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Heavy menstrual bleeding (HMB)

Emergency 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

  • Suspicion of malignancy
  • HMB with anaemia (Hb<85) or requiring transfusion

Category 2

Appointment within 90 days is desirable

  • HMB with anaemia (Hb>85)

Category 3

Appointment within 365 days is desirable

  • HMB without anaemia not responding to medical management

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

Medical management

A woman with heavy menstrual bleeding is referred for early specialist review when there is a suspicion of malignancy or other significant pathology based on clinical assessment or ultrasound.

  • Consider increased risk of hyperplasia or malignancy if:
    • endometrial thickness greater than 12mm (transvaginal USS ideally day 4-7)
    • irregular endometrium or focal lesion
    • weight >90kg
    • PCOS/diabetes/unopposed oestrogen
    • age >45yrs
    • intermenstrual or post-coital bleeding
  • Medical treatment prior to or while waiting for specialist review if no suspicion of malignancy:
    • Progesterone releasing IUD
    • Tranexamic acid
    • OCP
    • NSAIDS
    • Oral progestogens

Referral is also arranged for a woman who has not responded after six months of medical treatment.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • General referral information
  • Brief description of periods
  • Medical management to date
  • Current pap smear results
    • Current cervical screening
  • FBC Serum ferritin results
  • Pelvic USS (TVS preferable)
  • Adolescent patient – Coag profile including von Willebrand’s disease (vWD)

Additional referral information (useful for processing the referral)

  • TSH if symptomatic of thyroid disease
  • Previous management modalities, iron utilisation if deficient

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.

  • 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

  • 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

  • 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

  • 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

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

  • 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.)
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