What To Know About Ovarian Torsion—Also Known As Twisted Ovary

It's a rare but serious condition, and emergency treatment may be needed.

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Ovarian torsion—also known as a twisted ovary or torsed ovary—is a rare but serious condition that mainly affects people of reproductive age (15–45 years). Its most common first sign is lower abdominal pain, which may be sudden and severe. Nausea and vomiting can follow. An early diagnosis and surgery are imperative to save the ovary, according to a 2017 review published in the Tzu Chi Medical Journal.

To find out more about this condition, Health spoke with Beth Schwartz, MD, assistant professor of gynecology at Thomas Jefferson University in Philadelphia. Dr. Schwartz has diagnosed ovarian torsion in patients and, in 2018, published a paper on the condition in the Journal of Pediatric & Adolescent Gynecology.

What Is Ovarian Torsion?

"What this means is that the ovary or the fallopian tube—or both—twists around itself," Dr. Schwartz said. "Think about any part of your body twisting, and you can see how that could really hurt." That twist can affect blood flow, Dr. Schwartz added.

"The blood that's in the ovary can't get out and then, if it lasts long enough, new blood can't get in, and the ovary can eventually die if it's not treated," Dr. Schwartz said, "which is a big problem that can have effects potentially on fertility in the future."

How Rare Is a Torsed Ovary?

Ovarian torsion is very rare. One study published in 2015 in the International Journal of Gynecology & Obstetrics, estimated that, on average, only about 5.9 out of every 100,000 women of all ages experienced it over a one-year period, or 9.9 out of every 100,000 women aged 15–45.

It's uncommon overall, but ovarian torsion is still important to be aware of. It's the fifth most common cause of emergency gynecologic surgeries, accounting for 2.7% of all such surgeries, according to a resource from the National Library of Medicine.

Who's at Risk?

Why this happens to some people is a good question, Dr. Schwartz said, one without a clear answer. "We know that if you have a cyst on your ovary, it makes it more likely to twist, but besides that, we don't really understand why it happens to some women and not to others."

A cyst makes torsion more likely because it adds mass and unbalanced weight to the ovary, increasing its chances of flipping over. Specifically, a cyst of greater than 6 centimeters (about 2.4 inches) seen on an imaging test of a patient with symptoms of ovarian torsion would raise higher suspicion of the condition.

A twisted ovary can also happen as a complication of pregnancy or during fertility treatments when the ovaries grow larger because of extra hormones in the body.

Occasionally, though, ovarian torsion can occur in people who have none of these risk factors, Dr. Schwartz said.

What Can You Do To Prevent a Torsed Ovary?

Not much can be done to prevent ovarian torsion. "Some doctors might say that if you have a cyst you shouldn't do any crazy movements—don't do aerobics or jump on trampolines—but we have no evidence that these things have anything to do with it," Dr. Schwartz said. "It's not related to lifestyle or anything women are physically doing."

There is one thing that can lower a person's chances: Taking oral contraceptives, or another form of hormonal birth control, reduces the risk of cysts. In that sense, it could also protect against cyst-related torsion episodes.

How Is Ovarian Torsion Diagnosed and Treated?

The good news is that if ovarian torsion is diagnosed and treated early enough, a person can recover quickly with no lasting problems. The first test performed is often an ultrasound—it uses soundwaves to create an image of you're body's organs, tissues, and other structures, according to the National Library of Medicine's MedlinePlus resource. In this case, the healthcare provider will be looking at the ovarian size and cyst size and checking for ovarian blood flow.

Your provider may also order an MRI or CT scan to begin the diagnostic process, but ultrasound is more often the imaging procedure of choice.

Common conditions that can mimic an ovarian torsion are ectopic pregnancy, tubo-ovarian abscess, and appendicitis. Your healthcare provider will likely consider those as the reason for your symptoms as well.

An ectopic pregnancy happens when a fertilized egg stays in the fallopian tubes instead of moving into the uterus and becomes unviable. A tubo-ovarian abscess can develop in people with pelvic inflammatory disease when an infection (usually an STI) moves up through the uterus, according to a 2015 paper published in Surgical Case Reports.

The ultrasound alone can't diagnose an ovarian torsion, so if there's a high suspicion of the condition after this non-invasive test, your OB-GYN may take you in for an emergency laparoscopic examination. Usually, Dr. Schwartz said, the only way to know if you have an ovarian torsion is through this minimally invasive laparoscopic surgery—the same surgery that's used to untwist the organ.

Even though most people won't experience ovarian torsion in their life, Dr. Schwartz thought everyone should be aware of the potentially dangerous complications. "If anyone all of a sudden develops severe pain, they need to go to their doctor or go to the emergency room right away—especially any woman who knows she has an existing ovarian cyst," Dr. Schwartz said. "If it isn't relieved by normal pain medicines and especially if it's associated with vomiting, I think that's potentially an emergency until proven otherwise."

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