Gynaecology and Gynaecological Oncology Outpatient services at CALHN

The Central Adelaide Gynaecology Service provides outpatient services for patients living in the Central Adelaide Local Area Health Network (CALHN) at both The Royal Adelaide Hospital (RAH) and The Queen Elizabeth Hospital (TQEH).

The majority of inpatient care for benign related gynaecology conditions occurs at TQEH.

Services

Clinical services provided include:

• Colposcopy including laser and LLETZ
• General gynaecology
• Gynaecological dermatology
• Gynaecological oncology
• Menopause
• Menopause clinic
• Nurse led trail of void and Intermittent self-catheterisation
• Outpatient hysteroscopy
• Pelvic floor physiotherapy
• Pelvic mesh clinic (PDF 232KB)
• Reproductive endocrinology
• Uro-gynaecology Incontinence
• Urodynamic studies

Contact/lreferral process

Immediate referral process

Where consultation is “same day” urgent, the Gynaecology registrar or Gynaecology Oncology fellow can be contacted via switchboard to discuss patients details:

• RAH (08) 7074 0000
• TQEH (08) 8222 6000

If the condition is life-threatening, the patient should be sent to the nearest Emergency Department.

Royal Adelaide Hospital (RAH)

• Outpatient Referral Hub: 1300 153 853
• Outpatient referral fax number: (08) 7074 6247

Urgent referrals

A written referral marked URGENT should be faxed to RAH Outpatients and can be followed up with a phone call with one of the below:

• Referral Hub 1300 153 853
• Wing 1 Nurse Unit Manager Gynaecology: 0466 027 620 MUST be contacted to prioritise the patients. Every effort will be made to attend to the patient needs.
• Gynecology registrar via switchboard (08) 7074 0000

Non-urgent referrals

• All referrals must be in writing and sent by fax: (08) 7074 6247

All other appointment enquiries

For new, review or change or cancellation of appointments:

• Telephone the Outpatient Call Centre: 1300 153 853

To discuss clinically urgent or outpatient matters:

• Contact the Nurse Unit Manager for Gynaecological Outpatients: 
  Mobile: 0466 027 620
• Gynaecology registrar via switchboard
  Telephone: (08) 7074 0000

RAH referral forms

• Gynaecology Oncology referral form (DOCX 27KB)
• Pelvic Mesh Clinic patient referral form (PDF)
  

Location

All RAH Outpatient clinics are held on Level 3 (ground floor) of the RAH

Our clinic is located at Wing 1, level 3E (ground floor)

RAH Outpatient map

Royal Adelaide Hospital
1 Port Road SA 5000

The Queen Elizabeth Hospital (TQEH)

Outpatient referral fax number: (08) 8222 7188

For all enquiries regarding appointments including: new appointments, appointment change or cancellation call:

(08) 8222 7030 or (08) 8222 7010

Urgent referrals

A written referral marked URGENT should be faxed to:

• TQEH Outpatients: and can be followed up with a phone call with one of the below.

To discuss clinically urgent or outpatient matters please contact:

• Gynaecology registrar via switchboard on (08) 8222 6000
• Gynaecology outpatient department (08) 8222 6162

Location

TQEH Outpatient clinics are held on level 8A.

The Queen Elizabeth Hospital
Woodville Road
Woodville SA 5011

TQEH Clinical urgency priorities

Gynaecology / Gynaecology Oncology priorities are based on clinical urgency as displayed below.

Immediate priority

• Gynaecological emergencies with threat to major organs. Refer immediately to ED
• Emergency Department or appointment on the day

Examples

• Ovary torsion
• Ectopic Pregnancy
• Pelvic Inflammatory Disease
• Severe per vaginal haemorrhage

Referral process — RAH

• Must be discussed with the Gynaecology registrar or Gynaecological Oncology Fellow on call immediately via RAH switchboard on (08) 7074 0000 or Nurse Unit Manger on 0466 027 620.
• On-call service provided 24/7 by our Gynaecology Registrars.
• A written referral marked URGENT should then be faxed to (08) 7074 6247.

RAH email referrals

Referrals are triaged into an urgent, semi-urgent or non-urgent category.

• Please contact the GynaeOncology Registrar on call via the
  RAH switch board (08) 7074 0000 between 8 am and 5pm, Monday to Friday.
• The quality of the information provided will influence when an appointment can be made and if there is insufficient information then a request will be made for a new referral before an appointment is given.

Please use the referral form below when sending a referral by email

• Gynaecology Oncology referral form (DOCX 27KB)

The Gynae Oncology Registrar/Fellow will advise on the emails to send these referrals to. Please also send this via fax to (08) 7074 6247 (fax).

