Ovarian torsion (adnexal torsion) is when an ovary, and sometimes the fallopian tube, become twisted, cutting off the blood supply. This can result in the loss of the ovary, making it a medical emergency.

It’s unclear how often ovarian torsion occurs, but doctors agree it’s an uncommon diagnosis. You may be more likely to experience ovarian torsion if you have ovarian cysts, which can cause the ovary to swell. You may be able to reduce your risk by using hormonal birth control or other medications to help reduce the size of the cysts.

Keep reading to learn which symptoms to watch for, determine your overall risk, when to see a doctor, and more.

Ovarian torsion can cause:

  • severe, sudden pain in the lower abdomen
  • cramping
  • nausea
  • vomiting

These symptoms usually present suddenly and without warning.

In some cases, pain, cramping, and tenderness in the lower abdomen may come and go for several weeks. This can occur if the ovary is attempting to twist back into the correct position.

This condition never occurs without pain.

If you’re experiencing nausea or vomiting without pain, you likely have a different underlying condition. Either way, you should see a doctor.

Torsion can occur if the ovary is unstable. For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable.

You may also be more likely to develop ovarian torsion if you:

Although this can happen at any age, it’s most likely to occur during reproductive years, which are generally between the first menstrual cycle and menopause.

If you’re experiencing symptoms of ovarian torsion, seek immediate medical attention. The longer the condition goes untreated, the more likely you will experience complications.

After assessing your symptoms and reviewing your medical history, your doctor will perform a pelvic exam to locate any areas of pain and tenderness. They’ll also perform a transvaginal ultrasound to view your ovary, fallopian tube, and blood flow.

Your doctor will use blood and urine tests to rule out other potential diagnoses, such as:

Although your doctor can make a preliminary diagnosis of ovarian torsion based on these findings, a definitive diagnosis is typically made during corrective surgery.

Surgery will be done to untwist your ovary, and, if necessary, your fallopian tube. After surgery, your doctor may prescribe medication to reduce your risk of recurrence. Occasionally, it may be necessary to remove the affected ovary.

Surgical procedures

Your doctor will use one of two surgical procedures to untwist your ovary:

  • Laparoscopy: Your doctor will insert a slender, lighted instrument into a small incision in your lower abdomen. This will allow them to view your internal organs. They’ll make another incision to allow access to the ovary. Once the ovary is accessible, your doctor will use a blunt probe or another tool to untwist it. This procedure requires general anesthesia and is usually done on an outpatient basis. Your doctor may recommend this surgery if you’re pregnant.
  • Laparotomy: With this procedure, your doctor will make a larger incision in your lower abdomen to allow them to reach in and untwist the ovary manually. This is done while you’re under general anesthesia, and you’ll be required to stay at the hospital overnight.

If too much time has passed — and the prolonged loss of blood flow has caused the surrounding tissue to die — your doctor will remove it through either:

  • Oophorectomy: If your ovarian tissue is no longer viable, your doctor will use this laparoscopic procedure to remove the ovary.
  • Salpingo-oophorectomy: If the ovarian and fallopian tissue are no longer viable, your doctor will use this laparoscopic procedure to remove them. They may also recommend this procedure to prevent recurrence in postmenopausal women.

As with any surgery, risks of these procedures may include blood clotting, infection, and complications from anesthesia.

Medication

Your doctor may recommend over-the-counter pain relievers to help ease your symptoms during recovery, such as:

  • acetaminophen (Tylenol)
  • ibuprofen (Advil)
  • naproxen (Aleve)

If your pain is more severe, your doctor may prescribe opioids, such as:

  • oxycodone (OxyContin)
  • oxycodone with acetaminophen (Percocet)

Your doctor may prescribe high dose birth control pills or other forms of hormonal birth control to reduce your risk of recurrence.

The longer it takes to receive a diagnosis and treatment, the longer your ovarian tissue is at risk.

When torsion occurs, blood flow to your ovary — and possibly to your fallopian tube — is reduced. A prolonged reduction in blood flow can lead to necrosis (tissue death). If this happens, your doctor will remove the ovary and other affected tissue.

The only way to avoid this complication is to seek immediate medical attention for your symptoms.

If an ovary is lost to necrosis, conception and pregnancy are still possible. Ovarian torsion doesn’t affect fertility in any way.

Ovarian torsion is considered a medical emergency, and surgery is required to correct it. Delayed diagnosis and treatment can increase your risk of complications and may result in additional surgeries.

Once the ovary has been untwisted or removed, you may be advised to take hormonal birth control to reduce your risk of recurrence. Torsion doesn’t have an impact on your ability to conceive or carry a pregnancy to term.