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Gynaecology - public patient

Purpose

This page contains information for general practitioners on how to refer patients aged 16 years and over to Gynaecology services at Mater Hospital Brisbane.

Service 

The Gynaecology Service offers a comprehensive individualised approach to patient care. The multidisciplinary team consists of medical specialists, case managers and clinical nurses with access to allied health services including physiotherapy, psychology, social work, occupational therapy and dietetics. 

The Gynaecology service also offers specialised services for young adults aged 16 - 25 years at the Mater Young Adult Health Centre Brisbane. These clinics offers a number of clinical services and programs that have been developed with young people in mind.

Other specialised clinics include 

  • Colposcopy
  • Persistent Pelvic Pain 
  • Infertility 

How to Refer

If referral for care is indicated please list all of the General Referral Information and reason for request, and essential information as indicated below.

To refer, please fill in the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

Secure messaging  Medical Objects:   HM4101000R8
  HealthLink EDI:    materref   
Fax    07 3163 8548

 

 

 

 

Emergency

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region:

 

View list of conditions:

  • Ectopic pregnancy
  • Ruptured haemorrhagic ovarian cyst
  • Torsion of uterine appendages
  • Acute/severe pelvic pain
  • Significant or uncontrolled vaginal bleeding
  • Severe infection
  • Abscess intra pelvis or PID
  • Bartholin’s abscess / acute painful enlargement of a Bartholin’s gland/cyst
  • Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain
  • Urinary retention
  • Molar pregnancy
  • Inevitable and / or incomplete abortion
  • Hyperemesis gravidarum
  • Ascites, secondary to known underlying gynaecological oncology
  • Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries

 

Scope of Service

Conditions out of scope

The following conditions are not routinely provided at Mater Hospital Brisbane:

View list of conditions:

  • Elective cosmetic surgery e.g. labiaplasty
  • Tubal ligation (including reversal of tubal ligation)
  • Contraception
    • Contraceptive Advice
    • Contraception e.g. Implanon
    • Routine Mirena®/ progesterone-releasing IUD insertion for contraception
    • Elective Termination of Pregnancy
  •  Screening Pap Smears
  • Primary menopausal care
  •  Screening pap smear
  • Postnatal check-up
  • IVF services

 

Conditions in scope

Abnormal cervical screening, Cervical Dysplasia, Abnormal Cervix

Essential information (Referral will be declined without this)

  • General referral information
  • History of
    • any abnormal bleeding (i.e. post-coital and  intermenstrual) or abnormal discharge
    • previous abnormal cervical screening
    • immunosuppressive therapy
  • Medical management to date
  • Current cervical screening (LBC should be performed on any sample with positive oncogenic HPV)

Additional referral information (useful for processing the referral)

  • HPV vaccination history
  • STI screen result endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • History of smoking

Other useful information for management (not an exhaustive list)

  • Women who are in follow-up for pLSIL / LSIL in cytology in the previous program (pre-renewal NCSP) should have a HPV test at their next scheduled follow-up appointment
  • If oncogenic HPV is not detected, the women can return to 5-yearly screening
  • A single cervical screening test may be considered for women between the ages of 20 and 24 years who experience their first sexual activity at a young age (e.g. before 14 years) who have not recieved the HPV vaccine before sexual activity commenced
  • Adolescent patients with abnormal HPV should follow the same pathway as adult patients. Patients <25 years old should also have screening for STI as they are a high-risk group.
  • Consider using oestrogen cream +/- liquid cytology in post-menopausal women
  • Patients with positive non-16/18 but normal or LSIL on LBC would not need referral and only a repeat CST in 12 months 
  • Recall women in 6-12 weeks if they have an unsatisfactory screening report
  • Specific efforts should be made to provide screening for Aboriginal and Torres Strait Islander women. They should be invited and encouraged to participate in the NCSP and have a 5-yearly HPV test, as recommended for all Australian women
  • Routine coloposcopic examination is NOT routinely required following treatment for CIN II/III. These patients would need a speculum inspection of the cervix and a co-test (i.e. HPV and LBC at 12 months post-treatment. They do not routinely need referral to a specialist 

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Invasive Cancer (SCC, glandular, other). For optimum care, patient should be seen by gynaecological oncology within 2 weeks. 