Referral process — TQEH

• Must be discussed with the Gynaecology registrar on call immediately via TQEH switchboard on (08) 8222 6000.
• If the condition is life-threatening, the patient should be sent to the nearest Emergency Department.

Urgent priority

• Condition has the potential to require more complex or emergency care if assessment is delayed.
• Condition has the potential to have significant impact of quality of life if care is delayed
• Appointment for benign gynaecology within 1 month
• Appointment for gynaecology oncology pending discussion at MDM but generally within 1 -2 weeks

Examples

• Dysfunctional Uterine Bleeding
• Abnormal Uterine Bleeding
• PMB
• Abnormal smears – high grade
• Post Coital Bleeding
• Haemorrhaging gynaecological malignancies
• Trial of void and intermittent self-catheterisation

Referral process

RAH

• Monday to Friday, 9.00 am to 5.00 pm.
• Must be discussed with the Gynaecology registrar or Gynaecology Oncology Fellow via RAH switchboard on (08) 7074 0000
  or
  phone the Nurse Unit Manager Gynaecology on 0466 027 620.
• A referral faxed to (08) 7074 6247

TQEH

• Must be discussed with the Gynaecology registrar via TQEH switchboard on (08) 8222 6000. Fax: (08) 8222 7188

Semi urgent priority

• Condition is unlikely to require more complex care if assessment is delayed.
• Condition has the potential to have some impact of quality of life is care is delayed.
• Appointment between 6 to 12 weeks ( likely less)

Examples

• CIN II / HPV
• Abnormal vaginal bleeding
• Incontinence
• Poly Cystic Ovarian Syndrome
• Endometriosis
• Pelvic Pain
• Uterine Prolapse
• Pessary fitting
• Fibroids, polyps
• Lichen sclerosis
• Lichen Planus
• Dermatological Gynaecology conditions
• Vaginismus

Referral process

RAH

• Referrals faxed to RAH: (08) 7074 6247

TQEH

• Referrals faxed to TQEH: (08) 8222 7188

Non urgent priority

• Low priority
• Appointment usually within 12 weeks as there is little wait list in well managed clinics.

Examples

• Menopause
• Fertility management
• PCOS
• Gynaecology endocrine conditions
• Fertility management including male infertility
• Ovulation induction/ tracking

Referral process

RAH

• Referrals faxed to RAH: (08) 7074 6247

TQEH

• Referrals faxed to TQEH: (08) 8222 7188.

RAH staff and clinic days

Clinic type and doctors vary week 1 to week 4 . Below is general representation of what clinics occur.

Monday morning

Clinic:

• Urodynamic
• Colposcopy 
• LLETZ
• Gynaecological Oncology
• General Gynaecology

Doctors:

• Carolyn Marlow
• Paul Duggan
• Lino Scopacasa
• Martin Oehler 
• Gynae Oncology Fellow
• Gynae Oncology Nurse Consultant 
• Priti Pradhan 
• Gynaecology registrars

Conditions:

• Incontinence
• Bladder assessment prior to surgery
• Abnormal PAP smears
• Treatment for CIN II-III
• All malignant gynaecological conditions for patients in CALHN and interstate
• DUB
• PCOS
• Endometriosis
• Prolapse 
• Pelvic inflammatory disease 
• Fibroids 
• Polyps

Monday afternoon

Clinics:

• Hysteroscopy
• General Gynaecology

Doctors:

• Lino Scopacasa 
• Paul Duggan 
• Gynaecology registrar

Conditions:

• PMB
• DUB
• General Gynaecology conditions

Tuesday morning

Doctors:

• Carolyn Marlow
• Dermatology registrar 
• Gynaecology registrar

Conditions:

• Lichen Planus
• Lichen Sclerosuis
• Vaginismus
• General gynaecology conditions

Tuesday afternoon

Clinic:

• General gynaecology 
• Reproductive endocrine 
• Trail of Void / intermittent self-catheterisation clinic – Nurse led

Doctors:

• Paul Duggan
• Gynaecology Registrar
• Professor Robert Norman
• Reproductive endocrine fellow 
• Reproductive endocrine nurse specialist 
• Gynaecology Nurse

Conditions:

• As per general gynaecology conditions 
• PCOS
• Gynaecology endocrine conditions 
• Fertility management including male infertility.
• Ovulation induction/ tracking 
• TOV

Wednesday morning

Clinic: 

• Gynaecological Oncology 
• Pelvic Floor Physiotherapist

Doctors:

