Women’s Health Service Review Consultation

This service is suitable for:

• Birth sex females aged 18 years and above

This service is NOT suitable for patients:

• Under 18 years of age
• With a known history of, or suspected, gynaecological cancer (cervical, uterine/endometrial, ovarian, vaginal, or vulval cancer – personal history or active diagnosis)
• Seeking antenatal care: Pregnant patients should contact their GP, maternity service or midwife. General advice may be provided where appropriate.
• Seeking insertion or fitting of contraceptive devices (IUD, IUS/Mirena coil, subdermal implant, or contraceptive ring)
• With unexplained vaginal bleeding that has not yet been assessed by a doctor.
  • Many types of bleeding can be discussed during this service. However, some forms of bleeding require urgent in person assessment. 
  • Please seek urgent medical attention if you have: Very heavy bleeding, Bleeding after menopause, Bleeding during pregnancy, Bleeding together with severe pain, fainting, or feeling very unwell
• With active Venous Thromboembolism (blood clots in the veins)
• Seeking assessment and treatment of perimenopausal or menopausal symptoms, including HRT – book our dedicated Menopause Service.
• Emergency exclusions: Heavy bleeding causing dizziness or fainting, suicidal ideation or a severe mental health crisis

The Women's Health Service at Careoncall is a telehealth service designed to support women across a broad range of gynaecological and reproductive health concerns. It is staffed by GPs with a special interest in women's health, and operates in accordance with the best practice international medical guidelines.

Please note: Patients seeking assessment and treatment of perimenopausal or menopausal symptoms, including HRT, should book our dedicated Menopause Service.

The service aims to:

• Provide timely assessment of symptoms
• Offer evidence-based treatment options and/or prescriptions where clinically appropriate
• Provide referral letters for investigations (blood tests, ultrasound, specialist referral)
• Offer dietary, lifestyle, and health promotion advice
• Support patients in navigating the Irish healthcare system for women's health concerns

This service can discuss and advise on a wide range of women's health conditions, including but not limited to:

• Menstrual health
• PMS/PMDD
• Endometriosis
• PCOS
• Pelvic pain
• Ovarian cysts
• Vaginal and vulval health
• Pelvic organ prolapse
• Contraception
• Sexual health
• Urinary health

Menstrual disorders are very common and can significantly affect quality of life. This service covers:

• Heavy periods (menorrhagia): Defined as blood loss that interferes with everyday life. Soaking through a pad or tampon every 1–2 hours, passing large clots, or periods lasting more than 7 days are indicators.
• Painful periods (dysmenorrhoea): Cramping pain before or during menstruation. Primary dysmenorrhoea is common in younger women; secondary dysmenorrhoea may indicate an underlying condition such as endometriosis.
• Irregular or infrequent periods: Cycles that regularly occur less than 21 days apart, more than 35 days apart, or vary significantly from month to month.
• Absent periods (amenorrhoea): No period for 3 or more months in women who have previously had regular cycles, or who have not yet started menstruation by age 16.
• Intermenstrual and postcoital bleeding: Bleeding between periods or after sexual intercourse, which requires clinical assessment to exclude cervical or endometrial pathology. Generally, this requires a physical examination so advice only may be offered on this in particular.

PMS encompasses a range of physical and emotional symptoms that occur within the two weeks leading to a period and resolve with menstruation. 

PMDD is a more severe form characterised by significant mood disturbance. Common symptoms include:

• Mood changes: irritability, anxiety, depression, emotional lability
• Physical symptoms: breast tenderness, bloating, headaches, fatigue
• Sleep disturbance, poor concentration, reduced coordination

A symptom diary over two consecutive cycles is used to confirm the diagnosis, as diagnosis is based on clinical criteria which includes physical and emotional symptoms. Treatment options include lifestyle modification, CBT, SSRIs, hormonal therapies, and in severe cases, GnRH analogues. GnRh analogues would only be prescribed through a Consultant based clinic. 

Endometriosis affects approximately 10% of women of reproductive age. It occurs when tissue similar to the lining of the uterus (endometrium) grows in other areas of the body, typically within the pelvis. Symptoms include:

• Severe period pain that is disproportionate to the heaviness of bleeding
• Chronic pelvic pain throughout the menstrual cycle
• Deep pain during or after sexual intercourse (deep dyspareunia)
• Pain during bowel movements or urination, particularly around menstruation
• Fatigue, bloating, nausea
• Fertility difficulties

Diagnosis will involve pelvic examination, transvaginal ultrasound, possibly MRI, or laparoscopy. Our role here would be in helping with referrals and initiating symptomatic treatments as needed. This service can initiate hormonal management and facilitate referral for surgical assessment where appropriate.

PCOS is one of the most common hormonal conditions in women of reproductive age, affecting 5–10% of women. It is characterised by a combination of:

• Irregular or absent periods. A menstrual diary of the previous 6-12 months is very helpful.
• Elevated androgens (male hormones), which can be considered on the following symptoms: acne, excess facial/body hair (hirsutism), hair thinning
• Polycystic ovaries on ultrasound

PCOS is also associated with insulin resistance and metabolic syndrome. This service can assist with hormonal regulation, acne management, metabolic health advice, and fertility counselling. 

PCOS requires two of the key criteria listed above for Diagnosis.

Pelvic pain may be acute or chronic (lasting more than 6 months). Chronic pelvic pain affects approximately 1 in 6 women. Pelvic pain can stem from issues in your reproductive, urinary, digestive, or musculoskeletal systems, so a detailed history will be taken of these areas. 

