Ovarian Torsion

What is ovarian torsion?

Ovarian torsion is a condition in which an ovary twists around the ligaments that hold it in place. The ovaries are two small, almond-shaped organs on either side of the uterus (womb) that store eggs and produce hormones. Each ovary receives its blood supply through vessels that run within these supporting ligaments. When the ovary rotates, those blood vessels can become kinked or compressed, much like twisting a garden hose. This reduces or completely cuts off blood flow to the ovary. In many cases, the fallopian tube — the tube that carries eggs from the ovary to the uterus — twists along with the ovary. When both structures twist together, doctors may use the term adnexal torsion (“adnexa” refers to the ovary and fallopian tube as a unit).

Understanding what is ovarian torsion matters because it is a gynecologic emergency. Without prompt treatment, the ovary can lose its blood supply long enough for the tissue to die, a process called necrosis. This can lead to permanent loss of the ovary and, in rare cases, serious complications such as infection.

Ovarian torsion can occur at any age, from infancy through the years after menopause, but it is most common in women of reproductive age — roughly from the first menstrual period into the mid-forties. It also occurs in girls before puberty and, less often, in pregnant women, most commonly during the first trimester. Although ovarian torsion is not one of the most common causes of pelvic pain overall, it is one of the most time-sensitive, which is why doctors take sudden, severe pelvic pain very seriously.

Symptoms of ovarian torsion

Ovarian torsion symptoms often begin suddenly and can be severe, though the picture varies from person to person. The most typical features include:

• Sudden, severe pain in the lower abdomen or pelvis, usually on one side (the side of the twisted ovary)
• Pain that may radiate to the back, flank (the side of the body between the ribs and hip), or groin
• Nausea and vomiting, which frequently accompany the pain
• Pain that comes in waves or gets sharply worse with movement
• A tender mass that a doctor may be able to feel during a pelvic examination
• Low-grade fever, which can appear later if the ovarian tissue has been deprived of blood for some time

The character of the pain can differ depending on how the torsion behaves. In a complete torsion, where the blood supply is fully cut off, the pain is usually abrupt and intense, and many people can recall the exact moment it started. In intermittent or partial torsion, the ovary twists and then untwists on its own, so the pain may come and go over hours, days, or even weeks. These episodes of pain that suddenly appear and then resolve can be confusing and are sometimes mistaken for other conditions, such as ovarian cysts, kidney stones, appendicitis, or gastrointestinal upset.

Symptoms can also differ by age and situation. In young children, who may not be able to describe their pain clearly, torsion may show up as fussiness, refusal to eat, vomiting, or drawing the legs up toward the belly. In pregnant women, torsion pain can be harder to interpret because pregnancy itself causes many abdominal sensations. After menopause, torsion is less common but still possible, particularly when an ovarian mass is present, and the symptoms are broadly similar: sudden one-sided pelvic pain, often with nausea.

It is important to know that no single symptom proves or rules out ovarian torsion. Some people have classic, dramatic pain; others have milder or fluctuating discomfort. Because the consequences of a missed torsion can be serious, doctors generally keep it on the list of possibilities whenever a person with ovaries has sudden lower abdominal pain.

Causes and risk factors

Ovarian torsion causes usually come down to anatomy: anything that makes the ovary heavier, larger, or more mobile increases the chance that it will rotate on its supporting ligaments. Common contributing factors include:

• Ovarian cysts and benign masses. A cyst is a fluid-filled sac; the majority of ovarian growths associated with torsion are noncancerous. An enlarged ovary — often once it reaches several centimeters in size — is more likely to swing and twist. Dermoid cysts (benign growths that can contain different tissue types) are a frequently cited example.
• Fertility treatment. Medications used to stimulate the ovaries during fertility care can cause multiple follicles (fluid-filled sacs containing eggs) to grow, enlarging the ovaries and raising the risk of torsion.
• Pregnancy. Torsion is somewhat more likely in early pregnancy, partly because of the corpus luteum — a normal hormone-producing cyst that forms after ovulation — and hormonal changes that relax supporting tissues.
• Long or lax supporting ligaments. Some people, particularly children and adolescents, have naturally longer ovarian ligaments, allowing a normal-sized ovary to twist. This is one reason torsion can occur even without any cyst or mass, especially in younger patients.
• Prior torsion. An ovary that has twisted once may be more likely to twist again.
• Previous pelvic surgery. In some cases, changes after surgery, such as tubal ligation, have been associated with torsion, though this link is less consistent.

The right ovary appears to twist somewhat more often than the left. Many doctors believe this is because the sigmoid colon (the lower part of the large intestine) sits on the left side of the pelvis and may limit how much the left ovary can move.

Physical activity, such as exercise or sudden changes in position, is sometimes reported just before the pain begins, but torsion can also occur at rest. Importantly, ovarian torsion is not caused by anything a person did wrong, and it usually cannot be predicted or prevented in advance.