• Martin Oehler 
• John Miller
• Lino Scopacasa
• Gynae Oncology Fellow
• Gynae Oncology Registrars
• Gynae Oncology Nurse Consultant 
• Fiona Roney

Conditions:

• Malignant gynaecological conditions 
• Incontinence – Women and men 
• Vaginismus

Wednesday Afternoon

Clinic:

• Menopause 
• General Gynaecology 
• Pelvic Floor Physiotherapist

Doctors:

• Amita Singla
• Gynaecology Menopause Registrar
• Lino Scopacasa 
• Gynaecology registrar 
• Fiona Roney

Conditions:

• Menopause
• Hormonal management
• General gynaecology conditions 
• Incontinence – women and men 
• Vaginismus

Thursday morning

No Gynaecology Clinics

Thursday afternoon

Clinics:

• Colposcopy 
• Laser treatment clinic

Doctors:

• Roy Watson
• Lino Scopacasa
• Colposcopy Registrar

Conditions:

• Abnormal smears / HPV 
• Treatment clinic for CIN II - III 

Friday morning

Clinics:

• Colposcopy 
• General Gynaecology 
• Pelvic Floor Physiotherapist

Doctors:

• Roy Watson
• Colposcopy Registrar
• Amita Singla
• Gynaecology Registrar

Conditions:

• Abnormal smears / HPV 
• General Gynaecology conditions

Friday afternoon

Clinics:

• Gynaecological Oncology Long term review clinic only 
• Pelvic Floor Physiotherapist

Doctors:

• Gynae Oncology Registrar
• Fiona Roney

Conditions:

• Gynaecological Oncology review clinic 
• Incontinence – women and men 
• Vaginismus

TQEH staff and clinic days

Monday Morning

Clinic:

• Colposcopy week 1

Doctors: 

• Dr Roy Watson
• Registrar
• Nurse Consultant

Conditions:

• Abnormal smears / HPV  
• Available as required
• TOV/Pessarys

Monday Afternoon

• Clinic - Colposcopy week 1-4
• Doctor - Dr Amita Singla
• Conditions - Abnormal smears / HPV

Tuesday Morning

• Clinic - Nurse Led Clinic

Doctors: 

• Nurse Consultant weeks 1, 3 & 4
  

Conditions: 

• Available as required
• TOV/Pessarys

Tuesday Afternoon

Clinic:

• General Gynae week 1-4

Doctors: 

• Dr Priti Pradhan
• Dr Ray Yoong

Conditions:

• DUB
• PCOS
• Endometriosis
• Prolapse 
• Pelvic inflammatory disease 
• Fibroids 
• Polyps

Wednesday Morning

Clinic:

• General Gynae

Doctors: 

• Nurse TOV/Self catheterisation
• Dr Amita Singla wk 1
• Registrar
• Nurse Consultant

Conditions:

• As per General Gynae
• TOV/Pessarys/Self catheterisation

Wednesday Afternoon

Clinic:

• General Gynae

Doctors: 

• Dr Paul Knight week 4
• Dr David Munday week 2
• Registrar week 1-4
• Registrar week 2

Conditions - As per General Gynae

Thursday Morning

Clinic: 

• General Gynae
• Reproductive Endocrine

Doctors: 

• Dr Roy Watson week 1 and 3
• Registrar week 1 and 3
• Prof Robert Norman week 2
• Nurse Consultant

Conditions:

• As per General Gynae
• PCOS
• Gynaecology endocrine conditions 
• Fertility management
• Available as required Pessarys/TOV

Thursday Afternoon

Clinic:

• General Gynae

Doctors:

• Dr David Munday week 1-4
• Registrar week 1-4
• Dr Paul Knight
• Emily Bak Nurse Consultant

Conditions:

• As per General Gynae
• Urodynamics weeks 2,3 and 4
• Incontinence/ bladder assessment prior to surgery

Friday Morning

• Clinic - Nurse led Clinic
• Doctors - Nurse Consultant week 2
• Conditions - Available as required TOV/Pessarys

Friday Afternoon

• No clinics

Quality of information supplied and changes to appointment referrals

Referrals are triaged daily into an urgent, semi-urgent or non-urgent category.

The quality of the information provided will influence when an appointment can be made and if there is insufficient information then a request will be made for a new referral before an appointment is given.

Should changes occur to a patient’s medical condition during the waiting time for an appointment, referrers should send updated clinical information and where appropriate, contact one of the following.

• Gynaecology registrar via the:
  • RAH switchboard on (08) 7074 0000
  • TQEH switchboard on (08) 8222 6000
• RAH Nurse Unit Manager on 0466 027 620
• TQEH Gynaecology outpatient department 8222 6162

When tests are required prior to triage

Some conditions require tests to be performed by the referring doctor prior to triage.

