Persistent Pelvic Pain/Dysmenorrhea

Emergency department referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

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

Acute/severe pelvic pain

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

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 days is desirable

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 days is desirable

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

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

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

Other important information for referring practitioners

Not an exhaustive list

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
Medical management
- 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

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History including:
- pain, severity and duration, cyclical nature, dysmenorrhoea
- 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 results
HVS result
STI screen result
Endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
MSU, M/C/S results
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 (useful for processing the referral)

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

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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