Persistent Pelvic Pain/Dysmenorrhea

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Acute/severe pelvic pain
    • Refer to HealthPathways and or local guidelines
    • Severe dysmenorrhoea in Paediatric and Adolescent Gynaecology (PAG) patient may be symptom of outflow tract obstruction in duplex system, and congenital Mullerian anomalies, needing urgent referral to Statewide PAG Services at RBWH and QCH
    • Treat infection if present
    • Suppress menstrual cycle with oral progesterones/depo-provera/Mirena®. Aim for amenorrhoea
    • Aim to regulate stool to BSFS: 3-4.
    • Treat dysmenorrhoea with NSAIDS started 24 hours prior to menses
    • PAG patients use Ponstan, and progesterone

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Severe dysmenorrhoea in Paediatric and Adolescent Gynaecology (PAG) patient usually associated with heavy menstrual bleeding. Pain significantly disrupts daily activities, is refractory to first-line treatments (e.g., NSAIDs) and may also result in school absences, emergency presentations, or impacts quality of life and mental health
Category 2
(appointment within 90 calendar days)
  • Regular Emergency Department presentations: >3 presentations in 6 months not attributable to other acute causes of pelvic pain (i.e. ovarian cyst)
  • Symptomatic with USS findings e.g. presence of endometriomas / fixed retroverted uterus
  • Pelvic pain causing absenteeism from school/work on a regular basis not responding to simple analgesia or hormonal control
Category 3
(appointment within 365 calendar days)
  • Persistent pelvic pain not responding to maximal medical management
  • Associated bladder and/or bowel dysfunction (viscero-visceral hyperalgesia) not attributable to other primary cause
  • History of endometriosis and infertility

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History including:
    • pain, severity and duration, cyclical nature, dysmenorrhoea
    • dyschezia, dyspareunia,
    • history of subfertility or include criteria for current fertility wishes?
    • Medical management to date and efficacy
    • History of PID
    • Psychiatric history
    • Psychosocial factors influencing severity of presentation e.g. current or suspected DV, cultural factors, trauma, high levels of patient distress.
    • Functional status, including absenteeism frequency
  • Most recent or 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). TA Ultrasound in PAG patients, and if indicated by congenital anomaly MRI* is necessary.

*Discuss with Statewide PAG Services as MRI needs to be done by specialised radiology services with expertise in Congenital Mullerian Anomalies

3. Additional referral information Useful for processing the referral

  • BMI
  • Prior operative pictures/surgical notes/discharge summaries pertaining to laparoscopic intrapelvic surgery.

4. Request

  • Patient's 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

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • 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.

Last updated: 29 January 2025

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