12/18/2022
TWISTED O***Y
What Exactly Is 'Ovarian Torsion'?
Actress Busy Philipps brought the painful condition into the spotlight when she publicized her experience with ovarian torsion earlier this month.
Do you know what ovarian torsion is?
“Cougar Town” actress Busy Philipps sure does.
Earlier this month, Philipps posted an Instagram detailing a recent hospital visit.
The actress shared that she had experienced ovarian torsion, or a twisting of the o***y that caused intense pain.
Philipps wrote:
“I had a crazy excruciating pain in my lower right side and after a long time at Mass Gen, it was determined my o***y flipped over — it’s called torsion. Mine flipped back by itself and I’m OK, but sometimes if it doesn’t you have to get surgery or you can lose your o***y (which actually happened to a really good friend of mine).”
The ovaries are walnut-sized organs attached to the fallopian tubes and ovarian ligaments.
Ovarian torsion is when an o***y twists back and forth, causing intense pain in the pelvic area that comes and goes, explained Dr. Adeeti Gupta, a board-certified OB-GYN in New York.
‘It’s enough to stop you in your tracks’
As Philipps described, ovarian torsion makes itself known through sudden, intense pain.
“It’s enough to stop you in your tracks [and] cause you to bend over,” said Dr. Angela Jones, a board-certified OB-GYN in New Jersey.
Sudden onset nausea and vomiting are also common symptoms.
Sometimes ovarian torsion resolves itself on its own, as it did with Philipps. This is called intermittent torsion, meaning that the torsed o***y twists back into place and then ceases twisting.
However, experts say you shouldn’t wait to see if the o***y will twist back on its own. Waiting puts you at risk for cutting off the blood supply to the torsed o***y.
“You need to go in and be evaluated immediately,” especially if you have a known ovarian cyst, Jones told Healthline.
How ovarian torsion is treated
When a person comes in with a suspected ovarian torsion, medical professionals will check for a high pulse rate and examine the belly area for pain or tenderness.
The next step is to administer an ultrasound.
“One of the elements we look for is blood flood to the o***y, which is done by an exam called Doppler, and that’s done during the ultrasound,” Gupta told Healthline. “It should be done long enough so you can actually watch the blood flow come and go, and if you see an obstruction to the blood flow, then definitely that person should be taken up for surgery.”
Laparoscopic surgery to correct an ovarian torsion is minimally invasive.
In rare cases, a torsed o***y can be permanently damaged.
“Torsion… can essentially block the blood supply to the o***y, and it can lead to the death of the o***y, which is called necrosis,” said Gupta.
“It’s really sad if you get a necrotic, or dead o***y, in a 20-year-old or an 18-year-old because you have to remove the o***y,” she continued. “You don’t have another option.”
Ovarian torsion and cysts
Often, ovarian torsion occurs because of a cyst on the o***y.
The size of a cyst is the main factor in whether or not ovarian torsion may occur, Jones said.
Ovarian cysts are common in women and not necessarily a cause for alarm. In fact, most women will have at least one cyst on her o***y during her lifetime.
An OB-GYN will keep an eye on an ovarian cyst during routine gynecological exams to watch whether it grows in size.
“Anything that’s more significant than 5 centimeters in diameter increases your risk of having an ovarian torsion, which is sometimes why we’ll end up removing the cyst,” Jones explained.
Ovarian torsion can occur without the presence of a cyst, however.
“In cases where [torsion] happens without a cyst, it’s usually younger [girls],” explained Gupta. “They’re just attaining puberty and their body is growing, so the uterus, tubes, ovaries, everything’s growing, and… the o***y may tend to twist around.”
Teens who see a pediatrician for nausea, vomiting, and pain in the pelvic area run the risk of being misdiagnosed with appendicitis or gastroenteritis.
“I would just like all clinicians to be aware that [teenagers] could be having a torsion, which could be missed,” Gupta said.
There are other reasons women can feel pain in their pelvic area, such as menstrual cramps, endometriosis, or irritable bowel syndrome.
