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 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

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.

  • 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

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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.