Gynecology Resources
At Children’s Healthcare of Atlanta, our pediatric-trained team is experienced in the medical and surgical management of girls with a wide range of gynecology issues.
Common Conditions Treated
- Abnormal uterine bleeding
- Adnexal masses (ovarian/paraovarian cysts)
- Amenorrhea
- Complex contraception (pregnancy prevention in medically complex patients)
- Congenital adrenal hyperplasia
- Delayed puberty
- Disorders of sex development
- Dysmenorrhea
- Endometriosis
- Hormone replacement therapy
- Menstrual suppression for special needs
- Mullerian (uterine) anomalies
- Pelvic inflammatory disease
- Precocious puberty
- Premature ovarian insufficiency
- Polycystic ovarian syndrome
- Urethral prolapse
- Vaginal anomalies
- Vulvar vaginal issues
- Vaginal discharge
- Prepubertal vulvovaginitis
- Labial/vulvar masses and ulcers
- Lichen sclerosus
- Labial adhesions
- Labial hypertrophy
- Genital tract trauma
How to Refer a Patient to Children's Gynecology
Please reference our gynecology referral guidelines below before referring a patient for consultation. To refer a patient to Children’s Gynecology, use one of the following methods:
- Online referral form: Complete and submit our secure online form.
- Print and fax: Download our form and fax it to 404-785-9111.
- accessCHOA: This free, secure, web-based electronic health record system provides physicians the ability to electronically submit referrals to Children’s specialists.
For patients with the conditions listed below, we recommend a referral to our Adolescent Medicine Clinic, located at Hughes Spalding Hospital (phone: 404-785-9850), or an external gynecology provider.
- New patients >16 years: irregular periods, vulvovaginitis, contraceptive counseling, dysmenorrhea
- Return patients >16 years: controlled symptoms and no complex medical issues
Below are guidelines to follow when referring a patient for a consultation with Children’s Gynecology. These are meant to be general recommendations. If you have specific questions, call 404-785-DOCS (3627) and ask to speak with the on-call gynecologist.
Most issues we see do not warrant an urgent referral. However, if you feel your patient needs to be seen as soon as possible, note “urgent” on your referral. All referrals marked “urgent” are triaged to help make sure patients are seen in a timely fashion. If you wish to speak to the on-call pediatric gynecologist, call 404-785-9635.
Generally, conditions that may warrant an urgent initial outpatient visit include, but are not limited to:
- Ovarian, pelvic, adnexal masses
- Acute genital tract trauma
- Differences of sexual development
- Vaginal/menstrual outflow tract obstruction
The majority of conditions we see may not warrant an urgent evaluation given the available resources. These may include, but are not limited to, the following:
- Heavy menses
- Irregular or abnormal menstrual bleeding
- Painful menses (dysmenorrhea, endometriosis, pelvic pain NOS)
- Vaginal discharge or pain
- Precocious puberty
- Delayed puberty
- PCOS
- Office notes
- Lab results, if ordered
Criteria for referral:
Patient has underlying medical problem that would prohibit adolescent medicine or general GYN from providing care
Suggested work-up:
- Gonorrhea
- Chlamydia
- Trichomonas
- +/-RPR and HIV
Labs or documents required before scheduling:
- Office notes
- Growth curves
- Lab results, if ordered
Criteria for referral:
- No pubertal development by age 13
Suggested work-up:
- See irregular menses work-up
Lab documents to send as part of referral:
- Office notes
- Imaging, if done
Possible initial management:
- Ibuprofen 600mg TID
- Heating pads
- Warm bath
- Physical activity
Labs or documents required before scheduling:
- Office notes
- Lab results, if ordered
Criteria for referral:
- Bleeding >7days
- >7 pads per day
- Menses resulting in anemia
Suggested work-up:
- CBC
- Von Willebrand panel
- Fibrinogen
- TSH
- Iron studies
Possible initial management:
- Aygestin**
- Combined oral contraceptive pill (OCP)
- Consider the risk for thrombosis before starting OCP*
*AUB labs should be drawn before starting hormone therapy, if indicated.
**Initial therapy in patient with heavy menstrual bleeding that is actively bleeding
- Taper if hgb 8-11.9 and actively bleeding:
- Aygestin 10mg BID x3 days until 3 days after bleeding stops then continue 10mg daily OR
- Orthocyclen 1 tab q8 hours x3 days, then BID x2 days, then daily
- Maintenance if hgb >11.9 or not actively bleeding:
- Aygestin 10mg daily OR
- Othocyclen 1 tab daily (may skip placebo week)
- Send to Emergency Department for active bleeding (not spotting) and hgb <8
Labs or documents required before scheduling:
- Office notes
- Growth curves
- Lab results, if ordered
Criteria for referral:
- Irregular or absent bleeding
- Do labs if any androgenizing symptoms (acne, hirsutism)
Suggested work-up:
- LH
- FSH
- Estradiol
- 17-hydroxy-progesterone
- Free testosterone
- DHEA-S
- TSH
- Fasting complete metabolic profile
- Fasting lipid profile
- hCG (urine or serum)
- Prolactin
Possible initial management:
- OCP is the first line of therapy; consider the risk for thrombosis before starting OCP*
- Metformin is used by some, but it is not an FDA-approved indication
*AUB labs should be drawn before starting hormone therapy, if indicated.
Lab documents to send as part of referral:
- Office notes
- Imaging report*
Criteria for referral:
We must have imaging report prior to scheduling appointment.
Suggested work-up:
Patient to bring disc with images.
*AUB labs should be drawn before starting hormone therapy, if indicated.
Labs or documents required before scheduling:
- Office notes
- Growth curves
- Lab results, if ordered
Criteria for referral:
- Breast
- Genital hair
- Vaginal bleeding prior to age 8
Suggested work-up:
- LH
- FSH
- Estradiol
- TSH
- Prolactin
We require growth curves for all referred patients prior to scheduling.
Note, it is very important to provide a visual line graph, ideally for both height and weight, although both are not required. Multiple points are preferred, if available. If you have only seen the patient once, we will accept graphs with single points.
Office notes are crucial in helping us determine the intricacies of your patient’s case.
- We require office notes beyond just the reason for referral.
- Whether you refer to them as Clinical Notes, History of Present Illness (HPI), Interval History or Notes, we need notes that the provider took during the last visit that explain the child’s case and chief concern for referral.
- A short “reason for referral” is not sufficient.
Our pediatric gynecology providers, led by Nancy Sokkary, MD, Division Chief of Gynecology, collaborate with other pediatric specialties within Children’s, including general surgery, urology, hematology/oncology, endocrinology, reproductive endocrinology, pelvic and anorectal malformations, and pain management, to address reproductive health concerns.
Pediatric and adolescent gynecologists
Advanced practice providers
Children’s offers outpatient gynecology services at the Center for Advanced Pediatrics. Surgical procedures are performed at our Arthur M. Blank Hospital and Scottish Rite Hospital.
Center for Advanced Pediatrics
2174 North Druid Hills Road NE
Atlanta, GA 30329
Arthur M. Blank Hospital
2220 North Druid Hills Road NE
Atlanta, GA 30329
Scottish Rite Hospital
1001 Johnson Ferry Road NE
Atlanta, GA 30342
Contact Us 404-785-DOCS (3627)