LBC of PHSIL / HSIL

AIS or possible high grade glandular lesion 

Positive HPV 16/18 and 

  • unsatisfactory LBC
  • Past history of PHSIL / HSIL
  • Past history of positive HPV 16/18 

Positive HPV 16/18 and 

  • Normal LBC
  • PLSIL / LSIL 
  • Atypical glandular cells / endocervical cells of undetermined significance 

Positive HPV non 16/18 and 

  • Atypical glandular cells / endocervical cells of undetermined significance 
  • Previous test positive for oncogenic HPV
  • Women aged 70-74
  • Immune deficiency 

History of diethylstilboestrol (DES) exposure regardless of HPV status or LBC test 

Abnormal appearing cervix with normal cervical screening

Post-coital bleeding with normal cervical screening

No category 3 criteria

 

Cervical Polyp

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • No additional referral information

Other useful information for management (not an exhaustive list)

  • Small endocervical polyps (<2cm) in premenopausal women with normal cervical screening can be avulsed and sent for histology
  • Cervical polyps in post-menopausal women have a higher risk of malignancy

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Cervical polyp with positive oncogenic HPV and / or HSIL on LBC

Cervical polyps in post-menopausal women with normal cervical screening

Cervical polyps in pre-menopausal women with normal cervical screening

 

Dyspareunia

Essential information (Referral will be declined without this)

  • General referral information
  • History of:
    • nature of the pain – location, intermittent or persistent
    • general body muscle tensing and general or focal pelvic floor muscle tension before and during attempts at penetration
    • medical, surgical and obstetric history
    • Pelvic USS results (TVS preferable)

Additional referral information (useful for processing the referral)

  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • HVS M/C/S and viral PCR result

Other useful information for management (not an exhaustive list)

  • Advise using lubricant and adequate foreplay prior to intercourse
  • For superficial dyspareunia: (consider referral to women’s health physiotherapist)
    • breast feeding women – consider topical oestrogen
    • consider vaginismus and referral to a sexual medicine service
  • consider psychosocial issues and referral for counselling

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

No category 1 criteria

Severe pelvic pain associated with dyspareunia

Vulvodynia/Vulvar vestibulitis syndrome

 

Fibroids

Essential information (Referral will be declined without this)

  • General referral information
  • History of:
    • symptoms
    • Heavy menstrual Bleeding (HMB), brief description of periods, medical management to date
    • dragging sensation
    • urinary frequency
  • Current cervical screening
  • FBC iron studies results
  • Pelvic USS (TVS preferable)

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • If asymptomatic with normal menstrual pattern and normal Hb, there is no need for referral

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Suspicion of degeneration or malignancy

Urinary obstruction, renal impairment e.g. hydroneprhosis, history of urinary retention

Heavy Menstrual Bleeding (HMB) with anaemia (Hb<85) or requiring transfusion

Fibroid prolapse through cervix

Pressure symptoms (such are ureteric impingement)

HMB with anaemia

Abdominal discomfort

HMB without anaemia not responding to maximal medical management

Fibroids and reproductive issues

 

Heavy Menstrual Bleeding

Essential information (Referral will be declined without this)

  • General referral information
  • Brief description of periods
  • Medical management to date
  • Current cervical screening
  • FBC Serum ferritin results
  • Pelvic USS (TVS preferable)
  • Adolescent patient - Coag profile including von Willebrand's disease (vWD)

Additional referral information (useful for processing the referral)

  • TSH if symptomatic of thyroid disease
  • Previous management modalities, iron utilisation if deficient.

Other useful information for management (not an exhaustive list)

  • A woman with heavy menstrual bleeding is referred for early specialist review when there is a suspicion of malignancy or other significant pathology based on clinical assessment or ultrasound.  Link: https://www.safetyandquality.gov.au/our-work/clinical-care-standards/heavy-menstrual-bleeding/
  • Consider increased risk of hyperplasia or malignancy if:
    • Endometrial thickness greater than 12mm (transvaginal USS ideally day 4-7)
    • Irregular endometrium or focal lesion
    • Weight >90kg
    • PCOS / diabetes / unopposed oestrogen
    • Age >45yrs
    • Intermenstrual or post-coital bleeding
  • Medical treatment prior to or while waiting for specialist review if no suspicion of malignancy:
    • Progesterone releasing IUD
    • Tranexamic acid
    • OCP
    • NSAIDS
    • Oral progestogens
  • Referral is also arranged for a woman who has not responded after six months of medical treatment.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Suspicion of malignancy

