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Ovarian Remnant Syndrome

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Ovarian cysts are the fluid-filled or solid sacs in the ovaries. Surgical removal of ovarian cysts is an oophorectomy that can be unilateral or bilateral. Treatment of ovarian cysts sometimes requires removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy), during which some tissue residues remain in the abdomen. It can later develop and cause signs and symptoms, causing Ovarian Remnant Syndrome.

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What is Ovarian Remnant Syndrome?

Ovarian Remnant Syndrome(ORS) is a condition that results due to the remnant tissues of ovaries after unilateral or bilateral salpingo-oophorectomy. This procedure may or may not include a hysterectomy (uterus removal).

There is a pelvic mass developed in the pelvic region, causing pain after the procedure.  You may also experience painful sexual intercourse.

Treatment includes removing the remnant ovarian tissues with laparoscopy and laparotomy procedures. If not done during the actual surgical procedure, it may require additional procedures.

What are the Causes of Ovarian Remnant Syndrome?

The following are some of the most common causes of Ovarian Remnant Syndrome:

  • ● Unintentional retention of ovarian tissue after the procedure to remove the ovaries
  • ● Post-surgical inflammation of the ovarian region
  • ● Perioperative bleeding or bleeding after surgery
  • ● Thick and profuse pelvic adhesions after the surgery
  • ● Retroperitoneal placement of the ovaries can also make it difficult to avoid unintentional preservation of ovarian fragments

What are the Symptoms of Ovarian Remnant Syndrome?

If there are still hormones present after the surgery, this may indicate remnant ovarian tissues. However, this is difficult to note in women with external hormonal therapy.

The following are the signs and symptoms of Ovarian Remnant Syndrome:

  • ● Pelvic pain is usually sharp and severe and is the main symptom. Pain is generally in the lower abdomen. It can be cyclic or chronic and may present as a dull ache to a sharp, severe, and stabbing pain.
  • ● Pelvic mass in post-surgical examination or imaging
  • ● Urinary symptoms
  • ● Painful sexual intercourse
  • ● Urethral compression
  • ● Lower back pain
  • ● Variable bowel symptoms

Some women do not show any signs or symptoms. Ovarian Remnant Syndrome generally shows within five years of the surgery; however, sometimes some note even after 20 years!

How is Ovarian Remnant Syndrome Diagnosed?

The most preferred way of diagnosis is during the surgery. Your doctor might consider surgical exploration to remove any remnant ovarian tissues during the same surgical procedure.

For diagnosis after the surgery, usually, a keen note of the signs and symptoms is essential. A detailed history taking can help diagnose, followed by investigations like physical examination, ultrasound, MRI if needed to locate the remnant ovarian tissues. MRI findings, along with elevated CA125 levels, are a sign.

If there is confusion, it is also essential to measure the levels of follicle-stimulating hormones (FSH) and estradiol. Laparoscopy and histological investigation can also be helpful sometimes.

How is Ovarian Remnant Syndrome Treated?

For women with pain or mass in the pelvis, treatment is advisable. Women with Ovarian Remnant Syndrome test for cancer and undergo surgery for complete removal of the tissues.

Ovarian Remnant Syndrome does not give a good response to hormonal therapy. If there is no possibility of surgery due to lack of physical fitness or patient preference, the doctor recommends hormonal treatment. It suppresses the ovaries to function and prevents the growth of the pelvic mass. Laparoscopic removal of remnant ovarian tissue is usual.

Treatment may include medications like danazol, GnRH agonists, or progesterone sometimes.


The surgery is most successful and has a good result. It is necessary to follow the diet plan that your dietitian suggests. You can also do some light walking or similar activities to prevent blood clots and help your body heal faster.

What are the Risks Associated with Ovarian Remnant Syndrome treatments?

Usually, there are some common risks involved with the surgery. Rarely, an injury to the uterus or the small intestine may occur. You might experience some nausea and vomiting. It mostly will go away in a few days. Your doctor might give you medications to prevent it.

It is important to follow post-operative care instructions. It is to prevent infection after the surgery. You will also need to refrain from sexual activity for a few days after the surgery and keep the area clean.

The surgeon performs the surgery in the operation theatre under general anesthesia. There is always some risk of an allergic reaction from the anesthesia.

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Is Ovarian Remnant Syndrome Easily Identifiable?

No, it is difficult to determine as many times there are no symptoms. It can occur within five years and sometimes 20 years after the ovarian surgery.

How to Prevent Ovarian Remnant Syndrome?

Surgical exploration during the surgery and removing any remnant ovarian tissues during the same surgical procedure is the best way to prevent Ovarian Remnant Syndrome.

How Common is Ovarian Remnant Syndrome?

Ovarian Remnant Syndrome is a rare condition that occurs as a complication of ovarian surgery if ovarian tissue residue is left.

Can Ovarian Remnant Syndrome Cause Cancer?

Yes, the remnant ovarian tissues can cause malignancies like endometrioid adenocarcinoma. Your doctor might recommend an evaluation for cancer if you have Ovarian Remnant Syndrome.


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