Diagnosis

Ovarian torsion diagnosis begins with a careful conversation about the symptoms — when the pain started, what it feels like, and whether it comes and goes — followed by a physical examination, including a pelvic exam. During the exam, the doctor may feel tenderness on one side or a mass in the pelvic area.

Several tests commonly support the evaluation:

• Pelvic ultrasound. This is the main imaging test for suspected torsion. Ultrasound uses sound waves, not radiation, to create pictures of the ovaries. It is often performed both through the abdomen and transvaginally (with a slim probe placed in the vagina) for a clearer view. Doctors look for an enlarged ovary, swelling, a cyst or mass, follicles pushed to the edge of the ovary, and free fluid in the pelvis.
• Doppler ultrasound. Doppler is a setting on the ultrasound machine that shows blood flow. Reduced or absent blood flow to the ovary raises strong suspicion of torsion. However — and this is a key point — normal blood flow on Doppler does not rule out torsion. The ovary has a dual blood supply, and flow can appear intact even when the ovary is twisted, especially early or in intermittent torsion.
• Blood and urine tests. A pregnancy test is routinely done, both because pregnancy affects the diagnosis and because it helps exclude an ectopic pregnancy (a pregnancy growing outside the uterus), which can cause similar pain. Blood counts and other tests help assess for infection or inflammation and rule out alternative causes.
• CT or MRI scans. These are not the first-line tests for torsion, but they are sometimes obtained when the diagnosis is unclear or when other conditions, such as appendicitis or kidney stones, are being considered. They may show an enlarged, displaced ovary or a twisted vascular stalk.

Here is the honest reality: no imaging test can confirm ovarian torsion with complete certainty. The definitive diagnosis is made in the operating room, usually during laparoscopy — a minimally invasive procedure in which a thin camera is inserted through a small incision in the abdomen so the surgeon can look directly at the ovary. If the clinical suspicion of torsion is high, doctors often proceed to surgery based on the overall picture rather than waiting for perfect certainty, because time matters for saving the ovary. At hospital groups such as Acibadem, this evaluation is typically managed by the obstetrics and gynecology department, often in coordination with emergency medicine and radiology.

Treatment options

Ovarian torsion treatment is surgical in nearly all confirmed or strongly suspected cases. Unlike many gynecologic conditions, torsion is not managed with watchful waiting or medication alone, because a twisted ovary generally cannot untwist reliably on its own, and every hour of lost blood flow increases the risk of permanent damage. Pain medication and anti-nausea medication may be given for comfort, but they are supportive measures, not a cure.

The main treatment approaches include:

• Laparoscopic detorsion. This is the standard first-line procedure in most cases. Through a few small incisions, the surgeon uses a camera and slender instruments to gently untwist (detorse) the ovary and restore blood flow. Laparoscopy usually allows a shorter hospital stay and faster recovery than open surgery.
• Ovarian conservation. Modern practice strongly favors keeping the ovary whenever possible, especially in children, adolescents, and women who may want children in the future. Even an ovary that looks dark, swollen, and bruised at surgery can often recover its function once blood flow returns, so its appearance during the operation is not, by itself, a reliable sign that it must be removed.
• Cystectomy. If a cyst or benign mass contributed to the torsion, the surgeon may remove the cyst (a procedure called cystectomy) while preserving the rest of the ovary. Depending on the situation, this may be done at the same operation or at a later, planned procedure once the swelling has settled.
• Oophorectomy. Removal of the ovary (oophorectomy), sometimes together with the fallopian tube (salpingo-oophorectomy), is generally reserved for situations where the tissue is clearly dead, where there is significant concern about cancer, or in some postmenopausal patients. Your surgical team weighs these decisions individually.
• Oophoropexy. In some cases — particularly after repeated torsion, or when the ligaments are unusually long — the surgeon may stitch the ovary to a nearby structure to reduce the chance of future twisting. This is called oophoropexy. It is not performed routinely, and doctors discuss its potential benefits and uncertainties case by case.

Occasionally, open abdominal surgery (laparotomy) is needed instead of laparoscopy, for example when a mass is very large or the anatomy is complex. In pregnant women, surgery for torsion can usually be performed safely, and the anesthetic and surgical plan is adjusted to protect the pregnancy as much as possible.

After surgery, recovery from a laparoscopic procedure is often measured in days to a couple of weeks, though this varies. Follow-up typically includes a review of any tissue removed, and sometimes a later ultrasound to check how the ovary is healing. If a cyst was involved, your doctor may recommend periodic monitoring.

Living with ovarian torsion and outlook

For most people, ovarian torsion is a one-time emergency rather than a chronic illness. Once the ovary has been untwisted or, if necessary, removed, the acute problem is resolved. The longer-term outlook depends largely on how quickly treatment occurred and whether the ovary could be saved.

When the ovary is preserved, it often regains function over time, and many people go on to have normal hormone production, regular cycles, and the ability to conceive. When one ovary must be removed, the remaining ovary can usually take over hormone production and ovulation, so fertility is frequently still possible, although individual circumstances vary and no outcome can be guaranteed. If both ovaries were affected — which is uncommon — or if you have concerns about future fertility, a discussion with a gynecologist or fertility specialist can help clarify your options.

