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Contraceptive pill review

Contraceptive pill review

Form summary

Contraceptive pill questions

Have you ever been diagnosed with breast cancer?
Are you known to have a variant BRCA gene?
Do you regularly check your breasts?
Have you ever been diagnosed with ovarian cancer?
Have you ever been diagnosed with a blood clot in the leg or lung?
Have you ever had a heart attack or stroke?
Do you have a family history of breast cancer under the age of 50?
Do you have a family history of ovarian cancer?
Do you have a family history of blood clots in the leg or lung under the age of 55?
Do you have a family history of heart attack or stroke under the age of 45?
Do you have normal periods? *
A normal period is a regular cycle with no heavy bleeding or bleeding between periods
Do you have any of the following in relation to your periods?
Select all options that are relevant to you
Have you suffered from headaches in the past 3 months?
Have you suffered from migraines in the past 3 months?
Do you have an aura with your migraines?
An aura is warning signs you’re about to have a migraine, such as problems with your sight, numbness or pins and needles
Are you concerned about a sexually transmitted infection?
The pill does not protect against sexually transmitted infections such as chlamydia and gonorrhoea
Are you up to date with your cervical screening (smear test)?
You should be invited every 3 years between the ages of 25 and 49, every 5 years from age 50 to 64 and then over 65 if one of your last 3 smear tests was abnormal
Do you have any side effects with your medication?
Do you have any concerns or issues with taking your medication? *
Would you be interested in a long-acting reversible contraception?
For example, coil, implant or the depo injection

Height and weight

For example, 1.75
For example, 60.6

Blood pressure reading

Are you able to provide a blood pressure reading?

When you’re taking your blood pressure at home there are things you can do to help get an accurate reading.

Try to:

  • sit on an upright chair with a back
  • place your feet flat on the floor
  • rest your arm on a table and relax your hand and arm
  • wear something with short sleeves so the cuff does not go over clothes
  • relax, breathe normally and do not talk during the test
  • take another reading a few minutes after your first reading to check it’s accurate

Watch how to measure your blood pressure at home (opens in new tab)

For example, 31/03/1980
mmHg
mmHg
/min

Smoking status

What is your smoking status? *

Smoker

What type of tobacco or other product do you use mostly? *
How many cigarettes do you smoke on an average day? *
How many cigars do you smoke on an average day? *

When you quit smoking, good things start to happen. You can begin to see almost immediate improvements to your health.

It’s never too late to quit and it’s easier to stop smoking with the right support.

Get help with NHS Quit Smoking (opens in new tab)

Would you like to give up smoking? *

Ex-smoker

What type of tobacco or other product did you use mostly? *
How many cigarettes did you smoke on an average day? *
How many cigars did you smoke on an average day? *
Terms and conditions