HMB with anaemia (Hb<85) or requiring transfusion

HMB with anaemia (Hb>85)

HMB without anaemia not responding to medical management

 

Infertility, RPL

Essential information (Referral will be declined without this)

  • General referral information
  • History of
    • previous pregnancies, STDs and PID, surgery, endometriosis
    • other medical conditions
  • Include the following information about partner
    • age and health, reproductive history, testicular conditions
  • Weight/ BMI
  • FBC Group and antibodies Rubella IgG Varicella IgG, Syphilis Serology, HBV/HCV/HIV serology results
  • Day 21 serum progesterone level (7 days before the next expected period)
  • FSH, LH (Day 2-5), Prolactin, TSH if cycle prolonged and/or irregular
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • Partner seminal analysis result
  • Pelvic USS (TVS preferable)
  • Additional referral information (useful for processing the referral)
  • History of marijuana use (including partner)
  • Fasting blood glucose, testosterone and free androgen index test for those likely to have PCOS

Other useful information for management (not an exhaustive list)

  • IVF not available in Mater public hospitals
  • To assess tubal patency, consider Hysterosalpingography (HSG) or saline infusion USS (sonohysterography) if history suggestive of blocked fallopian tubes
  • Seminal analysis of partner (≥4 days of abstinence). Repeat in 4-6 weeks if abnormal.
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
    • simple moderate physical activity including structured exercise (at least 30 minutes/day) and optimising incidental exercise with weight loss and weight maintenance
    • achieve optimal weight BMI 20 – 30
    • referral to dietician
  • Infertility: folic Acid 0.5mg/day

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Imminent chemotherapy required

All other category 1 referrals for interfility are not accepted, refer to a private specialist to avoid delay

Category 2 referral for infertility are not accepted, refer to a private specialist to avoid delay

All referrals for infertility for example but not limited to 

  • Surgical management of hydosalpinx
  • Anovulation for ovulation induction (selected cases)
  • Unexplained infertility (selected cases) 
  • Recurrent pregnancy loss

(Definition - Infertility is the failure to achieve pregnancy after 12 months or more of unprotected intercourse

 

Intermenstrual Bleeding

Essential information (Referral will be declined without this)

  • General referral information
  • History of abnormal bleeding / hormonal contraceptive use
  • Current cervical screening
  • HVS result
  • BHCG result
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • Pelvic USS (TVS preferable)

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

Reference Material - RANZCOG - Investigation of Intermenstrual and Post Coital Bleeding

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Oncogenic HPV, LBC prediction of pHSIL/HSIL, possible high-grade glandular lesion, AIS, or invasive cancer - cervical or endometrial

Focal endometrial lesion

IMB not due to hormonal contraception

Abnormal cervical screening )(other than for Cat 1) 

Endometrium  >12mm / irregular on pelvic USS (TVS ideally day 4-7)

Persistent and/or unexplained IMB

IMB bleeding related to hormonal contraception that is not responding to medical management e.g. contraception manipulation

 

 

Known or Suspected Endometriosis

Essential information (Referral will be declined without this)

  • General referral information
  • Medical management to date/surgical history
  • History of pain and menstrual diary
  • Symptoms
    • dysmenorrhoea
    • deep dyspareunia
    • dyschezia
  • history of sub-fertility
  • Pelvic USS results (TVS preferable) if available

Additional referral information (useful for processing the referral)

  • No additional referral information

Other useful information for management (not an exhaustive list)

  • Medical management
  • Suppression of menstrual cycle with oral contraceptive pill / Implanon / Depo-Provera / Mirena®. 6-month trial appropriate prior to referral
  • NSAIDs for pain
  • NICE Guideline currently under development.  Nice Guideline: Endometriosis: diagnosis and management.  Anticipated publication date: September 2017