A few realistic points to keep in mind:

• Recurrence is possible. Torsion can happen again, in the same ovary or the other one, particularly in people with long supporting ligaments or recurrent cysts. Knowing the warning signs allows you to seek help quickly if pain returns.
• Follow-up matters. If a cyst or mass contributed to the torsion, your doctor may recommend ultrasound checks over time to watch for regrowth or new cysts.
• Emotional recovery is real. A sudden emergency and surgery can be stressful, especially when questions about fertility are involved. It is reasonable to ask your care team to explain what was found, what was done, and what it means for your future.

Doctors avoid promising specific outcomes because each case is different, but with timely treatment, the overall outlook after ovarian torsion is generally favorable in many cases.

Frequently asked questions

What is ovarian torsion in simple terms?

Ovarian torsion means the ovary has twisted around the ligaments that hold it in place, squeezing the blood vessels that supply it. Because the ovary cannot survive long without blood flow, torsion is treated as an emergency. It most often causes sudden, severe pain on one side of the lower abdomen, frequently with nausea or vomiting, and it usually requires surgery to correct.

Can ovarian torsion go away on its own?

Sometimes an ovary twists and then untwists spontaneously — this is called intermittent torsion — and the pain may temporarily disappear. However, this cannot be predicted or relied upon, and an ovary that has twisted once may twist again. Because there is no safe way to know from home whether the ovary has untwisted or is losing its blood supply, sudden severe pelvic pain should always be evaluated promptly rather than waited out.

How serious is ovarian torsion?

Ovarian torsion is considered a gynecologic emergency. The main risk is permanent loss of the ovary if blood flow is cut off for too long, which can affect hormone production and fertility on that side. In rare cases, dead tissue can become infected. The condition itself is rarely life-threatening when treated promptly, and outcomes are generally much better the sooner surgery is performed.

How is ovarian torsion diagnosed?

Doctors combine the story of your symptoms, a physical and pelvic examination, a pregnancy test, and imaging — usually a pelvic ultrasound with Doppler to assess blood flow to the ovary. Because imaging cannot completely rule torsion in or out, the final confirmation is made by looking at the ovary directly during laparoscopy, a minimally invasive camera procedure. When suspicion is high, surgeons often operate without waiting for absolute certainty.

What does ovarian torsion pain feel like?

Most people describe a sudden, sharp, or cramping pain low in the belly on one side, sometimes spreading to the back or groin. The pain is often severe enough to cause nausea or vomiting and may worsen with movement. In intermittent torsion, the pain can come in waves that appear and then ease. That said, pain patterns vary widely, and milder or unusual pain does not exclude torsion.

Can I still get pregnant after ovarian torsion?

In many cases, yes. If the ovary is untwisted in time, it often recovers and continues to release eggs. Even when one ovary must be removed, the remaining ovary can usually ovulate and support pregnancy. Individual fertility depends on many factors, so if you are planning a pregnancy after torsion, it is reasonable to discuss your specific situation with your gynecologist.

How long is recovery after ovarian torsion surgery?

Recovery depends on the type of surgery. After laparoscopic surgery, many people go home within a day or two and gradually return to normal activities over one to two weeks, though your surgeon’s advice may differ based on what was done. Open surgery generally requires a longer recovery. Some soreness at the incision sites, fatigue, and mild bloating are common early on; worsening pain, fever, or heavy bleeding should be reported to your care team.

Can ovarian torsion happen more than once?

Yes, recurrence is possible, particularly in people whose ovaries have long, lax supporting ligaments or who develop repeated cysts. If torsion recurs, or if the risk of recurrence is thought to be high, your surgeon may discuss oophoropexy, a procedure that fixes the ovary in place to reduce twisting. Knowing your history and recognizing the warning signs helps you seek care quickly if symptoms return.

When to see a doctor

Ovarian torsion is a time-critical emergency, and delay can mean the difference between saving and losing an ovary. Seek emergency medical care right away — do not wait to see if the pain passes — if you experience any of the following:

• Sudden, severe pain in the lower abdomen or pelvis, especially on one side
• Pelvic pain accompanied by nausea or vomiting
• Pain that comes in intense waves or that returns after previously easing
• Severe pelvic pain during pregnancy or during fertility treatment
• Pelvic pain with fever, dizziness, or fainting
• Sudden severe pain in a child or teenager with ovaries, even if she cannot describe it clearly

You should also arrange a timely, non-emergency evaluation if you have recurring episodes of one-sided pelvic pain, a known ovarian cyst that is causing new or changing symptoms, or ongoing pelvic discomfort that has not been explained. In hospital settings, including Acibadem facilities, suspected ovarian torsion is evaluated urgently by gynecology teams, because rapid diagnosis and treatment give the ovary the best chance of recovery. If you are ever unsure whether your pain is serious, it is safer to be examined than to wait.