ACR Appropriateness Criteria® Postmenopausal Subacute or Chronic Pelvic Pain: Update 2025

Chronic pelvic pain, which persists longer than 6 months by definition, is a common condition which affects women of all ages with causes differing by age group. This document will focus on gynecologic origins of chronic pelvic pain, etiologies including chronic pelvic inflammatory disease, postsurgical changes, vaginal or vulvar cysts, and pelvic venous congestion disorder. Ultrasound is the initial imaging modality of choice with MRI or CT of the pelvis may be used in select cases when initial ultrasound is inconclusive. 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 process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.