The American College of Radiology has updated its Appropriateness Criteria for acute pelvic pain, under three months, in postmenopausal women. The update focuses on gynaecological causes: ovarian torsion, pelvic inflammatory disease and acute complications of fibroids.
The panel treats this age group as distinct. Presentations are more often atypical, the causes can be harder to pin down, and the chance that an adnexal or uterine finding is malignant is higher than in younger women.
Ultrasound remains the first imaging test. MRI or CT is reserved for when ultrasound does not answer the question. The criteria combine graded literature review with expert consensus where evidence is thin.
For referrers, the practical message is to request pelvic ultrasound, including transvaginal views where acceptable, rather than going straight to CT, and to treat any complex adnexal finding in this age group with a lower threshold for further work-up.
- Request pelvic ultrasound, with transvaginal imaging where acceptable, as the first test
- Move to MRI or CT when ultrasound is inconclusive
- Keep ovarian torsion in the differential after the menopause, especially with an adnexal mass
- Have a lower threshold to characterise complex adnexal lesions, given the higher malignancy risk
- Tell the radiologist the menopausal status and any hormone therapy on the request
Why it matters
It reminds referrers that pelvic pain after the menopause carries a different differential and malignancy risk.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for radiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free