Skip links and keyboard navigation

Oligo/amenorrhoea, hirsutism, acne, female infertility

Find assessment and management information at Brisbane South HealthPathways under:

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)

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
    • State-wide Paediatric and Adolescent Gynaecology Service sees patients up to 18 years of age

Refer to State-wide Paediatric and Adolescent Gynaecology Service (SPAG) at Queensland Children's Hospital /RBWH

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • 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
(appointment within 90 calendar days)
  • Delayed puberty (16 years and over)
  • Primary or secondary oligo/amenorrhoea.
Category 3
(appointment within 365 calendar days)
  • 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

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • 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 (To be included in all referrals)

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
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

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 for Oligo/amenorrhoea, hirsutism, acne, female infertility referrals (Referral will be returned without this)

  • History including:
    • reproductive features (hirsutism, infertility and pregnancy complications), and
    • metabolic implications (insulin resistance, metabolic syndrome, IGT, DM2 and potentially CVD)
    • family history of delayed puberty or hypogonadism
    • chronic ill health or any medications  

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

Polycystic ovarian disease investigations include

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

Hirsutism investigations include

  • Fasting glucose, lipids results
  • Testosterone, SHBG results

Amenorrhea include

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

Delayed Puberty

  • Short stature screen
  • TFTs, renal function, FBC, ESR, or CRP, Anti TTG
  • Urinalysis
  • Chromosones (Karytope) in girls only (Turner Syndrome)
  • Bone age

If a specific test result is unable to 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 for Oligo/amenorrhoea, hirsutism, acne, female infertility referrals

  • Consider pelvic USS (day 1-4 menstrual cycle). TVS preferable. TVS USS may not be appropriate in virginal young girls
  • 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 desired) 

Out of Catchment

Metro South 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 South 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.

Last updated 21 December 2023