Pelvic mass

​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • Acute or severe pelvic pain
  • Suspected ovarian torsion
  • Suspected pelvic abscess​

When public outpatient services are not routinely provided

  • Asymptomatic fibroids < 8 cm
  • Asymptomatic simple ovarian cyst < 5 cm on pelvic ultrasound in pre-menopausal patient
  • Persistent, asymptomatic simple ovarian cyst < 5 cm on two pelvic ultrasounds performed 6-12 weeks apart in pre-menopausal patient and normal CA-125
    Note: annual ultrasound in primary care is recommended for monitoring​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Complex ovarian cyst > 5 cm confirmed on pelvic ultrasound in an adolescent female with any of the following tumour markers in normal range:
    • Alpha-fetoprotein (AFP)
    • Beta human chorionic gonadotropin (ßhCG)
    • CA-125
    • Lactate dehydrogenase (LDH)
  • Complex ovarian cyst with mild elevation of tumour markers (e.g. CA-125)
    Note: referral to gynaecology oncology is indicated (where available)
  • Complex ovarian cyst confirmed on pelvic ultrasound with any of the following features:
    • Ascites
    • Documented changes in character or significant increase in size
    • Elevated tumour markers (e.g. CA-125)
    • Increased blood flow
    • Papillary projections
    • Septations
    • Solid areas

      Note: referral to gynaecology oncology is indicated (where available)

  • High-risk presentations as indicated by any of the following features:
    • Risk of Malignancy Index (RMI) > 200
    • O-RADS 5
    • International Ovarian Tumour Analysis (IOTA)-ADNEX > 50%
    • Ascites
  • Pelvic mass in a pre-pubertal patient
  • Rapidly enlarging fibroids > 8 cm
  • Simple ovarian cyst > 5 cm and elevated CA-125 in a
    pre-menopausal patient
  • Simple ovarian cyst > 10 cm
  • Simple ovarian cyst and elevated CA-125 at any size in a post-menopausal patient​
​Category 2
Recommended to be seen within 90 calendar days.

  • ​Persistent, simple ovarian cyst 5-10 cm on two pelvic ultrasounds performed 6-12 weeks apart
  • Symptomatic ovarian cyst or hydrosalpinx
  • Symptomatic fibroids > 8 cm (e.g. pressure symptoms, menorrhagia)​

Category 3
Recommended to be seen within 365 calendar days.

  • Asymptomatic fibroids > 8 cm
  • Asymptomatic hydrosalpinx
  • Recurrent, simple ovarian cyst with or without trial of hormonal contraception
  • Symptomatic fibroids < 8 cm (e.g. pressure symptoms, menorrhagia)​

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Pelvic ultrasound (transvaginal preferable)
    • CA 19-9 result (if concerned for cancer)
    • CA-125 result
    • CEA result (if concerned for cancer)
    • AFP, HCG, Inhibin, LDH (if complex cyst and aged < 40 years)
    • Hormonal contraception use
    • Menstrual history (cycle – days/months, days of bleeding)
    • Previously trialled treatments
    • Height, weight and body mass index
    • Cervical screening test within the last 5 years or recent test if abnormal symptoms

​If available

  • Family history of breast and ovarian cancer
  • Computed tomography (CT) scan of abdomen-chest-pelvis report (if complex cyst)
  • Full Blood Count (FBC)
  • Urea, electrolytes and creatinine (UEC)
  • Liver function tests (LFTs)
  • Risk of Malignancy Index (RMI) score and/or International Ovarian Tumour Analysis (IOTA) classification
  • Pelvic examination (if sexually active)​

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.​

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing