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Picture an unexpected, severe pain gripping your lower abdomen—a pain that stops you in your tracks. While it may feel like just another cramp, it could be a sign of something far more dangerous: ovarian torsion. This sudden condition can jeopardize not only your reproductive health but also your overall well-being if not treated promptly. When ovarian torsion strikes, quick action is essential to prevent complications.

An ovarian torsion or adnexal torsion occurs when the ovary twists over the ligaments that support it, cutting off its blood supply. Sometimes, the fallopian tube twists as well. It generally happens only on one side, and while it typically affects women of reproductive age, it can affect girls as well.

While ovarian torsion may not be widely known, recognizing the symptoms and understanding the risk factors can be crucial in safeguarding your health.

Symptoms of Ovarian Torsion

Symptoms of ovarian torsion can come on suddenly, with acute pelvic pain on one side of the abdomen generally being the first sign. This pain can be dull or sharp, and it may be intermittent or constant. It may start as minor pain but progress over time, or it can be sudden and severe. Pain usually occurs on the side of the affected ovary, but it can radiate to the back and sides. Ovarian torsion typically occurs on the right side because the ligament on the right side is longer, which allows for greater movement. Plus, the sigmoid colon can help stabilize the ovary on the left side and prevent it from twisting. That said, ovarian torsion can occur on the left side, as cysts and other masses can occur on either ovary.

Other symptoms of ovarian torsion can include nausea or vomiting. Fever may be present if the ovarian tissue is already dying, or if there is an infection present. Some women may experience abnormal vaginal bleeding, though this is less common and generally only occurs if an abscess is present. If you experience any of these symptoms, seek emergency care right away. Waiting to get medical attention can increase the risk of losing the ovary.

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Self-Advocacy and Early Warning Signs

The pain from an ovarian torsion can be mild at first, but it is important not to dismiss any persistent pain or discomfort, no matter how mild it is at first. If a person with ovarian torsion is experiencing minor pain, it is likely to progress to more severe pain as the damage to the ovary worsens.

Keeping track of irregular periods, recurring pelvic pain or ovarian pain can help you know when something is out of the ordinary, particularly if you have a history of ovarian cysts. Having an ovarian cyst is the biggest risk factor for ovarian torsion, and having this information available can help a doctor with your diagnosis. To ensure you are doing all you can to recognize a problem, talk to your healthcare provider. Ask questions, such as:

  • Do I need to have my cysts monitored?
  • What should I do if I experience sudden abdominal pain?
  • Is there anything I can do to reduce my risk of ovarian torsion if I have a history of cysts?
  • Is birth control an option to help control cyst growth?

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Causes and Risk Factors

As mentioned, ovarian cysts are the most common cause of torsion. They increase the weight of the ovary, making it more likely to twist. Ovarian cysts are relatively common, affecting about 10 percent of women. More than 80 percent of people with ovarian torsion have a cyst or mass that is 5 cm or larger. The larger the mass, the higher the risk of torsion, but it can happen with masses of any size.

Multiple factors can put someone at risk for ovarian cysts. For example, fertility treatments, especially those that stimulate ovulation, are a significant risk factor. Some research indicates that approximately 20 percent of people using ovulation induction drugs develop ovarian cysts. Pregnancy is another risk factor. The growing uterus can shift the ovaries out of position, making torsion more likely. About ten to 25 percent of ovarian torsion cases occur in pregnant women.

Other risk factors include abnormally long ligaments supporting the ovaries, a history of ovarian torsion, or polycystic ovary syndrome. Other ovarian masses can also cause ovarian torsion, and it is more common with benign masses than cancerous ones. Vigorous exercise can also increase the risk of ovarian torsion in women with cysts or ovarian masses.

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Diagnosis

For women of childbearing age, doctors may first check for ectopic pregnancy since it shares some symptoms with ovarian torsion. A negative pregnancy test can effectively rule this out. Ruptured ovarian cysts can also present similar symptoms, particularly sudden sharp pain. Other possible causes, such as appendicitis or ovarian abscess, are also considered during diagnosis.

The primary imaging technique for diagnosing ovarian torsion is an ultrasound with Doppler, which assesses ovarian blood flow. Reduced or absent blood flow strongly indicates torsion. Additionally, ultrasounds may reveal edema and an enlarged ovary, and both pelvic and transvaginal ultrasounds are typically used. MRI and CT scans aren't standard for diagnosing torsion but can help rule out other conditions.

To confirm the diagnosis, doctors may perform laparoscopy. During this minimally invasive procedure, a small incision near the belly button allows for direct visualization of the ovary using a thin tube with a camera. Laparoscopies are often performed in emergencies, and depending on the cyst size, the surgeon may convert the procedure to a laparotomy to treat or remove the torsion.

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Treatment Options

The primary treatment for ovarian torsion is surgery called detorsion, which a gynecologist should perform. For women who can still have children, the goal is to save the ovary if possible. Before starting, the surgeon checks if the ovary is healthy enough. During the procedure, which is usually done with a small camera called a laparoscopy, the surgeon carefully untwists the ovary. Detorsion works for over 90 percent of patients.

If the ovary has gone too long without blood, the tissue may die, and the surgeon might need to remove it. This removal surgery is called an oophorectomy. If both the ovary and fallopian tube are removed, it's known as a salpingo-oophorectomy. These surgeries are usually done with laparoscopy, but if there are problems or the cyst is very large, the surgeon might need to switch to an open surgery.

Most ovarian cysts measure between one and three centimeters. While rare, giant ovarian cysts can reach over ten centimeters in diameter.

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Post-Surgical Recovery

Having an ovary removed does not appear to affect fertility or the onset of menopause as the remaining ovary compensates, but having one ovary has recently been connected to reduced live birth rates after IVF. That said, there is some evidence that having only one ovary can lead to an increased risk of neurological disease, like dementia or Parkinson's disease, and an overall increased mortality risk.

Recovery after an oophorectomy or salpingo-oophorectomy can vary. People who have minimally invasive surgery usually heal faster. They often have less pain and spend less time in the hospital than those who need open surgery, which might require an overnight stay. With laparoscopic surgery, most people can return to their usual activities within two or three weeks. Open surgery, however, involves a larger cut, so recovery can take longer. People who have open surgery might have restrictions on their activities for six to eight weeks, and full recovery can take up to 12 weeks. Once you've recovered, your doctor might suggest hormonal birth control to help prevent ovarian cysts and lower the chances of ovarian torsion happening again.

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Prevention and Risk Management

While ovarian torsion cannot be directly prevented, reducing the risk is possible. Ovarian cysts are the biggest risk factor, and they can't always be prevented in women who ovulate. However, birth control can stop ovulation and help prevent some cysts from forming. Hormonal treatments, including birth control, should be used under a doctor's supervision. Women with known ovarian cysts should discuss options for monitoring cyst size and symptoms with their doctor. For those at higher risk of ovarian torsion, regular ultrasounds may also be recommended.

Ultrasound image of ovarian cyst

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When In Doubt

Ovarian torsion is a serious medical emergency, so if you notice any symptoms, it's important to seek medical help immediately. Acting quickly can make a significant difference in saving the affected ovary. Keeping track of any symptoms can also help you recognize unusual changes and assist your doctor with a diagnosis. For those with existing ovarian cysts or who are prone to developing them, regular ultrasounds may be recommended to monitor your condition. Always reach out to your healthcare provider if you have questions or concerns.

Woman has stomach ache and press hands to stomach due to ovarian pain

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Disclaimer

This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.