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.

  • suspected ectopic pregnancy
  • suspected miscarriage

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

For any of the following symptoms in association with secondary amenorrhoea, please refer directly to endocrinology:

  • arrested or delayed puberty 16 years and over
  • suspected hypopituitarism or pituitary tumour
  • new onset virilisation in a female e.g. hirsutism, acne, balding
  • serum testosterone greater than 5nmol/l in a female

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • secondary amenorrhoea
  • suspected polycystic ovarian syndrome

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/psychosocial history
  • current medications and allergies
  • menstrual history:
    • menarche
    • cycle, day/months
    • days of bleeding
    • amount of blood loss e.g. change of pads or tampons per day/hours
    • previous trialled treatment
  • presenting symptoms including:
    • Tanner staging (pubertal development)
    • presence of acne and or hirsutism
    • cyclical abdominal pain including frequency and severity
    • headache/visual disturbances/galactorrhoea
    • significant weight/dietary/exercise changes
  • height/weight
  • BMI
  • blood pressure trends
  • abdominal examination findings
  • pelvic examination if sexually active
  • trans-vaginal pelvic in secondary amenorrhoea in adults greater than 8 years post menarche

Pathology

Investigations are to be completed prior to commencement of hormonal therapy e.g. commencement on contraceptive pill

  • complete blood examination (CBE)
  • iron studies
  • thyroid stimulating hormone (TSH)
  • beta-human chorionic gonadotropin (ßhCG) with permission
  • follicle stimulating hormone (FSH)
  • luteinizing hormone (LH)
  • oestradiol
  • testosterone
  • free androgen index
  • sex hormone binding globulin (SHBG)
  • prolactin
  • an up-to-date cervical screening test as per the cervical screening guidelines

Clinical management advice

Irregular periods are defined as

  • greater than 1 year post menarche: cycles greater than 90 days
  • between 1 to 3 years post menarche: cycles less than 21 or greater than 45 days
  • greater than 3 years post menarche: cycles less than 21 or greater than 35 days

Clinical resources

Consumer resources