Causes can include:

• Endometriosis, adenomyosis
• Pelvic inflammatory disease (PID)
• Ovarian cysts
• Adhesions from previous surgery or infection
• Interstitial cystitis or bladder pain syndrome
• Musculoskeletal causes
• Irritable bowel syndrome

Please note: Patients with severe pelvic pain, vomiting, fever, collapses, or pregnancy associated pain should seek urgent medical assessment.

PID is an infection of the upper female genital tract (uterus, fallopian tubes, ovaries) and is most commonly caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhoea. Symptoms include:

• Bilateral lower abdominal/pelvic pain
• Abnormal vaginal discharge (often with an unpleasant odour)
• Deep pain during intercourse
• Intermenstrual or postcoital bleeding
• Fever, nausea

Where PID is suspected, appropriate treatment and/or referral recommendations may be provided. Some patients may require urgent in-person assessment.

Ovarian cysts are fluid-filled sacs that develop on or within an ovary and are common in women of reproductive age.

• Simple cysts: Enlarged follicles; most resolve spontaneously
• Endometriomas: Associated with endometriosis
• Dermoid cysts (teratomas): May contain various tissue types

Small simple cysts (<5 cm) often require no treatment. Larger or complex cysts require further imaging and possible surgical intervention. This service can initiate assessment and referral for scans or A/E if the issue is more acute.

Important: Acute onset severe pelvic pain requires immediate medical assessment to exclude ovarian torsion.

This service covers a range of vaginal and vulval conditions including:

• Recurrent vaginal infections: Including bacterial vaginosis (BV) and recurrent vulvovaginal candidiasis (thrush)
• Vaginal dryness and atrophy: Can occur at any age but is particularly common in peri/postmenopausal women. Local oestrogen preparations can be prescribed
• Vulval skin conditions: Including lichen sclerosus, lichen planus, vulval dermatitis, and psoriasis
• Vulvodynia/vestibulodynia: Chronic vulval pain without an identifiable cause

Many vulval conditions are underdiagnosed. Appropriate clinical assessment, topical treatments, and referral to vulval dermatology can be facilitated.

Vulval skin conditions and vulvodynia do require a physical exam as part of the assessment. 

Pelvic organ prolapse (POP) affects approximately 1 in 10 women over the age of 50. It occurs when the pelvic floor muscles weaken, allowing the bladder, uterus, or rectum to bulge into the vagina. Symptoms include:

• A feeling of heaviness, dragging, or a 'something coming down' sensation in the pelvis
• A visible bulge at the vaginal opening
• Urinary urgency, frequency, or difficulty emptying the bladder
• Incomplete bowel emptying or constipation
• Discomfort during intercourse

Per international guidelines, conservative management (pelvic floor exercises, pessaries, local oestrogen) is first-line. This service can initiate conservative treatment, refer to pelvic floor physiotherapy, and facilitate gynaecological referral for surgical consideration if required. Physical examination may be advised also as part of the assessment. 

This service provides advice and prescription of reversible hormonal contraception, including:

• Combined oral contraceptive pill (COCP)
• Progestogen-only pill (POP/ mini-pill)
• Contraceptive patch and ring (e.g. Evra and Nuvaring)
• Emergency hormonal contraception (morning-after pill)

This service does NOT provide: prescriptions or fitting or insertion of contraceptive devices, including IUD (copper coil), IUS (Mirena/Levosert/Kyleena), or subdermal implant (Nexplanon). These require an in-person procedure at your GP practice, sexual health clinic, or family planning service.

For comprehensive contraception information, patients are directed to the Irish Family Planning Association (IFPA) at ifpa.ie.

Sexual health concerns addressed by this service include:

• Dyspareunia (painful intercourse): Can have physical causes (vaginal dryness, vaginismus, pelvic inflammatory disease, endometriosis) or psychological components. We can advise on any tests/examinations required as needed and treatment options once a clear path has been identified. 
• Low libido (hypoactive sexual desire disorder): Commonly associated with hormonal changes, relationship factors, and mental health; can be addressed with appropriate management.
• Vaginismus: Involuntary tightening of the vaginal muscles making penetration painful or impossible; referral to psychosexual therapy or pelvic floor physiotherapy may be indicated.

Any bleeding that occurs more than 12 months after the last period in a woman over 50 (or 24 months in a woman under 50) requires clinical assessment to exclude endometrial pathology. This service can facilitate appropriate investigation (transvaginal ultrasound, referral to rapid access gynaecology clinic) in accordance with HSE guidance.

Important: Postmenopausal bleeding is a red flag symptom that requires urgent investigation. Patients should not delay seeking assessment.

Urinary symptoms in women are commonly related to gynaecological conditions or pelvic floor dysfunction. For all referrals, the initial evaluation requires two documented mid-stream urine (MSU) samples from separate occasions, with laboratory-confirmed bacterial growth and antibiotic sensitivities.

This service covers:

• Recurrent urinary tract infections (rUTI): Defined as 2 or more UTIs in 6 months, or 3 or more in 12 months. Episodes must be laboratory-confirmed via urine culture. Management may include self-start antibiotics, prophylactic antibiotic therapy, or topical oestrogen for postmenopausal women.
• Stress urinary incontinence: Involuntary leakage when coughing, sneezing, or exercising. Pelvic floor physiotherapy is the first-line treatment and can be arranged via referral.
• Urgency urinary incontinence / Overactive bladder: A sudden, compelling urge to urinate. Management options include bladder retraining, lifestyle modification, and medication.