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Contraceptive pill review

Contraceptive Pill Review
Required fields are labelled
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you

All women on the pill should have a “pill check/ review” at least once a year. This form will allow a healthcare professional to re-issue your prescription for the pill if safe to without you having to come in for an appointment. If you wish to see the contraception nurse for a face to face review you can book this if you prefer. If we need to speak to you before issuing more tablets we will contact you (using the mobile number on your records).

Please request your contraceptive pill in the usual way. Please visit our Prescription and Medicines Centre for ways to request your pill.

Contraception Pill Review

Have you had any recent changes in your health that might affect your contraception? Required
Have you or any family members ever been diagnosed with a blood clot in the legs or the lungs? Required
Have you ever noticed a new or changing breast lump or been diagnosed with breast cancer? Required
Have you given birth within the last 6 weeks or currently breastfeeding? Required
Do you have epilepsy? Required
Do you suffer from severe headaches or migraines?
Are you experiencing any irregular bleeding?
Do you currently smoke? Required

My Blood Pressure

(only need for ‘combined pills’ with oestrogen and progesterone. (Not needed for progerstone only ‘mini pills’ i.e., desogestrel/cerazette/noriday)

If you do not have a blood pressure device, please book in for a blood pressure reading at the Practice.

Note: some pharmacies may be able to check your blood pressure for you also.

If your blood pressure is between 140- 160 on the top number OR between 90-100 on the bottom number – please book in for a pill review within the next 2 weeks.

If your blood pressure is between 160-179 on the top number OR between 100-110 on the bottom number – please book in for a GP review to take place within a week.

If your blood pressure is 180 or more on the bottom number or 110 or more on the bottom number – please call the practice for urgent assessment.

Calculate my BMI

eg. 1.75
eg. 60.6
Please note: BMI calculator is only for patients aged 18 and over.
Would you like to consider longer acting forms of contraception that may not need you to remember to take your pill every day? Required
Please be aware that some medication can reduce the effectiveness of ‘the pill’ (combined oral contraceptive pill) so if taking new medication, always check with the pharmacist or prescriber (this includes St John’s wort which you should avoid).

Please take a look at the links below for advice on what to do if you miss a combined oral contraceptive pill/ what to do if I have diarrhoea or vomiting/general advice on the pill

Should you have any questions, please contact the Practice.

Confirmation