastolic “Lower Number” / Heart Rate
Are you up to date with your smear?