Contraceptive Pill Review

Contraceptive Pill Review

Section

Please fill in the form below if you are due a review of the contraceptive pill you are taking.

When you are taking the oral contraceptive pill, you need to have a review (including blood pressure and weight) at least every 12 months. You may be due a review sooner if you have recently started or changed your contraceptive pill.

Blood Pressure

If you have a home BP machine, please submit a Blood pressure reading.

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Smoking

Do you currently smoke? *

Do not currently smoke section

Have you smoked in the past?
How many cigarettes did you smoke in a day?

Do currently smoke section

How many cigarettes do you smoke in a day?
Would you like to give up smoking?

Please ask at reception for more information about giving up smoking.

Medication

Have you started any new medication since we last issued you a prescription for the pill? *
Do you take any vitamin, herbal or buy other over the counter medication regularly?

Please book an appointment with your GP or with the Clinical Pharmacist to discuss any new prescribed medicines or any vitamins/herbal or over the counter medicines you may be taking.

Contraception Pill Review

In Metres
In KG
Do you regularly check your breasts?

Please ask reception for our information regarding the importance of regular breast self-examination.

Have you ever had breast cancer? *
Have any of your immediate family ever had breast cancer? *
Have you ever had a blood clot? *
Have any of your immediate family ever had a blood clot? *

Please book an appointment to see your GP.

Do you suffer from severe headaches or migraines?

Please make an appointment to see your doctor to discuss your headaches if you have not already done so.

Are you experiencing any irregular bleeding?
Have you ever experienced any bleeding after sex? *

Please book an appointment to see the practice nurse

Have you been diagnosed with any new health conditions since we last issued you a prescription? *

Please read the following symptoms carefully:

  • A sudden sharp pain in your chest, breathlessness or coughing up blood
  • Painful swelling in your legs
  • Weakness, numbness or bad "pins and needles" in an arm or leg
  • Unusual headaches or migraines that are worse than usual
  • Sudden problems with your speech or eyesight
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If you develop any new conditions, tell your clinician so that they can check its safe for you to take the pill.

If you go into hospital for an operation or have an accident which affects the movement of your legs or mobility, tell the doctor you are taking the combined pill. You may need to stop taking the pill or need other treatment to reduce the risk of developing thrombosis (blood clots). There are other contraceptive methods you can use instead.

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Information about what to do if you miss a pill can be found by visiting Contraception - Sexwise or in the box leaflet of your contraceptive pill you are taking.

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If you would like to read more about this and other contraceptive options, please visit the following websites or contact the practice to make an appointment:

If at any time you have concerns about your medication then please book a Pharmacist, Nurse or GP appointment.

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