Investigations/test required

*please include if patient is sexually active

• Full medical history
• Full blood examination, Biochemistry
• Urinalysis and/or MMS
• Endocervical pap smear*
• Pelvic/abdominal ultrasound*
• Vaginal swabs (general and STD check)
• List of current medication
• Allergies

If results are not provided with the referral, they will be requested and may be delays in appointing the patient.

Specific tests are requested by the Gynaecological Oncology Fellow prior to patient discussion at the weekly Multidisciplinary Team Meeting and subsequent appointment if relevant.

Test required and pre-management strategies

Non-urgent referrals will be allocated to the next available appointment and may incur a wait. The waiting time for appointments will vary and is dependent on the demand for this service and the medical urgency of the patient’s condition.

Abnormal Pap Smear/ Cervical screening test.

Required Investigations

• Higher risk CST
• Intermediate risk CST with abnormality on last CST/Pap smear
• See NHMRC Guidelines

Triaged to/ seen within

• Colposcopy within 6 weeks

Notes

• If menopausal, consider vaginal oestrogen while awaiting appointment.

Postcoital bleeding

Required Investigations 

• Recent Pap smear. NAT testing for Chlamydia, Gonorrhoea.
• Contact bleeding with normal smear does not require referral unless other clinical concerns

Triaged to/ seen within 

• Colposcopy within 6 weeks

Notes

• Treat any infection while awaiting appointment.

Cervical polyp

Required Investigations 

• Up-to-date CST (see NHMRC Guidelines)

Triaged to/ seen within 

• Gynae within 6 to 8 weeks

Notes

• Colposcopy if abnormal smear

Pelvic pain

Required Investigations 

• NAT test for Chlamydia, Gonorrhoea
• Pelvic ultrasound
• Urine culture or negative urinalysis.
• Consider ovarian suppression with OCP

Triaged to/ seen within 

• Gynae 6 to 8 weeks

Notes

• Advanced laparoscopic surgeons if endometriosis felt likely

Permanent contraception

Required Investigations 

• NAT testing if considering IUCD.
• Nb: referrals for routine insertion/removal of Mirena will not be accepted unless potentially difficult insertion

Triaged to/ seen within 

• Gynae next available

Vulval Pathology

Required Investigations 

• Swabs, NAT testing, serology, virology as appropriate

Triaged to/ seen within 

• Vulva clinic or colposcopy within 4 weeks

Bartholin’s cyst

Required Investigations 

• Antibiotic treatment is of little value. Acute abscess may require referral to ED

Triaged to/ seen within 

• Gynae
• Within 2 weeks 
• Or immediate ED

Ovarian cyst

Required Investigations 

• Recent ultrasound
• If cyst less than 4cm diameter, repeat ultrasound in 6-12 weeks.
• Age less than 35 – CA 125, CA 19.9, CEA, HCG, AFP, LDH
• Age over 35 – CA 125, CA 19.9, CEA

Triaged to/ seen within 

• RMI less than 200 – Gynae
• 6 – 12 weeks 
• RMI over 200, or other suspicion of malignancy – Gynae Oncology
• MDT review 
• Appointment 1 to 2 weeks

Notes

• May need to arrange repeat scan prior to being seen if features of cyst for calculating RMI are not available.

Known or suspected Gynaecological malignancy

Triaged to/ seen within

• Gynae Oncology
• Immediate MDT RV 
• Appointment within 1 to 2 weeks
• Known or suspected Gynaecological malignancy - BRCA gene mutation only

Triaged to/ seen within 

• High risk Breast/Gynaecology clinic
• Clinic occurs alternate month, allocation dependent on patient assessment

Notes

• Patients with strong family history of gynaecological malignancy can be seen for counselling

Known or suspected Gynaecological malignancy

Required Investigations 

• Only require referral if symptomatic
• Recent Ultrasound
• FBC
• LDH if over 7cm diameter or rapidly enlarging

Triaged to/ seen within 

• Gynaecology
• 8 weeks 
• Gynae Oncology if LDH elevated
• As above

Pelvic Inflammatory Disease

Required Investigations 

• FBC/ESR/CRP
• Cervical swab, NAT test for Chlamydia, Gonorrhoea.
• Pelvic Ultrasound

Triaged to/ seen within 

• Gynaecology within 2 to 4 weeks 
• Or ED

Notes

• If swabs or NAT positive, ensure treatment with appropriate antibiotics while awaiting appointment.

Vaginal discharge

Required Investigations 

• FBC/ESR/CRP
• Cervical swab, High vaginal swab, NAT test for Chlamydia, Gonorrhoea.

Triaged to/ seen within 

• Gynaecology within 4 weeks

Notes

• If swabs or NAT positive, ensure treatment with appropriate antibiotics while awaiting appointment

Menopausal symptoms, premature menopause

Required Investigations 

• If perimenopausal, two FSH/E2 levels 6 weeks apart.

Triaged to/ seen within 

• Menopause clinic next available

AUB – excessive or irregular menstrual loss

Required Investigations 

• FBC, Fe studies. TSH. Try symptomatic treatment (eg OCP, Mirena) before referral if younger than 35.
• Trans-vaginal pelvic ultrasound if age over 35 or under 35 and failed trial of symptomatic treatment
• Up-to-date CST.

Triaged to/ seen within 

• Gynaecology
• Within 2 weeks if HB low 
• Other 6 to 8 weeks

Post-menopausal bleeding

Required Investigations 

• Trans-vaginal pelvic ultrasound. FBC. Recent CST.

Triaged to/ seen within 

• Within 4 weeks 
• Direct entry Outpatient Hysteroscopy clinic (RAH) after telephone assessment 
• Not for outpatient hysteroscopy – gynaecology clinic 4 weeks 
• Gynaecology
• Gynae Oncology if suspicious of malignancy Colposcopy if abnormal CST.
  

Notes

• Triage as urgent

Abnormal appearing cervix

Required investigations

• Recent CST. Pelvic ultrasound.
• NAT testing for Chlamydia, Gonorrhoea.
• Nb. Significant pathology of the cervix in this setting is very unlikely. Consider whether this is a normal variant (ectropion, Nabothian cyst).

Triaged to/ seen within

• Colposcopy within 6 weeks

Pelvic organ prolapse

Required Investigations 

• Consider trial of vaginal oestrogen in postmenopausal women and pelvic floor exercises under physiotherapy supervision for 3-6 months prior to referral.
• Urine culture or negative urinalysis.

Triaged to/ seen within 

• Gynaecology.
• Urogynaecology if also incontinence
• Next available

Urinary incontinence, voiding difficulties

Required Investigations 

• Consider trial of vaginal oestrogen in postmenopausal women and pelvic floor exercises for three months prior to referral.
• Urine culture or negative urinalysis.
• If solely urgency, consider trial of anticholinergic.
• Bladder diary

Triaged to/ seen within 

• Urogynaecology 
• Next available

Recurrent UTI

Required Investigations 

• Urine culture
• Renal and Pelvic ultrasound.

Triaged to/ seen within 

• Urogynaecology within 6 to 8 weeks

Subfertility

Required Investigations 

• Refer after 12 months inability to conceive or if anovulatory or oligomennorhoeic.
• Earlier referral may be appropriate if over 35yo, 
• Mid-luteal E2/Prog x 2
• Semen analysis
• Pelvic ultrasound
  

Triaged to/ seen within 

• REI within Next available

Amenorrhoea/ PCOS

Required Investigations 

• Recent HCG, TSH, Prolactin
• Testosterone, FAI, DHEAS. FSH.
• Trans-vaginal pelvic ultrasound.

Triaged to/ seen within 

• Gynaecology.
• REI if indicative of PCOS or wishing to conceive within Next available

Sexual dysfunction

Required Investigations 

• This is uncommonly hormonal in origin. Consider referral to counselling services.

Triaged to/ seen within 

• ? Gynaecology

Notes

• Suggest referral to other services, such as SHINE

Patients wishing fertility preservation

Required Investigations 

• Example: previous ovarian surgery, age over 35, reduced ovarian reserve.

Triaged to/ seen within 

• REI
• Cancer related – urgent 
• Other next available

Referrals unlikely to be offered an appointment

• Patients that reside in other local health networks (LHN)s should be referred to Northern Adelaide LHN and Southern Adelaide LHN. Exceptions to this are direct entry into hysteroscopy, laser or Lletz clinics and women with malignant gynaecological conditions (RAH).
• Women will not be seen for general gynaecological checks, the only exception to this are women who require gynaecological examination couches and lifting equipment to provide care.
• Alternate care options / health information for low priority conditions while waiting for an appointment or if no appointment is made.
• Post discharge guidelines and information
• If the patient or their general practitioner is concerned about a deterioration in the patient’s condition please contact the Gynaecology Registrar or call the Nurse Unit Manager of Gynaecology at the RAH or Nurse Consultant at TQEH
• Patients whose condition has stabilised or resolved and for whom no further appointment is needed will be formally discharged. If their gynaecological health changes a new referral is needed.