Menstrual irregularities referral checklist

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.

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.

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.

References

• SOGC guideline: abnormal uterine bleeding in pre-menopausal women (opens in a new tab)

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