 The literature regarding etiology of acute, rather than chronic, pain in postmenopausal women is somewhat limited. In a single-center study, investigators noted that ovarian cysts account for one-third of the cases of pain attributed to gynecologic origin in perimenopausal and postmenopausal women [3]. This is a slightly less common cause of pain than in the reproductive age group. Uterine fibroids are the are the second most common cause of acute pelvic pain in the peri/postmenopausal group, and a significantly more common cause of pain than in the premenopausal group [3]. Acute pain from fibroids may be secondary to torsion of pedunculated fibroids, prolapse of a submucosal fibroid, or from acute infarction/hemorrhage in a degenerating fibroid. The third most common cause of pelvic pain is pelvic infection, which accounts for 20% of cases [3]. These cases of pelvic inflammatory disease (PID) include tubo-ovarian abscess, oophoritis, salpingitis, endometritis, cervicitis, or peritonitis from gynecologic origin. The majority of these are related to sexual activity; however, recent instrumentation and surgery are common iatrogenic causes. Isolated endometritis can also be seen with cervical stenosis. The fourth most common gynecologic cause of acute pelvic pain is ovarian neoplasm, which is the etiology in 8% of cases [3]. Ovarian torsion, retained intrauterine device, and endometriosis have been reported as causes of acute pain in the postmenopausal period; however, these are considered rare. In the postmenopausal woman, other causes of pelvic pain are attributable to the urinary, gastrointestinal, and vascular systems [4]. Imaging recommendations vary for these etiologies, and narrowing of the differential will help ensure optimal diagnostic imaging. Please see the corresponding ACR Appropriateness Criteria guidance document, which addresses these diagnoses listed in Appendix 1. OR Reprint requests to: publications@acr.org Postmenopausal Acute Pelvic Pain
Postmenopausal Acute Pelvic Pain.  The literature regarding etiology of acute, rather than chronic, pain in postmenopausal women is somewhat limited. In a single-center study, investigators noted that ovarian cysts account for one-third of the cases of pain attributed to gynecologic origin in perimenopausal and postmenopausal women [3]. This is a slightly less common cause of pain than in the reproductive age group. Uterine fibroids are the are the second most common cause of acute pelvic pain in the peri/postmenopausal group, and a significantly more common cause of pain than in the premenopausal group [3]. Acute pain from fibroids may be secondary to torsion of pedunculated fibroids, prolapse of a submucosal fibroid, or from acute infarction/hemorrhage in a degenerating fibroid. The third most common cause of pelvic pain is pelvic infection, which accounts for 20% of cases [3]. These cases of pelvic inflammatory disease (PID) include tubo-ovarian abscess, oophoritis, salpingitis, endometritis, cervicitis, or peritonitis from gynecologic origin. The majority of these are related to sexual activity; however, recent instrumentation and surgery are common iatrogenic causes. Isolated endometritis can also be seen with cervical stenosis. The fourth most common gynecologic cause of acute pelvic pain is ovarian neoplasm, which is the etiology in 8% of cases [3]. Ovarian torsion, retained intrauterine device, and endometriosis have been reported as causes of acute pain in the postmenopausal period; however, these are considered rare. In the postmenopausal woman, other causes of pelvic pain are attributable to the urinary, gastrointestinal, and vascular systems [4]. Imaging recommendations vary for these etiologies, and narrowing of the differential will help ensure optimal diagnostic imaging. Please see the corresponding ACR Appropriateness Criteria guidance document, which addresses these diagnoses listed in Appendix 1. OR Reprint requests to: publications@acr.org Postmenopausal Acute Pelvic Pain