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
  • severe infection
  • suspected pelvic abscess
  • suspected ovarian torsion

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

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to 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


  • concerns of ‘childhood non-accidental injury’, refer to Child Protection Services for further information
  • people with high-risk presentation (due to risk malignancy score (RMI) or International Ovarian Tumour Analysis (IOTA) classification), refer using the Gynaecology Oncology CPC
  • recurrent ovarian cysts without trial of hormonal contraception history/use
  • simple cyst less than 5cm in size and normal ca 125

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • ovarian cyst greater than 12cm
  • cyst with documented changes or significant increase in size
  • cyst with abnormal tumor markers
  • high risk due to RMI or IOTA classification
  • suspicion of malignancy or concerning features on imaging
  • ultrasound confirmed solid cyst in adolescent female
  • ultrasound findings cyst with concerning features such as:
    • abnormal blood flow
    • ascites
    • documented changes
    • papillary projections
    • septations
    • significant increase in size
    • solid areas

Category 2 (appointment clinically indicated within 90 days)

  • persistent ovarian cyst greater than 5cm on two pelvic ultrasounds 8 to 12 weeks apart
  • complex cyst, haemorrhagic, endometriotic or dermoid
  • symptomatic ovarian cyst pain

Category 3 (appointment clinically indicated within 365 days)

  • hydrosalpinx
  • symptomatic recurrent cysts not responding to simple treatments
  • simple cysts less 5cm in pre-menopausal women

For more on outpatient referrals, see the general referral information.

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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • for adult patients, relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • for paediatric patients, identify within your referral 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
  • interpreter requirements
  • past medical/surgical/obstetric/psychosocial history
  • current medications and allergies
  • hormonal contraception use
  • onset, duration and course of presenting symptoms
  • menstrual history:
    • cycle, day/months
    • days of bleeding
    • previously trialled treatments
  • height/weight
  • BMI
  • risk malignancy index (RMI) score and/or International Ovarian Tumour Analysis (IOTA) classification
  • pelvic examination if sexually active
  • two trans-vaginal/abdominal ultrasound reports minimum 8 to 12 weeks apart
  • computed tomography abdomen-chest-pelvis


  • complete blood examination (CBE)
  • urea electrolytes and creatinine (UEC)
  • liver function tests (LFTs)
  • beta-human chorionic gonadotropin (ßhCG)
  • cancer antigen 125 (CA125)
  • an up-to-date cervical screening test as per the cervical screening guidelines

Sexually active people

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

Women less than 35 years of age

  • alpha-fetoprotein (AFP)
  • lactate dehydrogenase (LDH)

Post-menopausal women

  • computed tomography chest-abdomen-pelvis

Clinical management advice

Possible indications for further evaluation of ovarian cysts include findings suggestive of cancer, such as suspicious masses on ultrasound (US), elevated levels of the tumor marker cancer antigen 125 (CA 125), and a family history of breast or ovarian cancer.

Adolescents and pre-menopausal women

  • for small ovarian cysts (less than 6cm) with normal CA 125 level, a follow-up ultrasound should be performed 8-12 weeks after the initial scan to check for cyst resolution. If the cyst has resolved, there is no need to refer for further assessment.
  • management of suspected cancer/s in children or adolescents is coordinated by the paediatric gynaecology service at the Women’s and Children’s Hospital (WCH) in collaboration with gynaecology oncology services based at the Royal Adelaide Hospital (RAH). Referrals for people under the age of 18 should be sent directly to WCH for clinical review.
  • suspicious or solid cysts should be referred for clinical assessment regardless of size

Most cysts are likely to be physiological, so a second ultrasound in the early follicular phase two cycles after the cyst was identified is recommended.

Post-menopausal women

  • simple cyst less than 5cm and a normal CA 125
    • repeat ultrasound and CA 125 in 4 to 6 months with referral if changes are identified
  • with confirmed cysts are unlikely to resolve, so a follow-up ultrasound may be performed to monitor growth

Clinical resources

Consumer resources