Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • significant or uncontrolled uterine and or vaginal bleeding
  • symptomatic severe anaemia secondary to uterine and or vaginal bleeding

Please contact the gynaecology on-call registrar to discuss your concerns prior to referral

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Exclusions

  • heavy menstrual bleeding without trial of first-line treatment
  • concerns of ‘childhood non-accidental injury’ – refer to Child Protection Services for further information

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • heavy bleeding with a haemoglobin of less than 100g/l

Category 2 (appointment clinically indicated within 90 days)

  • heavy bleeding with confirmed iron deficiency (ferritin less than 30ng/mL)

Category 3 (appointment clinically indicated within 365 days)

  • bleeding impacting on activities/quality of life
  • heavy bleeding uncontrolled with first-line treatment

All referrals for people less than 16 years of age, or those less than 18 years with intellectual disabilities, complex medical conditions, primary amenorrhea, pubertal delay, or Mullerian anomalies are to be sent to Women’s and Children’s Hospital (WCH).

Central Adelaide Local Health Network only accept referrals for people greater than 18 years of age.

Due to limitations in infrastructure and resources, WCHN Hospital cannot accommodate referrals for individuals with a body mass index (BMI) equal to or greater than 45, as well as individuals over the age of 69 years of age.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical/psychosocial history
  • history of bleeding tendency including family history
  • sexual history and contraception
  • current medications and allergies
  • human papillomavirus (HPV) vaccination history
  • menstrual history:
    • cycle, day/months
    • days of bleeding
    • blood loss e.g. change of pads or tampons per day/hours
    • previously trialled treatments
  • quality of life concerns including
    • missed work/school/extracurricular activities as a result
  • height/weight
  • BMI
  • blood pressure trends
  • abdominal examination findings
  • pelvic examination if sexually active

Pathology

  • complete blood examination (CBE)
  • human chorionic gonadotropin (ßhCG)
  • thyroid stimulating hormone (TSH)
  • iron studies
  • sexually active people, complete a sexually transmitted infection (STI) screen, including:
    • human immunodeficiency virus (HIV) and syphilis serology
    • chlamydia and gonorrhoea which requires endocervical swab or urine sample for polymerase chain reaction (PCR)

Irregular periods — less than 21 or greater than 35 days

Pathology to be completed prior to commencing hormonal medications:

  • day 2 to 6 bloods
    • follicle stimulating hormone (FSH)
    • luteinizing hormone (LH)
    • oestradiol
  • prolactin
  • testosterone
  • free androgen index (FAI)
  • sex hormone binding globulin (SHBG)
  • pelvic ultrasound

Tendency to bleed or bruise easily

To be completed when not actively bleeding:

  • coagulation screen
  • factor 8 screening
  • Von Willebrands syndrome
  • platelet function assay

Clinical management advice

Heavy menstrual bleeding is defined as unusually heavy or prolonged bleeding over several consecutive menstrual cycles in women of reproductive age.Irregular menstrual bleeding refers to menstrual cycles that are shorter than 21 days or longer than 35 days. The first-line treatment for uncomplicated heavy menstrual bleeding in women under 35 years involves the use of the oral contraceptive pill, or Mirena intra-uterine device, or tranexamic acid during menses. These options should be initiated/trialled before seeking input from specialist outpatient services. Consider referral to general practitioner with special interest - refer to the Royal Children's Hospital Melbourne Clinical Guidelines.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.