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What to Know About Ovarian Torsion

Medically Reviewed by Dan Brennan, MD on June 10, 2021

You may first experience pain in your abdomen before realizing that you have a twisted ovary. Ovarian torsion happens when your ovaries — and sometimes the fallopian tube — twist around the tissue they’re connected to. This cuts off the blood supply to your ovaries, which can cause organ damage as well as immense pain. 

Why Does Ovarian Torsion Happen?

Your ovaries are two small, almond-shaped organs in your body. There’s one on each side of your uterus. They’re meant to make hormones and release an egg for fertilization each month.

Ovarian torsion typically occurs on one side. If your ovaries become twisted, you’ll experience a lot of abdominal pain and will likely need immediate medical attention and possibly emergency surgery.

This condition can be caused by several factors, including cysts.

Benign ovarian cysts and teratomas. The twisting of these masses is rare but can happen in adults and children. Intermittent, non-radiating pain in your abdomen is a warning sign of this condition. You may also experience nausea and vomiting.

If ovarian torsion is left untreated, you'll risk losing your ovary or becoming infertile. This is because the blood supply to your ovary has been cut off, which can lead to necrosis. 

The difficult part about knowing if you have ovarian torsion is that there’s no physical indicator that lets you know something's wrong. You’ll only be able to tell by pain and tenderness in your abdomen. An internal hemorrhage or hyperstimulation, for example, which is when your ovaries swell in response to hormonal treatment, can cause ovarian torsion. The internal causes can make you wait to get help, but you shouldn’t wait in cases of severe, sudden pain. 

Symptoms of Ovarian Torsion

The most common symptom of ovarian torsion is sudden abdominal pain. You’ll feel an occasional but sharp pain. The pain will most likely make you feel nauseous and may cause vomiting. 

Other symptoms include: 

  • Pelvic pain
  • Crampy pain for a few days or weeks
  • Tender abdomen 

You may experience cramps over several days or weeks. This happens when your ovary is twisting and untwisting constantly. Pain may also go into your back or legs. Depending on whether you’re post-menopausal or perimenopausal can affect the level of pain you feel. 

In severe cases, if your ovary is necrotic and needs to be removed, you may have a fever. There will also be abnormal bleeding from your vagina, as well as discharge. If your abdomen or pelvic area is rigid or in pain when you stop touching your abdomen, you may already have a necrotic ovary. Your doctor may do a pelvic exam to feel for other problems and tenderness.

Who Is at Risk for Ovarian Torsion

Women in their reproductive years are most likely to experience ovarian torsion, but it can also happen in children and women who are post-menopausal. Pregnancy can put you at risk, too, with roughly 20% of ovarian torsion cases occurring in pregnant women.

If you're on fertility treatment, hormone treatment that triggers ovulation could put you at risk. Hormonal medication can also cause cysts to grow on your ovaries. Ovarian cysts and masses put your ovaries at a higher risk for twisting around themselves. 

Treating Ovarian Torsion

Surgery is the only treatment for ovarian torsion. Your doctor will recommend one of the following two surgeries.

Laparoscopy. During this minor surgery, the doctor makes an incision in your abdomen and inserts a thin tube with a camera on the end, called a laparoscope. Then, they’ll untwist the ovary, and if needed, they’ll untwist your fallopian tube, too. 

Laparotomy. This is an open surgery, which requires anesthesia and an overnight stay. Your doctor will make an incision in your abdomen and assess your reproductive organs. If possible, they’ll untwist and remove any present masses. After the procedure, you'll require rest. 

If your ovarian torsion is severe and blood supply was cut off from your fallopian tubes or ovaries, you'll most likely need to have them removed. 

You should seek immediate medical attention if you think your ovaries are twisted. This will help you relieve the pain quicker, and keep you from having to get your reproductive organs removed. During surgery, your doctor will determine whether your reproductive organs will still be functional or not. They will then guide you through the right treatment plan.

WebMD Medical Reference

Sources

SOURCES:

The American College of Obstetricians and Gynecologists: “Adnexal Torsion in Adolescents.”

Guile, S., Mathai, J., StatPearls, StatPearls Publishing, 2020.

Medscape: “Ovarian Torsion.”

Merck Manuals: “Adnexal Torsion.”

SAEM: “Ovarian Torsion.”

Yale Medicine: “Ovarian Torsion.”

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