Pelvic imaging: when scans help and how GPs decide

Pelvic symptoms are common and can arise from a wide range of causes involving the reproductive organs, urinary system, or bowel. Pelvic imaging is used selectively in general practice to help clarify the cause of symptoms when it is likely to guide management or referral.

This page explains how GPs decide when pelvic imaging is appropriate, which scans are commonly used, and how results are interpreted in context.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help or advice on medical scans, please book a GP appointment.

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The GP approach to pelvic symptoms

Assessment of pelvic symptoms usually starts with:

A detailed history, including pain pattern, bleeding, discharge, and urinary or bowel symptoms
Menstrual and reproductive history where relevant
Associated symptoms such as fever, weight loss, or acute pain
Examination where appropriate

Imaging is considered when symptoms suggest a structural cause or when clinical assessment alone does not provide a clear answer.

When pelvic imaging is commonly helpful

Pelvic imaging is more likely to be useful when:

Pelvic pain is persistent, worsening, or localised
There is abnormal vaginal bleeding or bleeding after menopause
A pelvic mass is suspected
Symptoms suggest ovarian, uterine, or bladder pathology
Blood test or examination findings require further clarification
Serious conditions need to be excluded

Imaging is not routinely required for mild, short-lived, or clearly functional symptoms.

Common pelvic imaging tests and how they are used

Pelvic ultrasound

Pelvic ultrasound is usually the first-line imaging test for pelvic symptoms. It is safe, does not involve radiation, and provides good visualisation of pelvic organs.

It may be used to assess:

The uterus and endometrium
Ovaries and suspected ovarian cysts
Fibroids
Pelvic masses
Causes of pelvic pain

Pelvic ultrasound may be performed transabdominally, transvaginally, or both, depending on the clinical question.

CT scans of the pelvis

CT imaging is used more selectively and is usually reserved for:

Acute or severe pelvic pain
Suspected infection or inflammation
Assessment of complex findings
Urgent referral pathways

CT scans involve radiation, so it is used when the expected benefit outweighs the risk.

MRI of the pelvis

MRI provides detailed soft-tissue imaging and may be recommended in specific situations, such as:

Further assessment of fibroids or complex ovarian findings
Suspected deep pelvic conditions
Clarifying findings from ultrasound or CT

MRI is usually guided by specialist pathways rather than routine GP investigation.

How GPs choose the right pelvic scan

The choice of imaging depends on:

The suspected underlying cause
Symptom urgency and severity
Age and menopausal status
Pregnancy possibility
Whether results will change management or referral

For broader decision-making, see:
How GPs use medical imaging in practice

Common conditions where pelvic imaging may be considered

Examples include:

Ovarian cysts
Uterine fibroids
Abnormal uterine bleeding
Pelvic inflammatory disease in selected cases
Post-menopausal bleeding
Pelvic masses

Many pelvic symptoms have non-structural causes and may not show abnormalities on imaging.

Seek urgent medical advice if you have:

Sudden severe pelvic or lower abdominal pain
Heavy vaginal bleeding or bleeding after menopause
Pelvic pain with fever or feeling acutely unwell
Possible pregnancy with pelvic pain or bleeding
Collapse or fainting with pelvic pain

Limitations of pelvic imaging

Not all causes of pelvic pain are visible on scans
Functional pain syndromes often have normal imaging
Incidental findings are common and frequently benign
A normal scan does not rule out all conditions

Results must be interpreted alongside symptoms, examination, and clinical history.

What happens after pelvic imaging

If imaging explains symptoms

A GP may:

Confirm a likely diagnosis
Adjust treatment
Refer to gynaecology or other specialists where appropriate
Arrange follow-up or further tests

If imaging is normal