But sudden, intense pain in that area shouldn’t be ignored.
“Just listen to your body,” said Jones. “If something doesn’t feel right, you should go and be evaluated.”
Philipps echoed the same sentiment in her Instagram post about her hospital visit.
“I felt like an idiot for going to the hospital but ultimately, going was the right move,” she wrote. “It always is.”
7 Potential Causes of O***y Pain: How They’re Diagnosed and Treated
Your ovaries are reproductive glands located on each side of your pelvis. They’re responsible for making reproductive eggs, also called ova. Your ovaries also serve as your body’s primary source of the hormones estrogen and progesterone.
If you have ovaries, you’ve probably experienced pain in them from time to time, typically related to your menstrual cycle. Sometimes, though, o***y pain can be a sign of an underlying condition.
In this article, we take a look at 7 potential causes of pain in your ovaries, along with their symptoms, diagnosis, and treatment.
1. Mittelschmerz
Some people experience o***y pain during regular ovulation each month. This condition is called mittelschmerz. The name comes from the German words for “middle” and “pain.”
Ovulation generally happens in the middle of your menstrual cycle, so you may feel the pain most around day 14 or so, as the egg bursts from the o***y and into your fallopian tube.
Different theories explain why ovulation might hurt. One theory is that because there isn’t an opening in the o***y, your egg has to go through the wall of the o***y, which may hurt. Some doctors think that the enlargement of the egg in the o***y just prior to ovulation may cause the pain.
Symptoms
You’ll typically feel discomfort in your pelvis on one side. This corresponds to which o***y is releasing the egg. Ovulation pain is often mild, feeling like a dull ache. Sometimes, the pain will be sharp and sudden. Overall, ovulation pain can last from a few minutes to several hours.
Some people experience bleeding or discharge during ovulation. Others may have nausea along with pain.
Ovulation pain typically isn’t anything to be concerned about. However, in some cases, it may be a sign of other health conditions, such as endometriosis or a s*xually transmitted infection (STI). Make an appointment with your doctor if your pain is severe or worrying.
Diagnosis
If you choose to visit a doctor, they may diagnose ovulation pain based on the timing of the pain and a pelvic exam that doesn’t show any problems. Keeping a diary about when you’re experiencing pain can also help with the diagnosis.
Treatment
Mittelschmerz pain generally goes away in 1 or 2 days. It doesn’t require treatment, though some people may get relief by using an over-the-counter (OTC) pain medication like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
If you’re not trying to get pregnant, starting a birth control pill regimen can get rid of ovulation pain. This is because, when taken as directed, birth control pills can stop ovulation entirely.
2. Ovarian cysts
Ovarian cysts are sacs or pockets filled with fluid that can form on the surface of an o***y. The most common types of cysts form during the menstrual cycle. These are called functional cysts and often go away over a period of weeks or months.
There are also other types of ovarian cysts that aren’t associated with the menstrual cycle. These include:
endometriomas, also called chocolate cysts, which can form on the ovaries of people with endometriosis
dermoid cysts, also called teratomas, which grow from cells present from birth and can contain tissues like skin and hair
cystadenomas, which are filled with a watery or mucus-like fluid and can potentially grow to be quite large
Most ovarian cysts are benign, which means they’re not cancerous. Generally speaking, older, postmenopausal people are at a higher risk of an ovarian cyst being malignant, or cancerous.
Symptoms
Most cysts don’t cause pain or other symptoms. Even large cysts may go unnoticed for long periods of time. When symptoms are present, they can include:
pain, including pelvic pain, dull pain in your lower back and thighs, pelvic pain around the time of your period, and pain during s*x
fullness in your abdomen
unusual va**nal bleeding
breast tenderness
pressure on your bladder and frequent urination
difficulty emptying your bladder or bowel completely
Ovarian cysts may grow large and risk rupturing. A ruptured ovarian cyst can cause potentially heavy bleeding. Get immediate medical attention if you have:
sudden and severe abdominal pain
fever
nausea or vomiting
cold or clammy skin
rapid breathing
lightheadedness
Diagnosis
If you’re having symptoms of an ovarian cyst, your doctor will first perform a pelvic exam to feel for the presence of a cyst on your o***y.
