Patient information from BMJ

Ovarian torsion

Last published:Jan 18, 2023

​Ovarian torsion happens when a woman’s (or girl’s) ovary or fallopian tube becomes twisted. This can block the blood supply to the ovary, causing it to die.

Ovarian torsion is a surgical emergency. This means that urgent surgery is needed to correct the problem. With prompt treatment it is usually possible to save the ovary so that fertility is not badly affected.

If you think that you or someone you are with has symptoms of ovarian torsion, seek medical help straight away.

What is ovarian torsion?

Ovaries are part of a woman’s reproductive system. They contain the eggs that grow into embryos when fertilised by a man’s sperm.

Women have two ovaries and two fallopian tubes. Fallopian tubes connect the ovaries to the womb (uterus).

Ovarian torsion happens when an ovary or fallopian tube - or both - becomes twisted. This blocks some or all of the blood flow to the ovary.

If the blood supply is blocked for long enough, the ovary can no longer support the eggs inside it. This means that the eggs cannot be released from the ovary or be fertilised.

Ovarian torsion is a surgical emergency. Prompt surgery can usually reverse the problem and save the affected ovary. But it’s vital to get treatment quickly.

If you think that you or someone you are with has symptoms of ovarian torsion, seek medical help straight away.

Why does it happen?

Ovarian torsion usually affects women and girls of reproductive age: that means women and girls who are able to become pregnant.

It can also happen in children of any age, and in women who have been through the menopause. But this is much less common.

Things that make ovarian torsion more likely include:

• Having one or more ovarian cysts

• Having unusually long fallopian tubes

• Having large ovaries

• Having fertility treatment

• Having cancer of the ovary, and

• Being pregnant.

What are the symptoms?

The main symptoms of ovarian torsion are:

• Sudden pelvic or abdominal (tummy) pain. The pain might come and go, but when it happens it will be severe. The pain is usually so severe that most people go straight to hospital, and

• Nausea, sometimes with vomiting or diarrhoea.

You might also be able to feel a swollen lump in your abdomen. Some people also have a fever, but this is less common.

If your doctor suspects that you have ovarian torsion, they will want to do some tests. These will usually include:

• An ultrasound scan, and possibly other imaging tests

• A pregnancy test (in women and girls of childbearing age), and

• A blood test.

If imaging tests show that there is torsion (twisting), then you will need surgery straight away. But even after scans, the only way to see for certain that torsion has happened is to have surgery.

What treatments are available?

If your doctor suspects that you have ovarian torsion, you will need emergency surgery to correct the problem.

Most people are able to have 'keyhole' surgery. This is less 'invasive' than traditional surgery. This means that the surgeon makes very small incisions (cuts) to do the operation.

This means that you shouldn’t need to stay in hospital as long as with open surgery. You are also likely to have less pain, and to need less pain medication, while you recover.

When this type of surgery is done in time, it is usually possible to save the ovary so that it still works.

Even if an ovary can’t be saved, surgeons do not usually remove it . It is very rare for a damaged ovary to cause problems later. But surgeons will remove a damaged ovary if they think it could lead to problems such as infection.

If you have an ovarian cyst, the surgeon might be able to remove it during the operation to repair the torsion. Or you might need to have a different procedure to remove the cyst at a later date.

Doctors are cautious about operating on pregnant women with ovarian torsion. The surgeon might try a different procedure to try to untwist the ovary, using ultrasound imaging to guide the procedure.

What to expect in the future

Women and girls who have this operation can usually go home within 24 hours. Your doctor will want to follow up with you a little while later, to check that you have recovered well.

You can have ovarian torsion more than once. So if you have symptoms at any time after having treatment, seek medical help urgently.

Your doctor might advise you to avoid sexual intercourse and vigorous exercise for several weeks after your operation.

If you have a history of ovarian cysts, your doctor might suggest that you start taking the contraceptive pill, as this can help to prevent cysts and ovarian torsion. But this is your decision.