Dryness of the vaginal canal

Kindly select from the list below some of the symptoms you may be experiencing
You can select more than one option

Vaginal dryness and discomfort

Flushes that are extremely hot

Sweats at night

Headaches

Mood swings

Problems with sleep

Palpitations

None of the preceding

Did you know that this product is only recommended for use by women especially since it is designed for vaginal insertion?

Yes

No

Are there any negative effects to Ovestin if you're already taking it?

Yes

No

Have you been using Ovestin for a long time?

Is Ovestin something you're taking right now?
If you answered yes, could you kindly inform us if your symptoms have improved?

Yes

No

Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

Yes

No

Can you relate to any of the following??
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.

Yes

No

If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option

Presently Pregnant

Presently Breastfeeding

Planning on getting pregnant

Neither Pregnant nor Breastfeeding

What is your biological gender?
Please select your option

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Did you know that pessaries is only recommended for use by women especially since it is designed for vaginal insertion?

Yes

No

Are you Soya, Lactose or Peanut intolerant?

Yes

No

Do you have a history of using any other HRT treatments before?
If you have, please tell us the HRT treatments you've tried and how long you've been using them.

Yes

No

Have you used Vagifem for a long time?

Are there any negative effects to Vagifem if you're already taking it?

Yes

No

Is Vagifem Vaginal Tablets something you're taking right now?
If you answered yes, could you kindly inform us if your symptoms have improved?

Yes

No

Do you have a family history of a member being diagnosed with cancer
Especially womb, breast, ovary, uterial or cervical cancer?

Yes

No

Do you experience the following?
Vaginal bleeding that is abnormal.
Gallstones problems
Diabetes condition
Migraines
Blood pressure that is too high.
A blood clotting disease, often known as a blot clot.
Porphyria
Breast issues

Yes

No

Can you relate to any of the following?
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Can you relate to any of the following?

Your hair loss started recently, and you've lost a lot of hair in less than four weeks.

Hair loss has occurred in irregular spots on your head.

Your scalp is itchy or inflamed.

You've lost your hair as a result of your pharmacological treatment.

You're completely bald or have lost all of your body hair.

Yes

No

Dryness of the vaginal canal

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