Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • suspected pituitary tumour with concerning features including:
    • acute new visual field loss (usually temporal and classically bitemporal superior quadrantinopia/hemianopia)
    • thunderclap headache
    • symptomatic cortisol insufficiency

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network


  • In vitro fertilisation (IVF) - not provided in public hospitals

Triage categories

Category 1 - appointment clinically indicated within 30 days

  • arrested puberty (16 years and over)
  • suspected hypopituitarism or pituitary tumour
  • new onset virilisation in a female e.g. hirsutism, acne, balding
  • serum testosterone greater than 5nmol/l in a female

Category 2 — appointment clinically indicated within 90 days

  • delayed puberty (16 years and over)

Category 3 — appointment clinically indicated within 365 days

  • biochemical hyperandrogenism and/or related clinical signs of acne and/or hirsutism without severe androgen excess
  • polycystic ovarian syndrome as per Rotterdam criteria
  • primary or secondary oligo/amenorrhoea

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical/reproductive history, including:
    • family history of delayed puberty or hypogonadism
    • history of chronic ill health or any medications
    • reproductive features (hirsutism, infertility and pregnancy complications)
    • metabolic implications (insulin resistance, metabolic syndrome, impaired glucose tolerance, type 2 diabetes and potentially cardiovascular disease)
  • current medications and dosages
  • use/frequency of alcohol, tobacco, and other drugs, including:
    • history of marijuana use (including partner)
    • other relevant medications that contribute to infertility e.g. illicit drugs, steroids, chemotherapy
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral
  • height/weight
  • body mass index (BMI)
  • abdominal/pelvic examination
  • transvaginal ultrasound (US) between days 1 to 4 menstrual cycle

Suspected infertility

  • complete blood examination (CBE)
  • electrolytes, urea & creatinine (EUC)
  • liver function test (LFT)
  • estimated glomerular filtration rate (eGFR)
  • follicle-stimulating hormone (FSH)
  • luteinizing hormone (LH) - Day 2 to 5
  • prolactin
  • thyroid stimulating hormone (TSH)
  • blood group and antibody screen
  • rubella immunoglobulin G (IgG)
  • varicella-zoster IgG
  • syphilis serology
  • hepatitis B surface antigen (HBsAg)
  • hepatitis C (HBC) serology
  • human immunodeficiency virus (HIV) antigen/antibody
  • day 21 serum progesterone level 7 days before the next expected period
  • endocervical swab or first catch urine for chlamydia +/- neisseria gonorrhoeae nucleic-acid-based amplification assays (NAA)
  • partner:
    • seminal analysis of partner
    • repeat in 4 to 6 weeks if abnormal

Suspected hirsutism

  • fasting blood glucose
  • lipids
  • testosterone
  • sex hormone binding globulin (SHBG)
  • dehydroepiandrosterone sulphate (DHEAS)

Suspected amenorrhea

  • human chorionic gonadotropin (ßhCG)
  • oestradiol

Delayed puberty

  • erythrocyte sedimentation rate (ESR) OR C-reactive protein (CRP)
  • thyroid function tests (TFTs)
  • insulin like growth factor (IGF1) or additional tests related to growth
  • coeliac screen
  • oestrogen (female)/testosterone(male)
  • urinalysis
  • karyotype (girls only) to exclude Turner Syndrome
  • bone age study X-ray

Suspected hypopituitarism

  • TSH
  • free thyroxine (FT4)
  • morning cortisol (8.00 am to 9.00 am)
  • adrenocorticotropic hormone (ACTH)
  • IGF1

Clinical management advice

Primary amenorrhoea is defined as the absence of menarche by:

  • age 13 years in a female without breast development
  • age 15 years in a female with normal growth and breast development
  • 5 years after breast development that occurred before age 10 years

Secondary amenorrhoea is defined as the absence of menstruation for:

  • more than 3 months in females with previously regular menstrual cycles
  • more than 6 months in females with previously irregular menstrual cycles

Common causes of primary amenorrhoea include:

  • hypogonadotropic causes such as constitutional delay, hypothalamic amenorrhoea and isolated gonadotrophin-releasing hormone deficiency e.g. Kalman syndrome, pituitary causes, hypopituitarism and hyperprolactinaemia
  • hypergonadotropic causes such Turner syndrome, gonadal dysgenesis, premature ovarian insufficiency
  • anatomical outflow tract abnormalities
  • rare hormonal conditions such as androgen insensitivity and 5-alpha- reductase deficiency

Most common causes of secondary amenorrhoea or oligomenorrhoea include:

  • hypergonadotropic causes such as premature ovarian insufficiency and early menopause
  • hypogonadotropic causes, such as hypothalamic amenorrhoea, pituitary tumours causing hyperprolactinaemia, hypopituitarism
  • intrauterine adhesions - Asherman syndrome
  • perimenopause in females aged 45 years and older
  • polycystic ovarian syndrome diagnostic criteria (Rotterdam Criteria) 2 of the following 3 criteria are required:
    • polycystic ovaries
    • oligo/anovulation
    • hyperandrogenism
  • clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
  • pregnancy

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.


When experiencing difficulty in conceiving, commence of 500mcg folic acid daily refer to gynaecology.


Specialist referral is required for investigation and management of primary amenorrhea. Children or adolescents experiencing amenorrhea, referral to paediatric gynaecology services at the Women's and Children's Hospital (WCH) is advised.

Medications known to induce hypothalamic or pituitary suppression, such as combined oral contraceptives, depot medroxyprogesterone, Gosselin, or those causing hyperprolactinemia, such as antipsychotics, antiemetics, verapamil, selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants, can be responsible for these symptoms.

Clinical resources

Consumer resources