Polycystic Ovarian Syndrome (PCOS)

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.

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

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

Category 2

Appointment within 90 days is desirable

No category 2 criteria

Category 3

Appointment within 365 days is desirable

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 20 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)

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

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 dietitian

Referral requirements

A referral may be rejected without the following information.

Essential referral information

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)

Body mass index (BMI)

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