Differential Diagnosis of Chronic Abdominal Pain in Women

Gynecologic Causes

Endometriosis is an estrogen-dependent condition causing chronic pain, typically regressing after menopause, according to the American College of Radiology 1
Adenomyosis is a gynecologic cause of chronic pelvic pain, as stated by Praxis Medical Insights 2
Pelvic inflammatory disease can present as chronic inflammatory disease with associated pain, as reported by the American College of Radiology and Praxis Medical Insights 1, 2
Ovarian cysts account for approximately one-third of gynecologic pain cases in postmenopausal women, according to the American College of Radiology 3, 4
Uterine fibroids are a common cause of chronic pain, significantly more common than in premenopausal women, as stated by the American College of Radiology 3
Ovarian neoplasm accounts for 8% of cases and must be considered given the prevalence of ovarian malignancy in this age group, as reported by the American College of Radiology 1, 3
Cervical stenosis can cause pain with associated endometritis, according to the American College of Radiology 1

Pelvic venous disorders, such as pelvic congestion syndrome, are characterized by engorged periuterine and periovarian veins, as stated by the American College of Radiology 1, 5
Intraperitoneal adhesions may be associated with chronic pain, although the causal linkage remains unclear, as reported by the American College of Radiology 1, 5
Hydrosalpinx is a dilated fallopian tube visible on imaging, according to the American College of Radiology 1, 5
Chronic inflammatory disease may show pelvic fluid, pyosalpinx, inflammatory adnexal masses, as stated by the American College of Radiology 1, 5

Vaginal atrophy is a common cause of pain, particularly in postmenopausal women, as reported by the American College of Radiology 1
Pelvic myofascial pain is a condition that may cause chronic pain, as stated by the American College of Radiology and Praxis Medical Insights 1, 2

Inflammatory bowel diseases are a gastrointestinal cause of chronic pelvic pain, as stated by Praxis Medical Insights 2
Urinary tract pathology can cause chronic pelvic pain, according to the American College of Radiology 1

Pelvic girdle pain is a common cause of chronic pain, as stated by Praxis Medical Insights 2
Myofascial pain is a condition that may cause chronic pain, according to Praxis Medical Insights 2
Musculoskeletal disorders of the lower back or pelvis can cause chronic pelvic pain, as reported by the American College of Radiology 1

In postmenopausal women, vaginal bleeding and suspected adnexal masses should take precedence over general pain complaints due to the risk of endometrial and ovarian neoplasia, as stated by the American College of Radiology and Praxis Medical Insights 1, 2

Assuming gynecologic origin without considering other systems can lead to misdiagnosis, as chronic abdominal pain has a broad differential including gastrointestinal, urologic, and musculoskeletal causes, according to the American College of Radiology 1
Failing to recognize age-specific patterns can lead to delayed diagnosis, as the differential shifts significantly between reproductive age and postmenopausal women, with malignancy risk increasing in older patients, as stated by the American College of Radiology 3