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 metropolitan Local Health Network switchboard and ask to speak to 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

For information on referral forms and how to import them, please view 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, 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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • 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/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