Ovarian Torsion

What is ovarian torsion?

Ovarian torsion is a medical emergency where one of your ovaries twists on the tissues supporting it. Your ovaries are oval-shaped glands located on both sides of your uterus. They release eggs during your reproductive years and make hormones that control your menstrual cycle and pregnancy. They’re held in place by bands of tissue (ligaments) suspended in your pelvic cavity.

The twisting can cut off the blood supply to the affected ovary, causing sudden, severe abdominal pain. Without emergency care, the tissue in your ovary may die, causing you to lose that ovary.

Sometimes, the fallopian tube near the ovary twists, too. When this happens, ovarian torsion is called adnexal torsion.

How common is ovarian torsion?

Researchers don’t know how common ovarian torsion is in the general population. But studies show that it’s the fifth most common gynecological surgical emergency. Around 3% of emergency room visits requiring surgery on the reproductive anatomy of people assigned female at birth (AFAB) are to treat ovarian torsion.

What are the symptoms of ovarian torsion?

The main symptom of ovarian torsion is sudden, severe abdominal pain. It’s frustrating because abdominal pain is a defining symptom of many conditions —and not all of them require an emergency room visit. But when it comes to ovarian torsion, getting to an ER quickly can save your ovary.

Other symptoms of ovarian torsion include:

• Moderate to severe pain in your lower belly.
• Nausea and vomiting.

Signs that the tissue in your ovary is starting to die include:

• Fever.
• Abnormal vaginal bleeding or discharge.

What does ovarian torsion feel like?

Everyone experiences pain differently. This can make it hard to know whether the pain you’re experiencing is a medical emergency like ovarian torsion or something else. Usually, people describe the pain associated with ovarian torsion as moderate to severe, not mild. In other words, it’s hard to miss.

The pain may feel:

• Sharp and stabbing (more common) or dull and crampy.
• Located throughout your lower belly (most common) or only on the side of the affected ovary (usually your right side).
• Isolated to just your lower belly or radiating (spreading) to your thighs, sides (flank) and lower back.
• Constant (common) or intermittent (uncommon).

Although it’s uncommon, ovarian torsion symptoms can be intermittent, which means the pain comes and goes. Sometimes, the ovary will twist and then untwist. The twisting cuts off blood flow, causing pain. When the ovary untwists and regains access to blood, the pain may go away. The back and forth can feel confusing. Even if your pain is intermittent, you need to see a healthcare provider for treatment if you’re experiencing ovarian torsion.

What causes ovarian torsion?

Ovarian torsion happens when something upsets the balance that allows your ovary to stay in place. A growth, like an ovarian cyst (especially a large one), can add extra weight to your ovary, causing it to shift or twist on the ligament holding it. Although it’s less common, cancerous tumors or other solid masses on your ovary can shift the weight, too, and cause torsion.

What are the risk factors of ovarian torsion?

Risk factors include:

• Age: Around three-fourths of people diagnosed are in their reproductive years. Most people with ovarian torsion are between ages 29 and 34. Still, anyone with ovaries (including fetuses) can have this condition.
• Growths on your ovaries: Up to 85% of people diagnosed with ovarian torsion have ovarian cysts or other benign masses on their ovaries. The risk is greater if the cyst or mass is 5 centimeters (about 2 inches) across or more.
• Longer-than-usual ovarian ligaments: You may have been born with longer-than-average ligaments that put you at greater risk of ovarian torsion.
• Pregnancy: Around 1 in 4 people diagnosed with ovarian torsion are pregnant. Changes in your body during pregnancy can increase your risk. For example, corpus luteum cysts are more common during pregnancy. Hormones relax your ligaments, making them more pliable and able to twist.
• Fertility treatments: Treatments that stimulate your ovaries to release more eggs (ovulation) increase your likelihood of developing follicular cysts. The follicle is the sac inside your ovary that releases an egg. It’s common for cysts to form in the follicle during ovulation. More active follicles mean a greater risk of cysts.

What triggers ovarian torsion?

Sometimes, your body’s physical movements can trigger ovarian torsion symptoms. Some people experience symptoms after intercourse or being physically active.

Still, ovarian torsion doesn’t require a trigger event to happen.

What are the complications of ovarian torsion?

Most people with ovarian torsion get treated and don’t experience complications. Without emergency care, though, the lack of blood flow to your ovary can cause the tissue to die. You can still get pregnant with one ovary, but studies have shown that having an ovary removed because of ovarian torsion can decrease your chances of pregnancy.

