General gynaecology

The Gynaecology Clinics at the Royal Women’s Hospital are run by specialist multidisciplinary teams with an interest in menstrual disorders and other abnormal uterine bleeding, endometriosis, ovarian cysts, uterine fibroids, polyps, PCOS and other gynaecological conditions.

Services available

Tertiary gynaecology care is provided by a team of specialist doctors, nurses, physiotherapists and dietitians. Advanced laparoscopic surgeons work collaboratively with colorectal and urological surgeons when required, such as for the management of complex endometriosis cases.

Gynaecology at the Women’s offers a range of specialist medical and surgical options, including:

  • Investigation and management
    • Endometriosis/adenomyosis including where bowel and/or bladder involvement is present
    • Menstrual disorders
    • Ovarian cysts, fibroids, uterine/cervical polyps
    • Pelvic pain
    • Polycystic Ovarian Syndrome (PCOS)
    • Uterine abnormalities
  • Surgical approaches (where appropriate)
    • Laparoscopic, vaginal and abdominal myomectomies, hysterectomies and cystectomies
    • Laparoscopy and ablation for endometriosis and other pelvic pathologies
    • Outpatient hysteroscopy (without general anaesthetic) via Rapid Access Hysteroscopy Clinic
  • Non-surgical pelvic pain clinics
    • Early Intervention Pelvic Pain Clinic (Connect Program)
    • Chronic Pelvic Pain Clinic.

Depending on the patient’s clinical presentation, they may be initially triaged to, or later connected with, one of our other services:

Gynaecology services work closely with the Women’s Gynaecology Research Centre based at the Royal Women’s Hospital and affiliated with the University of Melbourne. Patients have the opportunity to be involved in observational and clinical trials.

Inclusion criteria and referral instructions

This service is for patients for whom the Women’s is the closest hospital with gynaecology services. We take referrals for mature minors and gender diverse people.

Essential information

All referrals must include essential demographic, surgical, medical and social history details, and relevant information about the presenting complaint. This includes findings from physical examination and if a patient is currently pregnant or trying to conceive. In detail: Women’s health referrals.

Condition-specific criteria and investigations

Patients must meet condition-specific criteria and have the following information/investigations included with referral. Unless otherwise stated, all test results must be from within the last 6 months.

Persistent amenorrhoea or irregular bleeding (>6 months)

Investigations:

  • Pelvic ultrasound
  • βhCG (to rule out pregnancy)
  • PCOS tests: Oestradiol, Prolactin, LH, FSH, TSH, 17 hydroxyprogesterone, SHBG
Post-menopausal bleeding or persistent post-coital bleeding

Investigations:

  • Pelvic ultrasound
  • Most recent CST
  • STI screening
Persistent heavy menstrual bleeding

Investigations:

  • Pelvic ultrasound
  • FBE, Ferritin
  • Consider: TSH, CST
Dyspareunia (entry or deep)

Investigations:

  • Pelvic ultrasound
  • Consider: STI screening
  • Consider: High vaginal swab (Candida, BV)
Endometrial/cervical polyps

Investigations:

  • Pelvic ultrasound
  • Most recent CST
Endometriosis

Endometriosis with one or more of:

  • significant deep dyspareunia
  • dyschezia
  • associated reproductive issues
  • suspected endometrioma
  • bowel and/or bladder involvement.

Investigations:

  • Pelvic ultrasound
  • Most recent CST
  • Consider: STI screen
  • Consider: TSH
  • If heavy menstrual bleeding: FBE, Ferritin
Ovarian and other adnexal pathology

Any of the following:

  • Suspected malignancy identified on clinical examination or imaging
  • Post–menopausal cyst of any size
  • Pre-menopausal complex ovarian cyst, suspected endometrioma, or dermoid
  • Persistent and enlarging ovarian cyst on imaging performed at least three months apart
  • Hydrosalpinx

Investigations:

