Check The Symptoms You Are Experiencing.

random sudden flush of heat lasting a few minutes

sometimes i get sweaty at night

irritability, mood swings, anxiety, or feeling down

poor sleep

vaginal dryness, irritation, or discomfort during sex

increased frequency of urination, pain during urination, or urinary infections

reduced sexual desire or changes in sexual response

persistent tiredness, low energy, or fatigue

trouble remembering, concentrating, or brain fog

weight gain around the abdomen or trouble losing weight

stiffness, aches, or discomfort in joints or muscles

breast tenderness

thinning hair, hair loss, increased facial hair or dry less elastic skin

heart palpitations

I Am Currently Not Pregnant And Agree To Use Contraception While On Hormone Replacement Therapy Until After Menopause.

True

False

It Has Been Less Than 10 Years Since My Last Menstrual Period.

true

false

I Agree To Getting PAP Smear At Least Every 3 Years Until At Least The Age Of 65 .

true

false

Check Any Of The Following That You Have or Have Had.

breast, uterine, ovarian or estrogen-dependent cancer (you or a family member)

BRCA1 or Brca2 mutation (you or a family member)

Cowden syndrome or Lynch syndrome (hereditary nonpolyposis colorectal cancer)

Endometrial Hyperplasia

undiagnosed abnormal uterine bleeding such as heavy menses or any bleeding after 12 months of no menses

Liver or gallbladder disease

blood clot(s) or condition(s) that increase your risk of blood clots for example Factor V Leiden, PROTEIN C DEFICIENCY or systemic lupus erythematosus (SLE or lupus)

heart attack, stroke, or transient ischemic attack (TIA)

migraine with aura (visual, sensory, speech, or motor changes that precede or accompany the headache)

Porphyria Cutanea tarda

Have You Had A Hysterectomy (Uterus Removed)?

Yes

No

Name *

First Name

Last Name

I read and agree with thrively's Terms and Privacy statements. I also reviewed the Risks/Benefits page and wish to proceed with hormone replacement. I agree to be physically in Texas at the time of my telehealth consultation. *

yes