Am I Menopausal? Do I need HRT? 

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Please complete our short form below.

Once your form has been submitted, please allow upto 48 hours for the GP to review your answers. You will recieve a telephone call to discuss your options and treatment. 

If you do not have a blood pressure machine, please feel free to use our blood pressure machine next to the front desk at reception.  

Personal Details

Please indicate the extent to which you are bothered at the moment by any of these symptoms, with 1 = not at all, 2 = a little, 3 = Quite a bit, 4 = Extremely


(Contraception is recommended for all sexually active women under the age of 55 years unless your periods have stopped for over a year off hormones) 

Smoking Status

Types of HRT 

There are many different types of HRT and finding the right one for you, can be difficult

These are: 

HRT hormones – most women take a combination of the hormone’s oestrogen and progestogen, although women who do not have a womb can take oestrogen on its own

Ways of taking HRT – tablets, skin patches, gels and vaginal creams, pessaries or rings

Please note, you may not be suitable for certain types of HRT so answering the above and reading about HRT can be helpful prior to your doctors appointment 

Here are some useful links you may wish to have a look at:

Privacy Consent

This form collects personal and medical informanot tion about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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