Referrals
Menstrual irregularities referral checklist
Baseline workup, red flags, and referral note elements for menstrual irregularities.
Last reviewed 2026-01-05|gyne | bleeding | workup
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Minimum pre-referral workup
- Pregnancy test and menstrual calendar review.
- CBC for anemia and ferritin if heavy bleeding.
- TSH and prolactin when indicated.
- Pelvic ultrasound if structural cause suspected.
- Review medications, contraception, and bleeding disorders history.
Urgency tier
- Hemodynamic instability or symptomatic anemia.
- Heavy bleeding in pregnancy or postmenopausal bleeding.
- Severe pelvic pain, fever, or suspected infection.
- Rapidly enlarging pelvic mass.
- Bleeding requiring acute care or transfusion.
Referral packet checklist
- Age, parity, LMP, and cycle pattern description.
- Bleeding volume, duration, and associated symptoms.
- Contraceptive use and pregnancy plans.
- Exam findings and pelvic ultrasound results.
- Lab results and prior treatment trials.
Pre-referral optimization tasks
- Stabilize bleeding symptoms with first-line therapy when appropriate.
- Review iron replacement and anemia monitoring if heavy bleeding is present.
- Reinforce return precautions for heavy ongoing bleeding, dizziness, or severe pelvic pain.