The following signs and symptoms should be investigated:

• vaginal bleeding after menopause
• bleeding between periods
• abnormal, watery or blood-tinged vaginal discharge
• unexplained weight loss
• pelvic pain
• difficult or painful urination.

Initial examinations and investigations include:

• a general and pelvic examination (including a speculum examination and cervical screening test)
• referral to an experienced gynaecological ultrasonographer for a transvaginal pelvic ultrasound.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

Communication

The GP’s responsibilities include:

• explaining to the patient and/or carer who they are being referred to and why
• supporting the patient and/or carer while waiting for specialist appointments
• informing the patient and/or carer that they can contact Cancer Council on 13 11 20.

Checklist

Timeframe

Any bleeding or abnormal vaginal discharge after menopause (more than 12 months after the last period) should be investigated without delay.

Any new, persistent or progressive symptoms in patients over the age of 40 should be investigated within 4 weeks of presenting with symptoms.

Symptoms that do not respond to treatment initiated by the GP (e.g. oral contraception or progesterone) should be evaluated within 3 months of treatment beginning.

Test results should be provided to the patient within 2 weeks of initial presentation.

If any investigations cannot be provided locally, then referral to a specialist for investigation and diagnosis should occur within 4 weeks of initial presentation to the GP.