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The Wycliffe Medical Practice
The Wycliffe Medical Practice Lutterworth Medical Centre Gilmorton Road Lutterworth LE17 4EB
Tel: 01455 553 531
Fax: 01455 550 083
Out of Hours: 111
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Contraceptive Review Form

Contraceptive Review Form

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    Do you think you are getting any side effects from the pill?
    If you are taking the combined (21 day) pill, is your bleeding regular?
    If you are taking the progesterone only (mini-pill) is your bleeding acceptable?
    Are you breast feeding?
    Are you immobile (i.e. in a wheelchair)?
    Do you suffer from migraines?
    If yes, do your migraines provoke loss of vision, numbness, weakness or speech problems?
    Do you have breast lumps?
    Have you ever had breast cancer?
    Are you diabetic?
    Do you have gallstones?
    Do you take drugs for epilepsy or tuberculosis (TB)?
    Do you take St Johns Wort?
    Have you ever had a blood clot in your leg or lung?
    Has a close relative ever had a blood clot in the leg or lung?
    If yes, have you discussed this with your Doctor?
    Do you suffer from any form of heart disease?
    Have you ever had a stroke or mini stroke (TIA)?
    Have you had hepatitis A, B or C since your last review?
  • Smoking

  • Please note - we advise all smokers that they should stop smoking. Smoking does increase the risks of circulatory problems, particularly in women on the pill. If you would like help to stop smoking please pick up one of our ‘stop smoking’ packs in the Health Information room, or ask at Reception for one.

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