Top 25 Reasons for Gynecology Referral or Presentation
Menstrual Disorders
- Abnormal uterine bleeding unresponsive to medical therapy or with severe anemia requires gynecologic evaluation 1
- Dysmenorrhea unresponsive to medical therapy warrants referral 1
- Amenorrhea (primary amenorrhea by age 16 or secondary amenorrhea) necessitates evaluation 1
- Oligomenorrhea (infrequent menstruation) requires assessment, particularly when associated with fertility concerns 1
Pelvic Pain and Masses
- Acute pelvic pain with possible ovarian torsion, ectopic pregnancy, tubo-ovarian abscess, or adnexal mass requires urgent gynecologic consultation 1
- Chronic pelvic pain warrants referral for comprehensive evaluation 1
- Adnexal masses require gynecologic assessment, with referral to gynecologic oncology for intermediate-risk (O-RADS 4) or high-risk (O-RADS 5) lesions 1
- Endometriosis presents with pelvic pain, dysmenorrhea, and infertility requiring gynecologic management 2
Cervical and Vaginal Abnormalities
- Abnormal Pap test results requiring colposcopy mandate gynecologic referral 1
- Atypical glandular cells (AGC) on cervical cytology require colposcopy, endocervical curettage, and HPV testing 1
- Adenocarcinoma in situ (AIS) should be referred to a gynecologic oncologist 1
- Vulvar or cervical lesions of undetermined etiology require specialist evaluation 1
- Undiagnosed abnormal genital bleeding necessitates gynecologic assessment 3
Infections and Inflammatory Conditions
- Pelvic inflammatory disease requires referral if the primary provider is not comfortable with management 1
- Sexually transmitted infections with complications or recurrent disease may warrant gynecologic consultation 4
- Bartholin gland abscess and other vulvovaginal infections require evaluation 1
Reproductive and Fertility Issues
- Infertility (failure to conceive after 12 months of unprotected intercourse, or 6 months if age >35 years or with risk factors) requires referral to reproductive endocrinology 1
- Contraception management, particularly for intrauterine device insertion, may require gynecologic expertise 1
- Pregnancy management and prenatal care 1
- Premature ovarian insufficiency with menstrual dysfunction or fertility concerns requires referral to gynecology/reproductive medicine/endocrinology 1
Structural Abnormalities
- Possible genital tract anomalies (imperforate hymen, duplicated upper tracts, absence of vagina or uterus) require specialist evaluation 1
- Uterine leiomyomata (fibroids) causing symptoms or fertility concerns 2
- Urethral prolapse and other pelvic organ prolapse conditions 1
Cancer Screening and Surveillance
- Elevated CA-125 levels in postmenopausal women with pelvic mass, or CA-125 >200 units/mL in premenopausal women, warrant referral to gynecologic oncology 1
- Endometrial cancer risk factors with abnormal bleeding (particularly in women ≥35 years or with atypical glandular endometrial cells) require endometrial biopsy and gynecologic evaluation 1
- Surveillance after gynecologic cancer treatment requires ongoing gynecologic follow-up 5