Although it’s rare, the dead tissue can lead to an abdominal infection (peritonitis). The infection can spread to your organs and bloodstream without emergency treatment.

How is ovarian torsion diagnosed?

A transvaginal ultrasound can usually detect ovarian torsion because it’ll show no blood flow to your ovary. The only way to get a definitive diagnosis, though, is for a surgeon to see the twisted ovary inside your body. Often, they use a procedure called laparoscopy to examine your ovaries directly. If they see ovarian torsion during the laparoscopy, they can treat it right away during the same procedure.

What is the treatment for ovarian torsion?

Surgeons treat ovarian torsion by untwisting the ovary. They may also remove cysts that may be involved (ovarian cystectomy). Usually, they’ll be able to save your ovary.

Most often, surgeons perform laparoscopy to treat ovarian torsion. For this procedure, they’ll make a few small incisions (cuts). They’ll insert an instrument called a laparoscope into one of the cuts that allows them to see whether your ovary is twisted. If needed, they’ll perform surgery through the same incisions after they’ve found ovarian torsion.

Sometimes, you’ll need open surgery (laparotomy). You should be able to go home the same day following a laparoscopy. A laparotomy is a more involved surgery that’ll require an overnight hospital stay and longer recovery time.

Can ovarian torsion be prevented?

Ovarian torsion isn’t preventable.

If you have recurring ovarian torsion (which is rare), your healthcare provider may recommend a procedure called oophoropexy, which stabilizes your ovary so it doesn’t twist.

Some medical experts recommend oophoropexy in children who’ve already lost an ovary in childhood because of ovarian torsion. The procedure preserves the remaining ovary so they can still get pregnant if they choose to one day. Experts are still studying oophoropexy’s potential benefits in these instances.

What can I expect if I have ovarian torsion?

Most people with ovarian torsion get treated and return to their lives with two healthy, functioning ovaries. Surgery to untwist the ovary works in 90% of people.

Your surgeon may recommend removing the ovary if they’re concerned the tissue is damaged or if a cancerous growth caused the twisting. But this is less common.

When should I go to the ER?

Get to an emergency room (ER) immediately if you’re experiencing unexplained pain in your lower abdomen — especially if you already know you have a mass (like an ovarian cyst) that increases your risk of ovarian torsion.

Experts don’t know how long it takes for tissue to die once the ovary twists and symptoms start. This is why it’s essential to err on the safe side. The sooner you see a provider and they diagnose the torsion, the better.

What questions should I ask my healthcare provider?

Questions to ask include:

• What activities should I avoid as I heal from surgery?
• When will I need a follow-up visit to check on my recovery?
• What are the chances that I’ll have ovarian torsion again?
• Will surgery impact my fertility?
• What signs of a complication should I look out for?

Is ovarian torsion life-threatening?

Ovarian torsion isn’t usually life-threatening, but it can be. Although it rarely happens, an ovary with dead tissue can lead to severe infection without treatment. Still, for most people, the worst-case scenario involves losing an ovary.

Early treatment can prevent worst-case scenarios like losing an organ or developing a potentially life-threatening infection.

How long can you have ovarian torsion without knowing?

Most people see a provider within one to three days of experiencing symptoms of ovarian torsion. There have been cases involving people with intermittent torsion who’ve waited several months before getting diagnosed.

In this case, an ovary twists and untwists, causing alternating periods of pain and then no pain.

But there’s no way to know if this is what’s causing your pain without an official diagnosis. And time is of the essence. Don’t wait if you’re experiencing symptoms. Get to an ER ASAP.

Does ovarian torsion go away on its own?

It can, but it’s rare.

With intermittent ovarian torsion, the back-and-forth pattern of an ovary twisting and then untwisting may eventually lead to the ovary returning to its normal (untwisted) position.

But you should never assume ovarian torsion will resolve on its own. It’s too serious of a condition to leave to chance. Get to an ER immediately if you’re experiencing symptoms.

A note from Cleveland Clinic

It can feel both frustrating and scary to experience a symptom like abdominal pain that may indicate something minor — or a medical emergency that requires care ASAP. When it comes to ovarian torsion, there’s no way to know that the source of pain is a twisted ovary until your provider diagnoses you. Unfortunately, most people aren’t aware they have a (usually harmless) condition, like an ovarian cyst, that’s a risk factor for ovarian torsion.

Don’t chance it. If you’re experiencing severe abdominal pain, get checked out immediately. Fast action can save your ovary. It can even save your life.