What to Know About Ovarian Torsion, a Fertility-Threatening Condition
If you think it's happening to you, hightail it to the ER—it's an emergency.
Actress Busy Philipps spent some unexpected time in the hospital after experiencing a “crazy excruciating pain” in her lower right side, the actress posted on Instagram in 2017. The official diagnosis, Philipps wrote, was that she’d suffered an ovarian torsion, also known as a twisted ovary.
Philipps wrote that her ovary “had flipped over” but had then “flipped back by itself and I’m ok.” But she used the experience to remind her Instagram followers about the importance of paying attention to strange symptoms, whatever they may be. Although she was lucky, she pointed out that the condition—also called andexal torsion—can sometimes require surgery or result in the loss of an ovary, “which actually happened to a really good friend of mine,” she wrote.
Yikes: Loss of an ovary? Excruciating pain? To find out more about this scary-sounding condition, Health spoke with Beth Schwartz, MD, assistant professor of gynecology at Thomas Jefferson University in Philadelphia. Dr. Schwartz has not treated Philipps, but she has diagnosed ovarian torsion in other patients and published research on the condition.
“What this means is that the ovary or the fallopian tube—or both—twists around itself,” says Dr. Schwartz. “Think about any part of your body twisting, and you can see how that could really hurt.” And it gets worse, she adds, because that twist can affect blood flow.
“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,” says Dr. Schwartz, “which is a big problem that can have effects potentially on fertility in the future.”
Why this happens to some women is a good question, says Dr. Schwartz, 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. It 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 women who have none of these risk factors, says Dr. Schwartz. It’s more common in young women and teenagers, and the condition can even happen to babies and children, but older adult women can experience it as well.
Not much can be done to prevent ovarian torsion, either. “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,” says Dr. Schwartz. “It’s not related to lifestyle or anything women are physically doing.”
There is one thing that can lower a woman’s chances: Being on the pill. Taking oral contraceptives or another form of hormonal birth control reduces the risk of cysts. In that sense, it can also protect against cyst-related torsion episodes.
The good news is that ovarian torsion is relatively uncommon, accounting for less than 3% of gynecological complaints. And if it’s diagnosed and treated early enough, a woman can recover quickly with no lasting problems. Usually, says Dr. Schwartz, the only way to know if you have an ovarian torsion is through minimally invasive laparoscopic surgery—the same surgery that’s used to untwist the organ. But some doctors will make a diagnosis from an ultrasound alone.
Even though most women won’t experience ovarian torsion in their life, Dr. Schwartz thinks 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,” she says. “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.”
Philipps’ message to her followers is a good one in a broader sense, too, says Dr. Schwartz. The actress posted that she “felt like an idiot going to the hospital but ultimately, going was the right move! It always is! Even if they say you’re fine and send you on your way!” It’s a message she’s apparently been preaching for quite a while: “If you listen to my podcast,” she wrote, “you know our advice is always, don’t be a hero, go to the doctor.”