Oligo/amenorrhoea, hirsutism, acne, female infertility

On this page

Useful Management Information

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
- 5-10% weight loss or optimal weight BMI 20-25
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:  Monash International evidence-based guideline for the assessment and management of Polycystic Ovary Syndrome (PCOS) 2018

Two of the following three criteria are required:

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)

Minimum Referral Criteria

Category 1	Arrested puberty (16 years and over) Suspected hypopituitarism New onset virilisation in a female (hirsutism, acne, balding) Serum testosterone >5nmol/l in a female
Category 2	Delayed puberty (16 years and over)
Category 3	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 doesn't meet the minimum referral criteria 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, BMI), 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 including
- family history of delayed puberty or hypogonadism. History of chronic ill health or any medications
- reproductive features (hirsutism, infertility and pregnancy complications), and
- metabolic implications (insulin resistance, metabolic syndrome, IGT, T2DM and potentially CVD

For referrals related to Infertility include:

History of
- previous pregnancies
- STIs 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, Hepatitis BsAg, HBC serology, HIV results
FSH, LH (Day 2 - 5), prolactin, TSH results if cycle prolonged and/or irregular
Day 21 serum progesterone level results (7 days before the next expected period)
Endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
Partner
- Seminal analysis of partner (≥4 days of abstinence) report
  - Repeat in 4-6 weeks if abnormal

For Polycystic ovarian disease referrals include:

SHBG results
Testosterone, DHEA-S results
Fasting blood glucose result
Lipids, TSH results

For Hirsutism referrals include:
Fasting glucose, lipids results
Testosterone, SHBG results

For Amenorrhea referrals include:

Duration of amenorrhoea (i.e. >6 months)
Weight/BMI
ßeta HCG results
FSH, LH, prolactin, oestradiol, TSH results

For Delayed puberty referrals include:

Short stature screen
TFTs
Renal function
FBC
ESR or CRP
Anti TTG
Urinalysis
Chromosomes (karytope) in girls only (Turners syndrome)
Bone age

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Consider Pelvic USS (day 1-4 menstrual cycle) (TVS preferable if appropriate)
If suspected hypopituitarism then check other anterior pituitary hormones e.g. prolactin, TSH, T4, 09:00 cortisol, ACTH, IGF1, growth hormone
Consider 08:00 17 (OH) progesterone for Congenital Adrenal Hyperplasia

Infertility

History of marijuana use (including partner) or other relevant medications that contribute to infertility e.g. illicit drugs, steroids, chemotherapy

Delayed Puberty

LH/FSH, oestrogen or testosterone (highly desirable)

Send Referrals To

Smart Referrals

Coming Soon

Internal Referrals

Diabetes/Endocrinology (E-Blueslips)

Fax

5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Service Availability

Facilities

Gold Coast University Hospital

Robina 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.