Progesterone Only Contraceptive (POP) Pill Review

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This form is in the early stages of development; it is for annual review of the progesterone only pill (known as POP or mini pill).

Common brands include (Aizea, Cerazette, Cerelle, Desogestrel, Desomono, Desorex, Drosiprenone, Feanolla, Moonia, Norethisterone, Noriday, Primolut, Zelleta but there are many others. If you are not sure what type of pill you are taking please arrange your review with the practice nurse as usual.

Once you have completed and submitted the questionnaire, a practice nurse will review the information provided and either you will receive a prescription within 5 working days or contact from our reception staff to make an appointment to discuss this further with the practice nurse either by telephone or face to face

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Personal Details

If you have been advised by the surgery to submit a progesterone only contraceptive pill review please use this form.

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Contraception Pill Review

Have you missed any pills since your last review? (please remember the progesterone only pill is taken daily with no breaks): *

For various reasons people will sometimes miss medications. There is specific advice when it comes to the mini-pill on what to do and that advice varies between the types of pill you take. Please see the following link to understand what counts as a missed pill and what the advice is for the specific pill you have taken. If you havent followed this advice please do not complete this form and contact the practice to discuss what to do next. What should I do if I miss a pill (progestogen-only pill)? - NHS (www.nhs.uk). PLEASE CONTINUE TO THE NEXT QUESTION

Has there been any changes to your health since your last pill review?: *

Please make an appointment to see the practice nurse for review to make sure any changes to your health do not impact the contraceptive pill. PLEASE CONTINUE TO NEXT QUESTION

Have you been started on any new medication since your last pill review?: *

Sometimes new medication can affect the contraceptive pill. It is likely this will already have been considered but we will review your records and be in touch if we have any queries. PLEASE CONTINUE TO THE NEXT QUESTION.

Do you regularly check your breasts?: *

Please follow the link to learn about how to self examine and what to look for - if you notice any new findings or are concerned, please book an appointment through reception with one of the practice doctors). How should I check my breasts? - NHS (www.nhs.uk). PLEASE CONTINUE TO THE NEXT QUESTION.

Have you experienced a change in your bleeding pattern or had new irregular bleeding since your last pill review?: *

Please book an appointment to see the practice nurse but continue to complete questionnaire.

If you are aged 25-64 are you up to date with your smear tests: *

Please contact the surgery to arrange a smear test with the nurse if you are overdue but continue to complete the form.

Would you like to continue the progesterone only pill?: *

PLEASE COMPLETE THE FORM.

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Progesterone Only Contraceptive (POP) Pill Review

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