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

No category 1 criteria

Likelihood of inpatient admission

Multiple emergency presentations

Endometriomas on USS

Endometriosis/chronic not responding to maximal medical management

Associated bowel or bladder disturbance

Endometriosis and reproductive issues

 

 

Ovarian Cyst, Pelvic Mass

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Family history of breast and ovarian cancer
  • In paediatric and adolescent patients, remember to exclude germ cell tumours with markers: alpha feto protein LDH BHCG along with the other tumour markers

Other useful information for management (not an exhaustive list)

  • If cyst simple or haemorrhagic corpus luteal cyst and <5 cm repeat scan in 6 – 12 weeks
  • If recurrent cysts, consider COCP or Implanon®
  • If suspected torsion of uterine appendages, refer to emergency

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Suspicious of malignancy or high risk features:

  • USS findings such as solid areas, papillary projections, septations, abnormal blood flow, bilaterally or ascites
  • ovarian cyst >12cm
  • elevated CA125 and cyst >5cm in premenopausal patients or any size cyst in post-menopausal patient
  • Consider if significant pain and/or due to risk of torsion
  • Pre-pubertal patient

Persistent ovarian cyst >5cm on 2 pelvic USS 6 weeks apart

Complex cyst (haemorrhagic, endometriotic or dermoid)

Persistent pelvic pain

Hydrosalpinx

 

 

Mirena / Progesterone releasing IUD insertion or removal, for HMB or HRT

Essential information (Referral will be declined without this)

  • General referral information
  • History of - relevant family history, menstrual, obstetric, contraceptive, and sexual history
  • Current cervical screening

Additional referral information (useful for processing the referral)

  • Mirena® prescription – the referring GP is to give a prescription for the device to the patient who must bring the device with her to the clinic
  • Pelvic USS if lost strings, HMB or other clinical indication
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA [7]

Other useful information for management (not an exhaustive list)

  • Mirena® prescription to be supplied by referring GP. Patient must bring the device with her to the clinic
  • For paediatric and adolescent gynaecology patients please refer to state-wide paediatric and adolescent gynaecology (SPAG) services at LCCH/RBWH
  • Where available for the routine removal or insertion of Mirena®/progesterone releasing IUD please consider referral to True – relationships and reproductive health (formerly known as Family Planning Queensland) or a Women’s Health speciality primary care provider who may be able to provide this service in their own clinic.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

HMB with anaemia (Hb<85) or requiring transfusion

     HMB with anaemia (Hb>85)

HMB without anaemia not responding to maximal medical management

NB: Routine Mirena®/progesterone-releasing IUD insertion for contraception are out-of-scope for Gynaecology services.

 

Pelvic Floor Dysfunction

Essential information (Referral will be declined without this)

  • General referral information
  • Obstetric and gynaecological history
  • History of:
    • prolapse symptoms
    • protruding lump
    • dragging sensation
    • difficulty with defecation (requiring manual evacuation) / micturition including incontinence
  • MSU M/C/S results

Additional referral information (useful for processing the referral)

  • Pelvic USS (TVS preferable) if available
  • Bladder diary
  • Renal USS if major uterine procidenta

Other useful information for management (not an exhaustive list)

  • Medical management:
  • Consider referral to women’s health physiotherapist for the following:
    • prolapse – consider pessary.
    • stress incontinence – physiotherapist for pelvic floor exercises and bladder retraining for 3 months prior to referral
    • urinary urgency -  exclude infection
  • Consider trial of anticholinergics.
  • Treat constipation
  • Consider topical oestrogen in post-menopausal women
  • Lifestyle modification (Increased activity, dietary, weight, smoking, alcohol)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Uterine procidentia

Urinary obstruction

Difficulty voiding +/- significant residuals on bladder screening

Recurrent UTIs

Genital fistulae

Any other prolapse or incontinence

Obstructive defecation

Previous failed or complicated prolapse surgery (e.g. sling erosion)

 

Pelvic Pain, Dysmenorrhoea, PMS

Essential information (Referral will be declined without this)

  • General referral information
  • History of/to:
    • pain, severity and duration, cyclical nature, dysmenorrhoea
    • differentiate from GI pain
    • previous sexual abuse, PID
  • Current cervical screening
  • HVS result
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • MSU M/C/S result
  • Pelvic USS (TVS preferable) if available

