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.

  • acute/severe pelvic pain
  • significant or uncontrolled vaginal bleeding
  • severe infection

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

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • genital tract malignancy – please refer to gynaecology oncology
  • uncomplicated intermenstrual bleeding (IMB) have not trialled first-line treatment

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • focal endometrial lesion
  • heavy bleeding with a haemoglobin of less than 85mmol/L
  • post-menopausal women with endometrial thickness greater than 4mm
  • post-menopausal woman with cervical polyps
  • suspicion of malignancy
  • women who are over 45 years old, weigh more than 90kg, with an irregular endometrium, or endometrial thickness of greater than 12mm during the follicular phase (days 5 to 10) confirmed by transvaginal (TVS) ultrasound (US)
  • uterine fibroid leading to:
    • urinary obstruction or
    • renal impairment e.g. hydronephrosis, history of urinary retention or
    • cervical prolapse

Category 2 (appointment clinically indicated within 90 days)

  • anaemia of greater than 85mmol/l resulting from heavy menstrual bleeding
  • irregular endometrium, or endometrial thickness of greater than 12mm during the follicular phase confirmed by TVS US
  • persistent and/or unexplained IMB
  • post-menopausal women with endometrial thickness less than 4mm

Category 3 (appointment clinically indicated within 365 days)

  • fibroids leading to infertility
  • IMB uncontrolled with first-line treatment
  • irregular periods with normal US

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, the WCH 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/obstetric/psychosocial history
  • current medications and allergies
  • history of presenting complaint
  • 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
  • abdominal examination findings
  • pelvic examination if sexually active
  • height/weight
  • BMI
  • blood pressure (BP)
  • trans-vaginal/pelvic ultrasound (US) performed in the early follicular phase (days 5 to 10)

Pathology

  • complete blood examination (CBE)
  • iron studies
  • human chorionic gonadotropin (ßhCG)/(urinary ßhCG)
  • an up-to-date cervical screening test as per the cervical screening guidelines

Sexually active people

Please complete a sexually transmitted infection screen, including:

  • human immunodeficiency virus and syphilis serology
  • chlamydia and gonorrhoea which requires:
    • endocervical swab for culture and
    • endocervical polymerase chain reaction swab or urine sample

Heavy menstrual bleeding

  • pathology, coagulation screen if presenting before first pregnancy

Irregular periods (less than 21 or greater than 35 day)

Pathology to be completed prior to commencing hormonal medication/s or, after first period if stopping hormonal medications.

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

Post-menopausal

  • complete blood examination (CBE)

Additional information to assist triage categorisation

Other relevant radiology including location of company and accession number.

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.

Fibroids smaller than 3cm should be regarded as ‘normal’ as long as there is no evidence of growth or protrusion into the endometrial cavity (submucosal).

Concerning features may include:

  • suggestion of endometrial abnormality on ultrasound
  • anaemia
  • exposure to oestrogen without progestogens
  • women who are over 45 years old, weigh more than 90kg, with an endometrial thickness of greater than 12mm during the follicular phase (days 5 to 10)

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.