Ovarian Torsion: Symptoms, Causes, and Treatment

What is Ovarian Torsion?

Ovarian torsion is a serious medical condition where an ovary twists around the ligaments that hold it in place, cutting off its blood supply. This can lead to severe pain and, if untreated, permanent damage to the ovary. Ovarian torsion is considered a gynecological emergency and requires immediate medical attention.

According to the Mayo Clinic, ovarian torsion most commonly affects women of reproductive age, though it can occur at any age. It often involves the fallopian tube as well, a condition sometimes called adnexal torsion.

Common Causes

Several factors can increase the risk of ovarian torsion. The most common causes include:

• Ovarian cysts or masses: Large cysts (typically >5 cm) can make the ovary more prone to twisting. Source: NIH.
• Polycystic Ovary Syndrome (PCOS): Women with PCOS may have enlarged ovaries, increasing torsion risk.
• Pregnancy: The ligaments supporting the ovaries can stretch during pregnancy, making torsion more likely. Source: ACOG.
• Ovulation induction: Fertility treatments that stimulate the ovaries can lead to enlargement and torsion. Source: ASRM.
• Previous pelvic surgery: Scar tissue or altered anatomy can increase risk.
• Long ovarian ligaments: Some women naturally have longer ligaments, making the ovary more mobile.
• Tumors: Both benign and malignant ovarian tumors can contribute to torsion.
• Rapid weight loss or gain: Sudden changes in body weight can affect ovarian position.
• Strenuous exercise: Intense physical activity may trigger torsion in susceptible individuals.
• Anatomical abnormalities: Congenital differences in pelvic structure can play a role.

Associated Symptoms

Ovarian torsion typically causes sudden, severe symptoms. The most common signs include:

• Sudden, sharp pelvic pain: Often localized to one side, this pain may radiate to the lower back or thigh.
• Nausea and vomiting: Due to the intense pain and potential nerve involvement.
• Abdominal tenderness: The affected area may be very sensitive to touch.
• Fever: If the ovary becomes necrotic (dies due to lack of blood), infection can set in.
• Irregular vaginal bleeding: Some women experience spotting or light bleeding.
• Pain during intercourse: If torsion is partial or intermittent.
• Urinary symptoms: Such as frequent urination or difficulty emptying the bladder.

Symptoms may resemble other conditions like appendicitis, kidney stones, or ectopic pregnancy, making diagnosis challenging.

When to See a Doctor

Seek medical attention immediately if you experience:

• Sudden, severe pelvic pain that doesn’t improve with rest or pain relievers.
• Pain accompanied by nausea, vomiting, or fever.
• Abdominal swelling or tenderness.
• Pain that disrupts daily activities or sleep.

Early intervention is critical to preserve ovarian function. Delaying treatment can lead to ovarian necrosis (tissue death) within 6–12 hours.

Diagnosis

Diagnosing ovarian torsion involves a combination of:

• Medical history: Your doctor will ask about symptoms, menstrual cycle, and risk factors.
• Physical exam: A pelvic exam may reveal tenderness or a mass.
• Imaging tests:
  • Ultrasound (with Doppler): Checks blood flow to the ovary. Reduced or absent flow suggests torsion. Source: NIH.
  • CT or MRI: Used if ultrasound is inconclusive.
• Blood tests: To rule out infection (e.g., white blood cell count) or pregnancy (hCG test).

Note: Imaging may not always confirm torsion, so clinical suspicion plays a key role in diagnosis.

Treatment Options

Medical Treatments

• Surgery (Laparoscopy or Laparotomy):
  • Detorsion: The ovary is untwisted to restore blood flow.
  • Oophorectomy: If the ovary is necrotic, it may need to be removed.
  • Cystectomy: Removal of cysts to prevent recurrence.

  Surgery is the only definitive treatment for ovarian torsion. Source: Cleveland Clinic.

• Pain management: IV pain relievers may be given before or after surgery.
• Antibiotics: If infection is present or suspected.

Home Treatments (Post-Surgery)

• Rest and avoid strenuous activity for 1–2 weeks.
• Take prescribed pain medications as directed.
• Apply heat (e.g., heating pad) to ease residual discomfort.
• Monitor for signs of infection (fever, worsening pain, discharge).

Note: Home treatments cannot resolve ovarian torsion—surgery is always required.

Prevention Tips

While not all cases can be prevented, these steps may reduce risk:

• Attend regular gynecological exams to monitor ovarian health.
• Report any new pelvic masses or cysts to your doctor promptly.
• If you have PCOS or a history of ovarian cysts, discuss prevention strategies with your healthcare provider.
• Avoid high-impact activities if you’re at high risk (e.g., known large cysts).
• Seek early treatment for ovarian cysts or tumors.

Emergency Warning Signs

Call 911 or go to the ER immediately if you experience:

• Sudden, excruciating pelvic pain (especially one-sided).
• Pain accompanied by vomiting, fainting, or inability to stand.
• Signs of shock (pale skin, rapid heartbeat, confusion).
• Severe pain during pregnancy (could indicate torsion or other emergencies).

Ovarian torsion is a time-sensitive emergency. Do not wait to see if symptoms improve—seek help right away.

References

• Mayo Clinic. (2022). Ovarian Cysts.
• American College of Obstetricians and Gynecologists. (2021). Ovarian Cysts FAQ.
• National Institutes of Health. (2020). Ovarian Torsion.
• Cleveland Clinic. (2023). Ovarian Torsion Overview.