Additional referral information (useful for processing the referral)

  • No additional referral information

Other useful information for management (not an exhaustive list)

  • Medical management
  • Important to exclude cyclical bladder, bowel symptoms
  • Treat infection if present
  • Simple analgesia
  • Suppress menstrual cycle with oral contraceptive pill / implanon® / depo-provera / mirena®
  • Treat dysmenorrhoea with NSAIDS or COCP

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Suspicion of malignancy

Multiple emergency presentations

Pelvic pain and significant USS findings e.g. presence of endometriomas / fixed retroverted uterus

Chronic pain not responding to maximal medical management

 

Polycystic Ovarian Syndrome

Essential information (Referral will be declined without this)

  • Pelvic ultrasound (incl. TVS)
  • Day 21 Progesterone (D21P)
  • SHBG results
  • Free Testosterone (FAI), DHEA-S results
  • Fasting blood glucose results
  • Lipids, TSH results

If problems with sub fertility:

  • History of
  • previous pregnancies, STDs and PID, surgery, endometriosis
  • other medical conditions
  • Include the following information about partner
  • age and health, reproductive history, testicular conditions
  • Weight/ BMI
  • FBC Group and antibodies Rubella IgG Varicella IgG, Syphilis Serology, HBV/HCV/HIV serology results
  • Day 21 serum progesterone level (7 days before the next expected period)
  • FSH, LH (Day 2-5), Prolactin, TSH if cycle prolonged and/or irregular
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • Partner semen analysis result
  • Pelvic USS (TVS preferable on day 5-10)

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • Psychological features need to be screened for, acknowledged, discussed and counselling considered, to improve quality of life in PCOS and to facilitate effective and sustainable lifestyle change  consideration of depression and/or anxiety and appropriate management
  • Emphasis on healthy lifestyle, with targeted medical therapy where indicated
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • simple moderate physical activity including structured exercise (at least 30 minutes/day) and optimising incidental exercise assists with weight loss and weight maintenance
  • achieve optimal weight BMI 20 – 30
  • referral to dietician

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

 

Abnormal endometrium on ultrasound (i.e. irregular / focal lesion or thickened – over 12mm)

No category 2 criteria

Polycystic ovarian syndrome as per Rotterdam criteria

Diagnostic criteria for Rotterdam diagnosis of polycystic ovary syndrome
Two of the following three criteria are required:

  • polycystic ovaries on ultrasound (either 25 or more follicles per ovary or increased ovarian size (>10 cc)
  • oligo/anovulation
  • hyperandrogenism
    • clinical (hirsutism or less commonly male pattern alopecia) or
    • biochemical (raised FAI or free testosterone)

 

Post-Coital Bleeding

Essential information (Referral will be declined without this)

  • General referral information
  • Findings of speculum examination
  • Current cervical screening
  • HVS result
  • Sexual health history
  • STI screen result - endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA

Additional referral information (useful for processing the referral)

  • Pelvic USS (TVS preferable)

Other useful information for management (not an exhaustive list)

  • Pre-menopausal women who have a single episode of post-coital bleeding and a clinically normal cervix do not need to be reported if oncogenic HPV is not detected and LBC is negative

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Suspected malignancy

SCC, positive oncogenic HPV and/or HSIL on LBC, glandular lesion on cervical screening

Post-coital bleeding recurs or persists despite negative HPV or LBC

No category 3 criteria

 

 

Post-Menopausal Bleeding

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • No additional referral information

Other useful information for management (not an exhaustive list)

  • menopausal women with an incidental finding on pelvic ultrasound of a regular endometrial thickness of less than 11mm and having no episodes of postmenopausal bleeding would only need a repeat ultrasound and referral if developing vaginal bleeding

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Endometrial thickness >4mm

Cervical polyps

Suspicion of malignancy

Focal endometrial lesion

Endometrial thickness ≤4mm

No category 3 criteria

 

 

Primary, Secondary Amenorrhoea

Essential information (Referral will be declined without this)

  • General referral information
  • Duration of amenorrhoea (i.e. >6 months)
  • Weight/ BMI
  • BHCG results
  • FSH LH prolactin oestradiol TSH results
  • TAS – TVS USS may not be appropriate in non-sexually active females, therefore important to seek early advice from state-wide paediatric and adolescent gynaecology (SPAG) services

