Reviewed on : 11 Sep 2023

Reviewed by : Dionne Trivedi

Expires : 11 Sep 2025

GYNAECOLOGY 2WW

Please be advised that secondary care in Coventry and Warwickshire is continuing to experience increased demand in the number of Two Week Wait (2WW) referrals (August 2023)

The current waiting time is now consistently greater than 21 days for a first outpatient appointment for the Gynaecology 2WW service at University Hospital Coventry and Warwickshire NHS Trust (UHCW)

UHCW is exploring a number of operational plans for reducing the overall wait time with the aim to clear the majority of the backlog of patients

After several consultations with primary and secondary care stakeholders, we have amended the existing 2WW referral form to improve referral and triaging process

To support secondary care with clinical prioritisation, we would please ask for all 2WW referrals to include:

• A full physical, face to face examination
• Performance status completed
• Mental capacity status completed
• Need for interpreters completed
• Results transferred from EMIS as required on the form

After you have examined your patient, provide full clinical details of the patient examination within the 2WW referral form and complete all the required information boxes

All 2WW referrals should be made through the NHS eReferral Service (previously known as Choose & Book).

Please make all referrals (urgent and non-urgent) within 1 day in accordance with NICE guidance NG12

Please print for your patient a  Cancer Research UK Urgent Referral Leaflet – follow link (leaflets available to order through CRUK website)

Note: perimenopausal women with an endometrial thickness of more than 5mm should not be referred on a 2WW and should be referred to the heavy menstrual bleeding clinic* after assessment and management in primary care as per NICE guidance.

There is no heavy menstrual bleeding clinic at SWFT – Please refer via routine ERS

When a patient is referred on the Gynaecology two week wait (2WW) pathway at University Hospitals Coventry and Warwickshire (UHCW) an ultrasound scan is included in the patient journey.

Referral Criteria

Ovarian  *Please note appropriate investigations

Refer the woman urgently if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids)

• Elevated CA125 >35 with persistent abdominal distension/bloating

As per NICE, the following symptoms should be referred if associated with elevated CA125:

• Persistent abdominal distention/bloating
• Feeling full (early satiety) and/or loss of appetite
• Pelvic or abdominal pain
• Increased urinary urgency and/or frequency
• Unexplained weight loss, fatigue, or changes in bowel habit

Endometrial/Uterine *Please refer to the BMS guidance on PMB and *HRT Guidance

• Post-Menopausal bleeding not on HRT (Postmenopausal is absence of periods for 12 months; please DO NOT refer perimenopausal bleeding under this criterion)
• Post-Menopausal bleeding persistent/unexplained after cessation of HRT for 6 weeks *
• Women on HRT with persistent abnormal bleeding after 6 months of starting HRT*
• Dysfunctional bleeding on Tamoxifen – *see guidance for referral on Tamoxifen
• Women diagnosed with Lynch Syndrome with abnormal bleeding
• Asymptomatic postmenopausal women with ultrasound scan findings of endometrial thickness more than 8mm
• If referral for PMB, has patient been previously investigated for this within last 12 months

Cervical *Postcoital bleeding and intermenstrual bleeding with a normal cervix is not an indication for 2WW *see PCB guidance

• Appearance of the cervix on the speculum examination is consistent with cervical cancer: Suspicious lesion on cervix

Vulval/Vaginal

• Unexplained lump or suspicious lesion
• Bleeding due to ulceration

Recurrence of Cancer

• Suspicion of recurrence of known gynaecological cancer

Post Coital Bleeding (PCB) Guidance

Follow this link to GP Gateway Post Coital Bleeding Page

Lynch Syndrome

Previously known as hereditary non-polyposis colorectal cancer or HNPCC.

Other cancers which may be associated with Lynch syndrome include:

• endometrial
• ovarian
• stomach
• small bowel
• bile duct / gall bladder
• brain
• pancreas
• urothelial (kidney, ureter and possibly bladder)
• skin
• Some with Lynch syndrome may have more than one primary cancer