US Pelvis Transvaginal Pelvic US using a combined transabdominal and transvaginal approach is the initial imaging study of choice to evaluate postmenopausal subacute or chronic pelvic pain localized to the deep pelvis [9-12]. US can provide anatomic information about uterine size and endometrial canal distension, fallopian tube dilation, ovaries, and adnexal masses. Regarding the sequencing of examinations, several authors have pointed out that if the etiology of pelvic pain remains obscure after CT, a subsequent US has the capacity to provide additional information about the adnexa in particular [13,14]. US is broadly used and clinically accepted worldwide. However, high-quality evidence, such as clinical trials supporting specific usefulness of US, is lacking. Chronic pelvic inflammatory disease may be associated with pelvic fluid, hydrosalpinx or pyosalpinx, inflammatory adnexal masses, and peritoneal inclusions visible by US [15]. When pelvic adhesions are suspected, real-time dynamic US or cine clips may document abnormal adherence or lack of mobility of structures, particularly transvaginally. However, adhesive disease is a notoriously difficult diagnosis to confirm nonoperatively [16], and the evidence basis is anecdotal [15,17]. Furthermore, the causal linkage between adhesive disease and chronic pelvic pain remains unclear. Many women with pelvic venous disorders have morphologic findings of polycystic ovarian syndrome (enlarged ovaries with exaggerated central stroma and multiple small peripherally located follicles), but the associated clinical features of hirsutism and amenorrhea are rare [11,18]. Multiple investigators have identified a component of estrogen overstimulation in pelvic venous disorders, and symptoms may subside after menopause in some women [15]. There is a lack of clear definition and high-quality evidence in the clinical domain of pelvic venous disorders.
Postmenopausal Subacute or Chronic Pelvic Pain. US Pelvis Transvaginal Pelvic US using a combined transabdominal and transvaginal approach is the initial imaging study of choice to evaluate postmenopausal subacute or chronic pelvic pain localized to the deep pelvis [9-12]. US can provide anatomic information about uterine size and endometrial canal distension, fallopian tube dilation, ovaries, and adnexal masses. Regarding the sequencing of examinations, several authors have pointed out that if the etiology of pelvic pain remains obscure after CT, a subsequent US has the capacity to provide additional information about the adnexa in particular [13,14]. US is broadly used and clinically accepted worldwide. However, high-quality evidence, such as clinical trials supporting specific usefulness of US, is lacking. Chronic pelvic inflammatory disease may be associated with pelvic fluid, hydrosalpinx or pyosalpinx, inflammatory adnexal masses, and peritoneal inclusions visible by US [15]. When pelvic adhesions are suspected, real-time dynamic US or cine clips may document abnormal adherence or lack of mobility of structures, particularly transvaginally. However, adhesive disease is a notoriously difficult diagnosis to confirm nonoperatively [16], and the evidence basis is anecdotal [15,17]. Furthermore, the causal linkage between adhesive disease and chronic pelvic pain remains unclear. Many women with pelvic venous disorders have morphologic findings of polycystic ovarian syndrome (enlarged ovaries with exaggerated central stroma and multiple small peripherally located follicles), but the associated clinical features of hirsutism and amenorrhea are rare [11,18]. Multiple investigators have identified a component of estrogen overstimulation in pelvic venous disorders, and symptoms may subside after menopause in some women [15]. There is a lack of clear definition and high-quality evidence in the clinical domain of pelvic venous disorders.