If a cyst is detected, they’ll then order additional tests, such as:
a pregnancy test to rule out pregnancy
a transva**nal ultrasound to help characterize the size, location, and contents of the cyst
blood tests for an ovarian cancer marker called CA125, if you’re in postmenopause
Treatment
Many ovarian cysts will go away on their own without treatment. Because of this, your doctor may adopt a “wait and see” approach. If your cyst is causing discomfort, OTC pain medications may help to ease this.
If you have frequent ovarian cysts, your doctor may recommend using hormonal birth control. This stops ovulation from happening and can reduce the likelihood of cyst formation.
Some types of ovarian cysts require surgical removal. This is often done using laparoscopy, which is minimally invasive and involves removing the cyst through a small incision in your abdomen. Surgery may be recommended for ovarian cysts that:
don’t go away on their own after several menstrual cycles
cause significant pain
are large or getting larger
appear atypical in an ultrasound
3. Endometriosis
Another cause of o***y pain may be a condition called endometriosis. In endometriosis, tissue similar to the endometrium, which lines the inside of the uterus, grows outside the uterus.
When it lines the uterus, the endometrium typically sheds each month with your menstrual cycle. When similar tissue grows outside the uterus, however, it can become trapped and form scar tissue and adhesions. The ovaries are often one area where this tissue grows.
Symptoms
The main symptom of endometriosis is pain. This can show up in many ways, including:
severe menstrual cramps (dysmenorrhea)
chronic pelvic or lower back pain
pain that happens during or after having s*x
painful urination or bowel movements, which are often worse around the time of your period
digestive discomfort
Endometriosis pain can vary in intensity from person to person. Some people may experience mild discomfort, while others can have severe pain that greatly affects their daily life.
The amount of pain you experience may not speak to the extent of the endometriosis. For example, you may experience severe pain but have a mild case of endometriosis.
Other symptoms of endometriosis include:
fatigue
nausea
diarrhea
constipation
infertility
It’s important to make an appointment with a doctor if you’re having symptoms that are consistent with endometriosis. Endometriosis can be hard to diagnose, so connecting with a doctor early can be beneficial in helping to manage your symptoms.
Diagnosis
Endometriosis is difficult to diagnose, as its symptoms are similar to many other health conditions. A 2017 studyTrusted Source showed that this can lead to delays in diagnosis, at an average of 6.7 years for women between the ages of 18 and 45.
The initial steps in the diagnosis of endometriosis include taking a thorough history, during which your doctor will record your symptoms and note your personal and family medical history. They’ll also do a pelvic exam to feel for cysts or scarring.
Next, your doctor will use imaging to visualize the area around your reproductive organs. They’ll often use an ultrasound, and possibly an MRI.
The only sure way to diagnose endometriosis is through laparoscopy. During this minimally invasive surgical procedure, your doctor will look inside your pelvic area for the presence of endometriosis lesions or adhesions. They may also collect a biopsy sample to examine in a lab.
Treatment
There’s currently no cure for endometriosis. Because of this, treatment focuses on alleviating symptoms and improving quality of life.
Some medications may help to reduce symptoms. These are:
hormonal birth control, which can work to ease pain and bleeding
gonadotropin-releasing hormone agonists, which treat endometriosis by affecting the hormones of your menstrual cycle, introducing a temporary menopause
OTC pain medications, which may reduce mild endometriosis pain
Surgery can also help treat endometriosis. During endometriosis surgery, your doctor will locate endometriosis lesions in your pelvic area and either remove or destroy them. Surgery is typically recommended for endometriosis that:
causes severe symptoms
hasn’t responded to other types of treatment
is affecting fertility
Some people have also found that other interventions can help with their endometriosis symptoms. Some examples include getting acupuncture, adjusting diet, or taking dietary or herbal supplements.
4. Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the reproductive organs in people with ovaries. It affects the cervix, uterus, fallopian tubes, and ovaries. This infection may, but not always, be s*xually transmitted. The Centers for Disease Control and Prevention (CDC)Trusted Source says that PID is most common in women of reproductive age.
Many different bacteria can cause PID. However, the bacteria that cause the STIs gonorrhea and chlamydia cause about one-thirdTrusted Source of reported instances of PID.
PID can lead to permanent damage to your reproductive organs. This can lead to serious complications like infertility and an increased risk of ectopic pregnancy.
Symptoms
You may have PID with or without symptoms. Your symptoms may also be mild or confused with other health conditions. When PID causes symptoms, they may include:
pain or tenderness in your pelvis or abdomen
burning during urination
frequent urination
irregular bleeding
changes to va**nal discharge
pain during s*x
fever, with or without chills
Because PID can lead to potentially serious complications, it’s important to visit your doctor if you’re experiencing the symptoms of PID. Early treatment can help to prevent or reduce the damage that happens due to PID.
Diagnosis
Several tests may help to diagnose PID. These include:
a pelvic exam to check for inflammation and tenderness of your reproductive organs
culturing of a sample from your va**na or cervix to test for an infection
tests for STIs like gonorrhea and chlamydia
blood and urine tests to check for signs of inflammation and aid in ruling out other health conditions
Your doctor might also use additional procedures to confirm a diagnosis of PID or assess damage to the reproductive organs. Examples include:
pelvic ultrasound
endometrial biopsy
laparoscopy
Treatment
Treatment involves taking a course of antibiotics. In order to clear the infection, it’s important to take your entire course of antibiotics as directed, even if you begin to feel better.
It’s also important that s*xual partners get treatment as well. This helps to reduce the chance of your infection coming back.
In rare situations, surgery may be needed to help treat PID. This is typically the case if a pocket of pus called an abscess has formed or ruptured in your pelvic area due to the infection.
5. Ovarian torsion
Ovarian torsion is when your o***y twists around the ligaments that are holding it in its place in your pelvic area. This can cut off the blood supply to the o***y and cause the ovarian tissue to die.
Most often, ovarian torsion happens due to a mass on the o***y. This can be due to:
an ovarian cyst
polycystic ovarian syndrome
a tumor on the o***y
Being pregnant or undergoing fertility treatments are also risk factors for ovarian torsion, due to the enlargement of the follicles of the o***y. Research into people diagnosed with ovarian torsion found that 8 to 15 percentTrusted Source of those experiencing ovarian torsion were pregnant.
Symptoms
The symptoms of ovarian torsion can include:
sudden, severe pelvic pain that may radiate to the abdomen, back, or side (flank)
nausea
vomiting
It’s also possible to have symptoms that come and go over a period of days or weeks. This can happen if the o***y is twisting and then returning to its usual position.
Ovarian torsion is a medical emergency and requires timely treatment. Get medical attention immediately if you’re experiencing symptoms of ovarian torsion.
Diagnosis
The diagnosis of ovarian torsion will involve laboratory blood and urine tests to help rule out other health conditions. Often you will also take a pregnancy test, since pregnancy is a risk factor for ovarian torsion.
A transva**nal or pelvic ultrasound can help your doctor to view the affected o***y. This can also help your doctor to assess whether or not the o***y is receiving blood.
While all of the above tests can help to point to ovarian torsion, a definitive diagnosis is made during corrective surgery.
Treatment
Ovarian torsion is treated using surgery. During this procedure, your doctor will work to carefully untwist your o***y. If an ovarian cyst is present, they may also remove it. They’ll often do this using laparoscopy.
If the ovarian tissue has begun to die or the ovarian mass appears cancerous, your doctor may remove the o***y and associated fallopian tube. This procedure is called a salpingo-oophorectomy.
