Contraceptive Pill Review

Your Practice Name Here Logo


Which kind of pill do you take?

Your Details:
DOB:
These questions relate to your general health.
How many Standard Drinks of alcohol do you have on average each week?
How much / what do you smoke each day (if anything)?
How would you like to enter your height and weight?
Your BMI is one indicator of a healthy weight.

Your BMI: Please provide your height and weight

These questions relate to taking the pill.
Do you take a desogestrel type or standard type progesterone?
Please provide a blood pressure reading if known (see "information")
/
Please provide the name of the oral contraceptive pill you take (if known).
Has there been any significant change in your health since your last pill check?
Do you rely on your pill for contraception (instead of cycle control)?
Do you have a family history of deep vein thrombosis (DVT)?
Have you suffered from high blood pressure during pregnancy?
Are you thinking of changing or stopping your pill within the next year?
It is possible to take your pill each day without a break. How long do you take your pill before taking a break?
Have you received you pill from somewhere other than the practice, such as sexual health services?
This section relates to things that can prevent the pill working.
Missing pills can stop the pill from preventing pregnancy. Please click the button below to find out what to do when a pill is missed.
Please select which type of progesterone pill you use in order to allow information on dealing with missed pills to be shown.
Vomiting and diarrhoea can stop the pill from preventing pregnancy. Please click the button below to find out what to do in this situation.
Please select which type of progesterone pill you use in order to allow information on dealing with diarrhoea or vomiting to be shown.
There are long lasting alternatives to the pill such that tummy upsets or missed pills are not an issue. Please click the button below to learn more.
Would you like to consider long-acting reversible contraception, such as the coil, implant or injection, as an alternative to the pill?
Are you happy for a clinician to see your responses and complete your review without further discussion (if appropriate)?

Questions, concerns or additional comments: