Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. This twisting can cut off blood flow to the ovary and fallopian tube.

Ovarian torsion can cause severe pain and other symptoms because the ovary is not receiving enough blood. If the condition continues for too long without treatment, it can lead to ovarian necrosis (tissue death), loss of the ovary, and in rare cases, infertility.

Ovarian torsion usually affects only one ovary. Doctors may also call this condition adnexal torsion.

This article discusses the ovaries and ovarian torsion in more detail, including symptoms, when to see a doctor, causes, and treatment. It also explores ovarian torsion, assisted reproduction, and complications.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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The ovaries are two small female reproductive organs located on either side of the pelvis. They are roughly the same size and shape as an almond.

The ovaries contain eggs which are released about once each month after maturing. This process is called ovulation. A person will start to ovulate during puberty. It is the part of the menstrual cycle that enables pregnancy.

The ovaries also produce hormones that facilitate a range of processes in the body.

Symptoms of ovarian torsion can include the following:

However, diagnosing ovarian torsion can be challenging because the symptoms are similar to those of other conditions, including:

It is essential to seek medical attention if a person has any of the symptoms of ovarian torsion.

To diagnose ovarian torsion, a doctor may use the following tests:

  • a transvaginal ultrasound, which involves inserting a small ultrasound probe into the vagina
  • an abdominal ultrasound, which uses an ultrasound probe on the outside of the abdomen
  • other imaging tests, such as a CT scan or MRI scan
  • a complete blood count (CBC) test, which can measure the number of white blood cells in the body

However, a doctor cannot fully confirm the ovarian torsion without performing surgery to see the ovary.

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Illustration by Alyssa Kiefer

People between the ages of 20 and 40 years old are most likely to experience ovarian torsion.

However, people of all ages, from infancy to postmenopause, can experience ovarian torsion.

Sometimes, the presence of a cyst or other tissue mass in the ovary can displace it. The extra weight or mass on the ovary can cause it to start to twist and rotate around its supporting ligaments.

Another common cause is an ovarian ligament, connecting the ovary to the uterus, that is longer than usual. A longer ovarian ligament makes ovarian torsion more likely.

Assisted reproductive technologies (ART), such as inducing ovulation, are another factor that may increase the risk for ovarian torsion.

Pregnant people can experience ovarian torsion, as can those who are not pregnant. In the first trimester, a person may have corpus luteum cysts that cause the ovary to twist.

Higher hormone levels during pregnancy can also relax tissues in the body, including the ligaments that hold the ovaries in place. If the ligaments are not taut, they may be more prone to twisting.

Surgery is the only way to untwist an ovary. A doctor may also prescribe medications to reduce pain and nausea for comfort prior to the surgery.

A doctor will often recommend performing surgery as quickly as possible. If ovarian torsion restricts blood flow for too long, the ovarian tissue may die, and a surgeon will need to remove the ovary. Surgical removal of one or both ovaries is known as oophorectomy.

Laparoscopy

Ideally, a doctor can perform the procedure using laparoscopy. Laparoscopy involves making small, keyhole-like incisions in the abdomen.

The doctor will insert several medical instruments, including a video camera, into the abdomen and pelvis and attempt to untwist the ovary.

Laparotomy

Sometimes, if a doctor cannot see the ovary well enough or if the bleeding is severe, they may need to perform a laparotomy. This means making a large incision under the navel to expose the ovary and untwist it.

During surgery

A doctor will continue to observe the ovary to ensure that it has enough blood flow to “live.” The ovary should turn pink from purple or black after being untwisted. If it shows signs of tissue death after untwisting, the doctor may have to remove the ovary.

Aftercare

Most of the time, a person can return home the same day after a laparoscopy.

A doctor may make recommendations about follow-up care, such as avoiding heavy lifting or intense physical activity for a few weeks.

A person can help relieve pain and discomfort by taking over-the-counter (OTC) medications, such as ibuprofen or acetaminophen. People should consider speaking with a doctor before taking OTC medications following surgery.

People should report signs of an infection or another complication to a doctor as soon as possible. Signs of an infection include:

  • fever
  • redness and inflammation at the incision sites
  • foul-smelling discharge
  • a wound that does not heal
  • increasing pelvic pain
  • bleeding

People who undergo ART have a greater risk of experiencing ovarian torsion than those who do not.

The elevated risk is usually due to the hormones required for in vitro fertilization or ovulation induction.

These hormones may cause the ovaries to enlarge, develop multiple cysts, or both. While ovarian cysts are usually harmless, they can increase the risk of ovarian torsion.

While ART can be a successful treatment when a person has problems conceiving, people should always discuss the possible risks with a doctor and seek medical attention if they experience symptoms of ovarian torsion.

One possible complication of ovarian torsion is necrosis. Ovarian necrosis refers to the death of ovarian tissue due to blood loss. A doctor will remove the affected ovary surgically if this happens.

Surgery for ovarian necrosis can affect fertility, as the ovaries produce and release eggs for fertilization.

However, if a doctor does not remove the ovary, a person will be at risk of ovarian infections that can cause an abscess or peritonitis.

It is essential for anyone who experiences ovarian torsions to go to follow-up appointments to ensure the ovary is healing well and receiving enough blood.

Ovarian torsion can lead to ovarian necrosis and other complications without prompt medical intervention.

If a person seeks urgent medical attention and undergoes surgery to reduce the torsion, there are unlikely to be further complications.

However, if ovarian torsion has restricted blood flow to the ovary for too long, or the person has a cyst or tumor, they may require further treatment.