6. Ovarian remnant syndrome
If you’ve had recent surgery on your ovaries, you may want to ask your doctor about ovarian remnant syndrome (ORS). The Genetic and Rare Diseases Information Center says that this condition happens when ovarian tissue remains in your pelvic area following surgery to the ovaries, such as oophorectomy or salpingo-oophorectomy.
Tissue may be left over after surgery for a number of reasons. Some of these include:
the presence of adhesions
bleeding during surgery
anatomic variations
poor surgical technique
Symptoms
Pelvic pain is the most common symptom with ORS. Additional symptoms can include:
feeling a pelvic mass
not developing the expected menopausal symptoms after your surgery
endometriosis-like symptoms, such as pain during s*x, pain during urination or a bowel movement, or digestive symptoms
It’s also possible that some individuals may not experience any symptoms at all. However, most will experience some type of symptoms within the first 5 years after surgery.
If you’ve previously had surgery to your ovaries and are experiencing pelvic pain, make an appointment with your doctor. It’s possible that ORS is the cause.
Diagnosis
In order to diagnose ORS, your doctor will note your history of previous surgery to your ovaries. They’ll also perform a pelvic ultrasound to look for a pelvic mass.
A definitive diagnosis is made through laparoscopy. During laparoscopy, they’ll collect and test a sample of the remaining ovarian tissue.
Treatment
The treatment of ORS often involves surgery to remove the remaining ovarian tissue. If surgery isn’t recommended or isn’t desired, hormone therapy can help instead. This therapy works to suppress ovulation and reduce ORS symptoms.
7. Referred pain
The ovaries are located near many other organs and parts of your body. As a result, you may experience pelvic and o***y pain from other medical conditions.
When you experience pain in one part of your body that’s actually due to pain in another area, it’s called referred pain. Doctors are still trying to figure out why exactly referred pain happens.
It’s likely that referred pain occurs due to the way nerves are connected in your body. A pain sensation felt in one area must travel to the brain through your network of nerves. Some of these nerve pathways may overlap or converge, leading you to feel pain at a different location.
An example of referred pain happens during a heart attack. While your body is reacting to a blockage of blood vessels serving the heart, you may feel referred pain in your neck, shoulders, or jaw.
Symptoms
Some examples of conditions that may cause referred pain in the area of the ovaries include:
Appendicitis. Pain from appendicitis would be near your belly button or on your right side. You may also experience loss of appetite, constipation, or signs of infection, like fever, chills, and vomiting.
Constipation. Constipation is likely if you’ve had fewer than three bowel movements in the last week. You may also experience hard stools, straining while on the toilet, and feeling like you haven’t completely emptied your bowels.
Kidney stones. Pain that’s severe, focused on your side and back, and near your ribs may be kidney stones. Additional symptoms may include blood in your urine, pain that comes in waves, and fever or chills.
Pregnancy. If you’ve missed your period, pregnancy is possible. You may also experience breast tenderness, nausea and vomiting, or fatigue. Ectopic pregnancy is another possibility, especially if the pain is severe. You may also feel pain in your shoulder, or you may feel lightheaded.
Urinary tract infection (UTI). If your pain is more in the center of your pelvis, you may have a UTI. A UTI can also cause frequent or urgent urination, burning sensation while p*eing, or cloudy urine.
It’s a good idea to contact your doctor if you’re experiencing pelvic pain that happens with other symptoms. They can help to determine what may be causing your symptoms and develop a treatment plan.
Diagnosis
If you’re experiencing pelvic pain, your doctor will try to figure out what’s causing it. In addition to taking your medical history and doing a physical exam, they may also:
perform a pelvic exam
order tests of your blood or urine
administer a pregnancy test
use imaging methods like ultrasound, CT scan, or MRI to view the tissues of your pelvis or abdomen
The specific tests that are ordered will depend on the other symptoms that you’re experiencing.
Treatment
There’s no one specific treatment for referred pain. Once your doctor has identified the condition that’s causing your pain, they’ll work to treat it.
Is it ovarian cancer?
You may worry that your o***y pain means you have ovarian cancer. While you shouldn’t ignore the possibility, ovarian cancer is relatively rare.
The American Cancer SocietyTrusted Source says that a woman’s lifetime risk of getting ovarian cancer is about 1 in 78. The rate at which women are diagnosed with ovarian cancer has also been falling over the past couple of decades. Ovarian cancer most often affects older women, with most women being diagnosed at 63 years or older.
There are several risk factors for ovarian cancer, including:
having a family history of it
having certain genetic changes
having overweight or obesity
having endometriosis
never having children or having children later in life
taking hormone replacement therapy after menopause or using fertility treatments
smoking ci******es
If you have a family history of ovarian cancer, there are resources available to you. Your doctor or a genetic counselor may be able to help you learn more about your individual risk.
Symptoms
The very early stages of ovarian cancer may not have any symptoms. Because of this, you may not experience any symptoms until the cancer has spread. The most common symptoms of ovarian cancer include:
bloating or swelling in your abdomen
pelvic or abdominal pain
fullness while eating
frequent urination
Some additional symptoms that may happen with ovarian cancer are:
fatigue
pain during s*x
back pain
period changes, such as very heavy periods or irregular periods
unintentional weight loss
an upset stomach
constipation
You may have noticed that the symptoms of ovarian cancer are similar to those of several other health conditions. However, when they’re due to ovarian cancer, these symptoms are often persistent and noticeably different from what’s normal for you.
The key with cancer is early detection. If you’re experiencing persistent symptoms that are concerning to you, make an appointment with a doctor to discuss them. Even if they’re not due to ovarian cancer, they may be caused by another health condition that needs attention.
Diagnosis
The diagnostic process for ovarian cancer will begin with your doctor taking your medical history and performing a physical exam. They’ll also do a pelvic exam to check for lumps or masses.
Imaging can help your doctor to view your ovaries and surrounding organs. They may use a variety of imaging methods, including ultrasound, MRI, CT scan, or PET scan.
Another test that your doctor may order is a blood test for a marker called CA125. Levels of CA125 are often elevated in individuals with ovarian cancer.
A biopsy of ovarian tissue is vital for diagnosing and staging ovarian cancer. The sample will be taken to a lab and viewed under a microscope for signs of cancer.
Treatment
The treatment of ovarian cancer typically includes surgery. This often involves removing the affected o***y. Depending on how far the cancer has spread, it can also include removal of other surrounding tissues, which may include removal of the:
nearby lymph nodes
omentum
fallopian tubes
uterus
cervix
Chemotherapy can also help treat ovarian cancer. This treatment uses drugs that can kill cancer cells or stop them from growing. It may also be used after surgery to help eliminate any cancer cells that remain in the body.
In some situations, ovarian cancer can be treated with targeted therapy. This involves the use of drugs that target specific proteins on cancer cells. Examples of targeted therapy drugs for ovarian cancer include the monoclonal antibody bevacizumab (Avastin) and drugs called PARP inhibitors.
Which treatment is recommended depends on many factors, including, but not limited to:
the type of ovarian cancer
the stage of the cancer
your age and overall health.
Your doctor will work with you to decide on a care plan that’s appropriate for your individual situation.
Takeaway
O***y pain can have a variety of causes. Some of them aren’t serious, while others can cause potentially severe health complications.
If your pain is mild, consider keeping a diary to log when your pain occurs, how much it hurts, and any other things you notice. For example, you may find that you have recurring o***y pain only around the middle of your menstrual cycle, such as with mittelschmerz.
Even if your pain doesn’t affect your everyday activities, it’s best to get help sooner rather than later. Conditions such as endometriosis and PID can lead to infertility without treatment.
If you’ve suddenly noticed o***y pain along with symptoms like sudden severe pain, fever, or vomiting, seek prompt medical care. It’s possible that you have a ruptured ovarian cyst or ovarian torsion.
It’s a good rule of thumb to visit a doctor if you’re having persistent or recurring pelvic pain that concerns you. They can give you a pelvic exam and other tests to help identify the specific issue you’re having and to target a treatment that will help you feel better soon.
