Premenstrual Syndrome (PMS) /Premenstrual dysphoric disorder (PMDD)
Adult

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Emergency Referrals

Useful Management Information

Refer to local guidelines

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Severe PMDD with risk of self-harm or severe functional impairment impacting safety NB: Referral to a Persistent pain service may be considered if chronic pelvic pain coexists and remains uncontrolled
Category 2 (appointment within 90 calendar days)	Severe PMS/PMDD symptoms unresponsive to initial medical management (e.g., SSRIs, hormonal treatments) and causing significant impact on daily functioning, including work, relationships, or school Co-existing psychiatric disorders that exacerbate PMDD symptoms, requiring close gynaecologic and mental health management Moderate to severe PMS/PMDD with substantial impact on quality of life, affecting daily activities and relationships but without immediate safety concerns Symptoms persisting despite trial of first-line treatments (e.g., lifestyle modifications, basic hormonal therapies) Worsening symptoms requiring review for alternative treatments (e.g., second-line hormone therapy, SSRIs) or multidisciplinary input NB: Referral to a persistent pain service may be considered if symptoms are accompanied by chronic pelvic pain that has not responded to initial treatments
Category 3 (appointment within 365 calendar days)	Mild PMS/PMDD symptoms that do not significantly impair daily functioning but require specialist advice or management adjustments
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at 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

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), 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

Medical management to date and/or therapies previously tried
Mental health assessment, including any diagnosed psychiatric conditions or current use of psychiatric medications, and history of mental health support if relevant
Screening for suicidal ideation or other severe psychological symptoms, particularly in cases of PMDD

Additional Referral Information

Family history of PMS/PMDD or other menstrual disorders
Any relevant medical history
If chronic pelvic pain is present, describe its relationship with the menstrual cycle, severity, and impact on quality of life*

*This information would help decide if a concurrent referral to a persistent pain service is necessary

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Gynaecology (E-Blueslips)
Colposcopy (E-Blueslips)

Fax

(07) 5687 4497

Post

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

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Graeme Walker

Medical Director Gynaecology

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.

Premenstrual Syndrome (PMS) /Premenstrual dysphoric disorder (PMDD)Adult