Progesterone Only Contraceptive (POP) Pill Review



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

Page {{ paginatorProps.current }} of {{ }} ({{ paginatorProps.percentage }}% completed)
Personal Details

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

Please double check you've entered the correct email address
May be used to identify you
Contraception Pill Review

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 ( PLEASE CONTINUE TO THE NEXT QUESTION

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

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.

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 (  PLEASE CONTINUE TO THE NEXT QUESTION.

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

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


Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.