Persistent Pelvic Pain/Dysmenorrhea
Adult

Endometriosis and Pelvic Pain Service

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Emergency Referrals

Useful Management Information

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
Medical management
Important to exclude cyclical bladder, bowel symptoms
Treat infection if present
Simple analgesia (NSAIDS)
Suppress menstrual cycle with oral progesterones or oral contraceptive pill / Iimplanon® / depo-provera / Mmirena®. Aim for amennohrroeaamenorrhoeaincluding continuous COCP
Aim to regulate stool to BSFS: 3-4.
Treat dysmenorrhoea with NSAIDSwith NSAIDS started 24 hours prior to mensess+/or COCPavoiding use of inactive pills. +/- TXA
PAG patients use Ponstan, and progesterone (separate section?)

Patient resources

Pelvic Pain Foundation Australia
QENDO:Supporting Australian with Endometriosis
[LT1] DOES THIS BELONG IN A PAG CPC APPENDIX?
[LT2] Addressed by Prof Kimble

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Severe dysmenorrhoea in PAG patient usually associated with heavy mentrual bleeding definted as pain, that significantly disrupts daily activities, is refractory to first-line treatments (e.g., NSAIDs), pain may also result in scholl absences, emergency presentations, or impacts quality of life and mental health, Refer to Statewide PAG Services
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) USS findings e.g. presence of endometriomas / fixed retroverted uterus with symptoms 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 (viscerovisceral hyperalgesia) not attributable to other primary cause History of endometriosis and infertility
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

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

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

History of/to:
- 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. This should be collected by the clinicians looking after the woman. Not sure it belongs on a referral for all and sundry to view?
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

Additional Referral Information

BMI
Prior operativ e pictures/surgical notes/discharge summaries pertaining to laparoscopic intrapelvic surgery. I

Send Referrals To

Smart Referrals

Preferred Method About Smart Referrals

Secure Web Transfer

Gold Coast Health

Internal Referrals

Endometriosis Pelvic Pain Interdisciplinary Clinical Service (EPPICS) (e-BlueSlips)

Fax

(07) 5687 4497

Post

Endometriosis and Pelvic Pain Service
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 744 284

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Graeme Walker

Medical Director Gynaecology

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Persistent Pelvic Pain/DysmenorrheaAdult