  • Pelvic ultrasound/s
  • If suspected malignancy or post-menopausal ovarian cyst: Cancer antigen 125 (CA 125)
Pelvic pain

Essential information:

  • Comprehensive pain assessment
  • Current management to date, including medicine, surgery, analgesia regimen
  • Assessment of bowel, bladder and sexual function

Investigations:

  • Pelvic ultrasound (within last 6 months)

Please also consider:

  • If heavy menstrual bleeding: FBE, Ferritin
  • Most recent CST
  • STI screen
  • Previous pathology testing (e.g. Coeliac serology, calprotectin)
  • Other specialists seen
  • Relevant surgical or endoscopy reports
  • Other relevant imaging: abdominal or spinal if available
Polycystic ovarian syndrome (PCOS)
  • If confirmed: Seen by Endocrine Metabolic Clinic or Reproductive Services (if trying to conceive)
  • If suspected and meet criteria: Seen by general Gynaecology

Investigations:

  • βhCG (to rule out pregnancy)
  • Hormonal tests: Oestradiol, Prolactin, LH, FSH, TSH, 17 hydroxyprogesterone, SHBG
  • If not on oral contraceptive pill: biochemical androgens >3 months after cessation (free androgen index, free testosterone, DHEAS)
Uterine abnormalities

Uterine abnormality on USS with:

  • Associated symptoms
  • Planning pregnancy

Investigations:

  • Pelvic ultrasound
Uterine fibroids

Uterine fibroids on USS with one or more of:

  • Pain
  • Heavy bleeding
  • >6cm in size or multiple smaller
  • Increasing size
  • Plan or trying to conceive

Investigations:

  • Pelvic ultrasound
  • FBE
  • Ferritin

Urgent referral

Immediate assessment

The following gynaecological presentations require immediate assessment and should be directed to the patient’s closest emergency department:

  • severe, uncontrolled pelvic pain
  • haemodynamically unstable or concern
  • known endometriosis with hydronephrosis or bowel obstruction
  • torsion of the ovary (suspected or confirmed)
  • pelvic sepsis
  • sexual assault/violence
  • torsion or degeneration of uterine fibroids/leiomyoma
  • ovarian hyperstimulation syndrome.

Urgent assessment

Please mark your referral urgent if the patient has any of the following:

  • concerns of malignancy (clinically, imaging or tumour markers)
  • abnormal appearance of the cervix, vagina or vulva on examination
  • post menopausal bleeding on Tamoxifen or thickened endometrium
  • abnormal bleeding and is taking Tamoxifen
  • persistent intermenstrual bleeding and aged >40, or with risks factors for endometrial cancer
  • haemoglobin <100g/L
  • infected Bartholin’s cyst.

Deteriorating condition

For assessment or care due to concerning or deteriorating condition, please consider the most appropriate of:

  • re-referral with additional information and relevant updated investigation for triage reassessment
  • Women’s Health Triage Advice on (03) 8345 2192
  • registrar advice via the Women’s switchboard on (03) 8345 2000
  • Women’s Emergency Care.

Exclusion criteria

The following are not accepted for gynaecological care at the Women’s:

  • reversal of tubal ligation
  • cosmetic (non-medical) services (example, labiaplasty)
  • statewide gender affirmation services (available at Monash Health and the Royal Children’s Hospital)
  • general gynaecological conditions that have not first received standard management and investigations in primary care.

Guidance in assessing, managing and referring some problems can be found on HealthPathways Melbourne and the Victorian Statewide Referral Criteria.

Send referral

GPs and other specialists can refer to our Gynaecology Clinics via Fast Fax: (03) 8345 3036.

Use our Women’s Health Referral Form – jump to Referral templates (Downloads).

In detail: How referrals are processed

Appointments

Clinics are held across various days and times.

Most appointments are held face-to-face with some telehealth and phone options depending on clinical presentation and reason for consultation.



Date reviewed: 21 February 2025

Date reviewed: 21 February 2025