Outpatient Hysteroscopy Clinic
Important
Diagnostic Hysteroscopy is available at all public hospital Gynaecology services. Please refer patients to their local Gynaecology Service unless management at KEMH is specifically required.
Role of the service
The KEMH Outpatient Hysteroscopy Clinic accepts patients who live within the KEMH catchment. The clinic offers diagnostic and therapeutic hysteroscopy procedures in an outpatient setting, avoiding the need for a general anaesthetic.
This service is particularly suitable for women requiring investigation of abnormal uterine bleeding or intrauterine pathology as well as for some patients with medical comorbidities that may preclude the use of a general anaesthetic.
Medically complex patients are best managed in a co-located tertiary service where there is ready access to specialised diagnostic services and medical consultation.
Outpatient endometrial sampling should be considered and offered where feasible, and the patient has consented appropriately.
Clinical inclusion criteria
Women requiring further investigation or treatment for:
- Postmenopausal bleeding
- Heavy menstrual bleeding
- Suspected or confirmed uterine polyps requiring assessment or treatment
- Suspected or confirmed submucosal fibroids requiring assessment or treatment.
Clinical exclusion criteria
- Patients who are unable to tolerate or decline an outpatient procedure
- Asymptomatic postmenopausal women with incidental endometrial thickening generally do not require a hysteroscopy unless there is increased vascularity, or the patient has other risk factors including obesity, unopposed oestrogen, genetic risk or strong family history. Consider Pipelle sampling and/ or general gynae referral.
Patients who are unable to tolerate an outpatient hysteroscopy should be referred directly to the General Gynaecology Service in the patient's catchment area for assessment.
All patients receive information outlining the outpatient procedure and analgesia recommendations. Local anaesthetic may be provided if required. Sedation and general anaesthesia are not available.
Referral requirements
Referrals should include:
- Detailed menstrual and gynaecological history, including the nature and duration of symptoms
- Relevant clinical concerns and indication for hysteroscopy
- Medical and surgical history
- Current medications and allergies
- Menopausal status.
Mandatory referral investigations (all women)
- Pelvic ultrasound, including a transvaginal ultrasound where appropriate
- Up to date Cervical Screening Test or Co-test as indicated
Additional investigations for heavy menstrual bleeding
- Full Blood Examination (FBE)
- Iron studies
- Thyroid Function Tests (TFTs)
- STI screening
Urgent referrals
Referrals are triaged according to symptom severity and menopausal status.
Priority is given to patients with:
- Postmenopausal bleeding with increased endometrial thickness on ultrasound
- Women with a history of breast cancer who are currently taking tamoxifen.
Urgent cases can be discussed with the Gynaecology On-Call Registrar on (08) 6458 2222.
Referral process
All referrals from GPs to this clinic are sent to the Central Referral Service WA (CRS) (external site). Ensure you provide the relevant information in the referral to enable appropriate triage, including required investigation results and letters from treating medical practitioners if relevant and request outpatient hysteroscopy clinic at WNHS.
Referrals using GP software that include all the relevant history and information are also welcome using CRS referral form templates (external site).