What happens when an ovarian cyst twists?

Torsion is twisting of the ovary, often together with the fallopian tube and the tissues carrying its vessels. A cyst can change the ovary's size or balance and make rotation easier. The cyst itself may be benign; the urgent concern is the twist and its effect on circulation.

Pain is often one-sided and may be accompanied by nausea, vomiting, abdominal tenderness or bloating. Symptoms can fluctuate if the ovary twists and partly untwists. [Ovarian Cysts](/conditions/ovarian-cysts/) explains the broader range of cyst types and symptoms.

A clinician may arrange examination, pregnancy testing and pelvic ultrasound, sometimes using a transvaginal approach. [Transvaginal Ultrasound](/treatments/diagnostics-and-imaging/transvaginal-ultrasound/) can show the ovary and cyst, but imaging does not always settle the diagnosis.

When torsion is suspected, urgent keyhole surgery may untwist the ovary and address the cyst. [Laparoscopic Ovarian Cystectomy](/treatments/gynaecological-surgery/laparoscopic-ovarian-cystectomy/) covers cyst removal through this approach. The combined pill may reduce formation of some functional cysts but cannot treat an active twist; see [Combined Pill](/treatments/contraception-and-family-planning/combined-pill/).

Seek emergency care immediately for sudden severe pelvic pain, vomiting, faintness, fever or increasing abdominal tenderness. A known cyst plus new intense pain should be assessed urgently, even if earlier symptoms were mild.

Ask whether the cyst could have caused twisting, what the ultrasound can and cannot show, and whether surgery is needed now. Ask what will happen to the cyst and ovary during the procedure.