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Intermenstrual bleeding


Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Oncogenic HPV, LBC prediction of pHSIL/HSIL, possible high-grade glandular lesion, AIS, or invasive cancer – cervical or endometrial
    • Focal endometrial lesion
  • Category 2
    (appointment within 90 calendar days)
    • IMB not due to hormonal contraception
    • Abnormal cervical screening (other than for Cat 1)
    • Endometrium >12mm / irregular on pelvic USS (TVS ideally day 5-10)
    • Persistent and/or unexplained IMB
  • Category 3
    (appointment within 365 calendar days)
    • IMB bleeding related to hormonal contraception that is not responding to medical management e.g. contraception manipulation

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • History of abnormal bleeding / hormonal contraceptive use
  • Recent co-test result (HPV and LBC)
  • HVS result
  • BHCG result
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • Pelvic USS (TVS preferable)

3. Additional referral information Useful for processing the referral

  • BMI

4. Request

Last updated: 13 June 2023