Oligo/amenorrhoea, hirsutism, acne, female infertility
Emergency referrals
Phone on call Diabetic and Endocrinology Registrar via:
- Royal Brisbane & Women’s Hospital switch - (07) 3646 8111
- The Prince Charles Hospital switch - (07) 3139 4000
- Redcliffe Hospital switch – (07) 3883 7777
- Caboolture Hospital switch – (07) 5433 8888
and send patient to the Department of Emergency Medicine (DEM) at their nearest hospital.
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
- Suspected hypopituitarism
- New onset virilisation in a female (hirsutism, acne, balding)
- Serum testosterone >5nmol/l in a female
Category 2
Appointment within 90 days is desirable
- Delayed puberty (16 years and over)
Category 3
Appointment within 365 days is desirable
- Primary or secondary oligo/amenorrhoea. For optimum care, patient should be seen within 6 months.
- Biochemical hyperandrogenism and/or related clinical signs of acne and/or hirsutism without evidence of severe androgen excess
- Polycystic ovarian syndrome as per Rotterdam criteria in the absence of any other explanation
- All referrals for infertility (definition: – infertility is the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse)
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 local Healthpathways or local guidelines
- Focus of management should be on education and support with a strong emphasis on healthy lifestyle, with targeted medical therapy where indicated
- 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
- IVF not available in public hospitals
- 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
Infertility
- Folic acid 0.5mg/day
Hirsutism
- Self-administered and professional cosmetic therapy are first line (laser recommended)
- Eflornithine cream can be added and may induce a more rapid response
- If cosmetic therapy is not adequate, pharmacological therapy can be considered
- Pharmacological therapy – cyproterone acetate, spironolactone
Diagnostic criteria for Rotterdam diagnosis of polycystic ovary syndrome:
Two of the following three criteria are required Monash International evidence-based guideline for the assessment and management of Polycystic Ovary Syndrome (PCOS) 2018:
- 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)
Amenorrhea in children or adolescents:
- In adolescents – consideration needs to be given as to whether the patient should be referred to a paediatric or adult facility. Some general considerations would be:
- Primary amenorrhoea with growth failure and delayed puberty would more likely be best assessed by a paediatric service.
- secondary amenorrhoea to an adult facility
- statewide Paediatric and Adolescent Gynaecology Service sees patients up to 18 years of age
- Refer to Statewide Paediatric and Adolescent Gynaecology Service (SPAG) at Queensland Children’s Hospital/RBWH
Referral requirements
A referral may be rejected without the following information.
Send referral
Hotline: 1300 364 938
Fax: 1300 364 952
Electronic: eReferral system
Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways
Login to Brisbane North Health Pathways:
brisbanenorth.