Criteria for referral to public hospital specialist clinic services

• Suspected endometriosis that has not responded to adequate medical management
• Significant deep dyspareunia
• Dyschezia
• Known endometriosis with associated reproductive issues
• Suspected endometrioma.

Information to be included in the referral

Information that must be provided

• Details of previous surgical and medical management including the course of treatment, and outcome of treatment, over the past 12 months
• Transvaginal pelvic ultrasound results. (Transabdominal pelvic ultrasound results can be provided for women who have not become sexually active, are a survivor of sexual assault or have declined a transvaginal pelvic ultrasound.)
• Functional impact of symptoms on daily activities including impact on work, study, school or carer role
• Planning for pregnancy.

Provide if available

• Description of symptoms
  • dysmenorrhoea
  • deep dyspareunia
  • dyschezia
  • history of sub-fertility
• Sexually transmitted infections test results.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Referrals may be made to suitable community-based services wherever possible (see 1800 My Options).

Where a public health service also operates a community health service or GP clinic, demand for reproductive health services should be met through these GP clinics.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

Not applicable.