ACR Appropriateness Criteria® Postmenopausal Subacute or Chronic Pelvic Pain

Abstract

Pelvic pain is common in both reproductive age and postmenopausal women, and the major etiologies change throughout the life cycle. Chronic pain is defined as lasting for at least 6 months. There are many gastrointestinal and urinary disorders associated with chronic pain in this age group, which are not discussed in this guideline. Pain may be localized to the deep pelvis, with potential causes including pelvic congestion syndrome, intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis. Ultrasound is the initial imaging modality of choice, while CT and MRI may be appropriate for further characterization of sonographic findings. Alternatively, pain may be localized to the vagina, vulva, or perineum, with potential causes including vaginal atrophy, vaginismus, vaginal or vulvar cysts, vulvodynia, or pelvic myofascial pain. Imaging is primarily indicated in context of an abnormal physical exam and ultrasound is the initial modality of choice, while MRI may be appropriate for further characterization in select cases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Clinical Review of Neuromusculoskeletal Complementary and Alternative Approaches for the Treatment of Chronic Pelvic Pain Syndrome

“…Unsurprisingly, CAM treatments were rarely recommended. This is in contrast to national recommendations by societies representing the United Kingdom [13], Japan [14], the United States [15], and Canada [16], which recommend conservative treatment as the first-line approach for CPPS, including addressing stress relief, dietary modification, exercise, musculoskeletal physical therapy, and psychological support. Interestingly, despite recommendations of national societies, a recent review concluded that China was the largest contributor to randomized controlled trials investigating CAM interventions for health conditions in the last decade [17].…”

Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline

“…We reviewed relevant recommendations related to the 12 clinical/diagnostic scenarios previously published by radiology and specialty societies, including: the Canadian Association of Radiologists, 9 the American College of Obstetricians and Gynecologists, 10,11 the American College of Radiology, 12 -28 the American Society of Clinical Oncology, 29 the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group, 30,31 the European Society of Urogenital Radiology, 32 the French College of Gynecologists and Obstetricians, 33 the International Society of Ultrasound in Obstetrics and Gynecology, 34 the International guideline on polycystic ovarian syndrome, 35 -38 the National Institute for Health and Care Excellence, 39 -47 the Society for Maternal-Fetal Medicine, 48 the Society of Abdominal Radiology, 49 the Society of Obstetricians and Gynaecologists of Canada, 50 -57 the Royal College of Obstetricians and Gynaecologists, 58 -60 and the 2017 Royal College of Radiologists. 61…”

Ultrasound diagnostic criteria and grades of pelvic congestion syndrome and asymptomatic pelvic venous congestion: a structured report

“…There is no consensus on defining quantitative diagnostic criteria for PCS and APVC based on dilated gonadal veins, dilated external right and/or left pudendal vein, adnexal varices, vulvar varices and parauterine crossing veins. TAUS, PelUS, and TVUS have been proposed as an alternative to the gold standard as the initial diagnostic examination in patients with suspected PCS 8 . In our study, the protocol included TAUS, PelUS, TVUS, ThighUS, and TLUS for a complete evaluation of the abdominal and pelvic venous systems.…”

“…Alternative methods with comparable diagnostic accuracy include computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Transabdominal ultrasound (TAUS), transvaginal ultrasound (TVUS), and pelvic ultrasound (PelUS) are the initial diagnostic methods for assessing the anatomy and characteristics of pelvic venous flow 8 .…”