What Is Ovarian Torsion, and Are You at Risk?

Medically Reviewed By Amanda Kallen, MD
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Ovarian torsion occurs when an ovary becomes twisted around the ligaments that support it. It is a medical emergency that requires immediate treatment to avoid the loss of the ovary. Ovarian torsion is among the most common gynecological emergencies. The risk of ovarian torsion is five times higher during pregnancy.

This article provides an overview of ovarian torsion, known medically as adnexal torsion. It discusses the symptoms and risk factors and looks at the treatment options to help preserve the ovary and its function.

What is ovarian torsion?

Cropped image of person holding hands on abdomen in early pregnancy
Katarina Simovic/Stocksy United

Ovarian torsion is the twisting of an ovary around the ligaments that support it. In many cases, the fallopian tube also becomes twisted.

This change in structure can reduce or even stop blood flow to the ovary. When this happens, tissue in the ovary can die.

Ovarian torsion more commonly affects the right ovary. Experts attribute this to the presence of the sigmoid colon on the left side of the body, which may limit the movement of the left ovary.

What are the risk factors for ovarian torsion?

Ovarian torsion is rare but can occur at any age. Researchers have identified certain factors that may increase your risk of ovarian torsion. These include:

  • being of reproductive age
  • pregnancy
  • presence of an ovarian mass, such as a cyst or tumor, which will usually be noncancerous
  • fertility treatments that induce ovulation, which can increase the risk of ovarian cysts that may cause torsion

If you have risk factors for ovarian torsion, consider talking with an OB-GYN about the possible symptoms. Being aware of the symptoms to watch for can help you identify ovarian torsion early and get prompt treatment to prevent the loss of the ovary.

What are the symptoms of ovarian torsion?

Ovarian torsion may produce a range of symptoms. The primary symptom is pain, which may differ among individuals in terms of type and severity.

Pain

Researchers have found that people with ovarian torsion may experience pain in different ways. They might have:

  • pain in the lower abdomen or pelvis
  • pain that extends to the lower back or side
  • pain that sharp and stabbing, typically before menopause
  • pain that is dull and constant, usually after menopause

Pain from ovarian torsion may come and go, as the ovary can twist and untwist over time.

Urgent symptoms

If ovarian torsion has started to cause tissue death in the ovary, the symptoms may include:

  • a fever of 100.4ºF (38ºC) or higher
  • vaginal bleeding
  • unusual vaginal discharge
  • tenderness to touch in the abdomen
  • rigidity in the abdomen
  • pain that occurs upon the removal of pressure from the abdomen, known as rebound tenderness

If you experience these symptoms, contact an OB-GYN right away. This is particularly true if you are pregnant or have already received a diagnosis of an ovarian cyst or another ovarian mass. These symptoms can indicate the death of tissue, which could lead to the loss of the ovary.

What causes ovarian torsion?

In the body, a group of ligaments supports each ovary. However, ovaries are not fixed in place and have the ability to move.

As a result, if something causes an ovary to become unbalanced, such as a cyst or tumor, the ovary can turn and twist.

How do doctors diagnose ovarian torsion?

To diagnose ovarian torsion, the OB-GYN will first ask you about your symptoms and medical history. The initial symptoms of ovarian torsion can be similar to those of other conditions. The OB-GYN may take steps to rule out other possible causes of your symptoms.

Tests for ovarian torsion

If you have risk factors for ovarian torsion or your OB-GYN suspects it, they will likely perform medical tests. These may include:

  • Blood tests: The OB-GYN may use this approach to check for an infection or signs of a hemorrhage.
  • Pregnancy test: Pregnancy is an ovarian torsion risk factor, so it is useful to confirm it or rule it out.
  • Doppler ultrasound: This test, which can be either transvaginal or pelvic, can help OB-GYNs detect signs of torsion and rule out other conditions.

In some cases, surgery may be necessary to provide a definitive diagnosis.

What are the treatment options for ovarian torsion?

Surgery is the only treatment for ovarian torsion. During the operation, the OB-GYN or another surgeon will confirm a diagnosis of torsion, evaluate the extent of the damage, and untwist the ovary, if possible.

Surgery to treat ovarian torsion is very effective. More than 90% of people who undergo surgery to correct torsion recover with full function of the ovary.

If your doctor identifies a cancerous growth, they may need to remove the ovary. They may also recommend the removal of the ovary and the fallopian tube if you have reached menopause.

Q:

Can I still get pregnant after surgery for ovarian torsion?

Anonymous

A:

The short answer is yes. The goal of surgery for ovarian torsion is to preserve the ovary whenever possible, even if there is damage, as there are often viable eggs remaining. Even if one ovary is removed, there are data to suggest that the chances of pregnancy do not significantly decrease.

Other studies suggest that it may be more difficult to conceive, but overall fertility is still preserved. This is because if the other ovary remains, it will ovulate every month rather than alternating with the other ovary that was removed. This assumes the person does not have other conditions that prevent monthly ovulation.

Amanda Kallen, M.D. Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Frequently asked questions

These are some other questions that people often ask about ovarian torsion. Amanda Kallen, M.D., has reviewed the answers.

Is ovarian torsion an emergency?

Yes. As ovarian torsion cuts off blood flow to the ovary, there is a high risk of tissue death, which can lead to loss of the ovary and infertility. Contact your OB-GYN right away if you experience severe pain with or without nausea or vomiting, particularly if you have known risk factors for ovarian torsion.

Can ovarian torsion resolve itself?

Your ovary may twist and untwist, causing the symptoms to come and go. This is known as intermittent torsion. If you are not experiencing pain, and your doctor does not detect any signs of torsion in an exam, they may recommend observation to see whether torsion occurs again.

Does ovarian torsion show on ultrasound?

Certain features of ovarian torsion can appear on ultrasound. These include swelling in the ovary, absence of blood flow, and a whirlpool sign of blood vessels. However, surgical evaluation is the most definitive diagnostic tool for ovarian torsion.

Summary

Ovarian torsion is the twisting of an ovary around the ligaments that support it. It is an emergency that requires urgent treatment to prevent ovary loss or tissue damage.

The primary risk factor for ovarian torsion is a mass on the ovary, such as a cyst or tumor. Conditions that increase the risk of ovarian cysts — such as pregnancy or certain infertility treatments — can increase the risk of ovarian torsion.

Contact your OB-GYN right away if you experience symptoms that include lower abdominal pain, fever, bleeding, or unusual vaginal discharge. The OB-GYN can provide a diagnosis and suggest appropriate treatment.

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Medical Reviewer: Amanda Kallen, MD
Last Review Date: 2022 Aug 2
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