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.

  • known endometriosis with:
    • hydronephrosis
    • bowel obstruction
  • severe infection
  • severe/uncontrolled pelvic pain
  • suspected ovarian torsion
  • suspected pelvic abscess

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

Exclusions

  • pelvic pain without trial of first-line treatment

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • greater than two emergency presentations requiring admission
  • endometriosis with associated bowel or bladder disturbance confirmed on ultrasound (US)

Category 3 (appointment clinically indicated within 365 days)

  • suspected endometriosis
  • suspected endometriomas confirmed on US
  • endometriosis related reproductive concerns
  • chronic pelvic pain unresponsive to trial of first-line treatment
  • pain with intercourse or penetration unresponsive to trial of first-line treatment

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
  • current medications and allergies
  • past medical/surgical/obstetric/psychosocial history
  • hormonal contraception use
  • onset, duration and course of presenting symptoms
    • dysmenorrhoea
    • deep dyspareunia
    • dyschezia- pain with defecation
    • history of sub-fertility
  • 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

Pathology

  • complete blood examination (CBE)
  • beta-human chorionic gonadotropin (ßhCG)
  • an up-to-date cervical screening test as per the cervical screening guidelines
  • trans-vaginal/pelvic ultrasound (US) - preferably with a specialist service who perform dedicated endometriosis US if sexually active.

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

Clinical management advice

Women’s Health physiotherapists play a crucial role in pelvic pain management, utilising their expertise to provide comprehensive care and support to patients through various modalities such as physiotherapy, and counseling, ultimately enhancing the overall effectiveness of treatment and promoting optimal well-being.

Medical management

  • important to exclude cyclical bladder, bowel symptoms
  • consider non-steroidal anti-inflammatory drugs or oral contraceptive pill for dysmenorrhoea
  • suppress menstrual cycle with oral contraceptive pill/implanon®/Depo-Provera/Mirena®
  • treat infection

Clinical resources

Consumer resources