Additional referral information (useful for processing the referral)

  • Renal USS 

Other useful information for management (not an exhaustive list)

  • Primary amenorrhoea – is defined as the absence of menses at age 16 years in the presence of normal growth and secondary sexual characteristics and 14 in the absence of secondary sexual characteristics
  • Secondary amenorrhoea – absence of menses for more than six months after the onset of menses
  • Refer to state-wide paediatric and adolescent gynaecology (SPAG) services at LCCH/RBWH
  • Address excessive exercise or dieting
  • If BMI is greater than 30, manage weight loss
  • Address any significant stress or anxiety
  • Review medications if relevant (e.g. antipsychotics, metoclopramide)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

No category 1 criteria

Primary amenorrhoea

Secondary amenorrhoea

 

Vulva lesion, Genital warts, Boil, Swelling, Abscess, Ulcer, Bartholin's Cyst

Essential information (Referral will be declined without this)

  • General referral information
  • History of:
    • Pain, swelling
    • pruritus
    • dyspareunia
    • localised lesions (pigmented or non-pigmented lesions)
    • STIs or other vaginal infections
    • local trauma
  • Elicit onset, duration and course of presenting symptoms
  • Date of last menstrual period
  • Medical management to date
  • Cervical screening if referral for warts

Additional referral information (useful for processing the referral)

  • Vulva ulcers – swab M/C/S and viral PCR result
  • Vulval rashes – scraping, swaps or biopsy (as appropriate)
  • STI screen result -endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA (as appropriate)
  • Syphillis HIV serology (as appropriate)

Other useful information for management (not an exhaustive list)

  • For paediatric and adolescent gynaecology patients, please refer to state-wide paediatric and adolescent gynaecology (SPAG) services at LCCH/RBWH
  • Antibiotic treatment of Bartholins cyst is of no value.
  • In women where a vulval cancer is strongly suspected on examination, urgent referral should not await biopsy
  • Vulval cancers may present as unexplained lumps, bleeding from ulceration or pain.
  • Vulval cancer may also present with pruritus or pain. For a patient who presents with these symptoms and where cancer is not immediately suspected, it is reasonable to use a period of ‘treat, watch and wait’ as a method of management. However, this should include active follow-up until symptoms resolve or a diagnosis is confirmed. If symptoms persist, the referral may be urgent or non-urgent, depending on the symptoms and the degree of concern about cancer.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Vulval disease with suspicion of malignancy  [4]

  • For optimum care, patient should be seen within 2 weeks.   

Unexplained vulval lump, ulceration or bleeding [4]

  • For optimum care, patient should be seen within 2 weeks.   

Postmenopausal women with abnormal vulval lesions including warts

Pregnant or immunosuppressed

Suspected vulval dystrophy

Bartholin’s cysts or other vulval  cysts in patients >40 years old

Vulval warts where:

  • the patient is immunocompromised (e.g. HIV positive, immunosuppressant medications)
  • the diagnosis is unclear
  • atypical genital warts (including pigmented lesions)
  • there are positive results from the screen for other STI’s

Vulval lesion where:

  • there is treatment failure or where treatment cannot be tolerated due to side-effects
  • there are problematic recurrences

Vulval rashes

Vulval warts

Bartholin’s cyst/labial cysts

 

Other Gynaecology Condition

Essential information (Referral will be declined without this)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

 

 

Our Specialists

 

Dr Michael Beckmann Director of Obstetrics and Gynaecology
Dr Thea Bowler

Gynaecologist

Dr David Hodgson

Gynaecologist

Dr Tal Jacobson

Gynaecologist

Dr Luke McLindon

Gynaecologist

Dr Kym Warhurst

Gynaecologist

Dr Thea Bowler

Gynaecologist

Dr Peta Wright Gynaecologist/Adolescent Gynaecology
Dr Amy Mellor Gyanecologist/Adolescent Gyanecology

Contact Us

If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200

Current Waiting Time for Appointments

We provide up to date data on how long patients are waiting for their first appointment by specialtly here.

Referral Guideline Development

These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.

 

Content last reviewed: 1 June 2018

 

 
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