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What is Normal?

The ovaries are small, walnut - sized lumps of tissue that are about one inch away from the top of the uterus on either side. They are off-white, and, in young girls and adolescents, are smooth. After the onset of menstruation, however, the ovaries begin to go through a series of events that leads to a change in their appearance.

Just prior to ovulation, a small (1/2 inch) clear collection of fluid forms around the developing egg and becomes visible below the surface of the ovary. This combination of the fluid, hormone producing cells and the egg is called a follicle . During ovulation, the surface of the ovary bursts open, and the egg is carried away in a surge of fluid towards the fallopian tube. The surface cells of the ovary heal quickly, leaving behind a yellow-appearing pocket of cells called the corpus luteum. The corpus luteum produces the hormone progesterone, but if no pregnancy occurs, it disappears shortly after the menstrual period. As time goes on, the surface of the ovary becomes pitted and irregular, evidence of many ovulations and subsequent healings. After the menopause, the monthly formation of follicles and ovulation cease. The ovaries decrease in size to that of an almond and become a pale white.

The manual part of the pelvic examination allows the doctor to feel the size and shape of the uterus, tubes and ovaries. During this part of the examination, the doctor pushes the cervix upward from the inside of the vagina. This moves the top of the uterus closer to your abdominal wall, where the size and shape of the uterus can be felt between the doctor's two hands. Thus, the doctor should be able to detect conditions that increase the size of the uterus, such as fibroids.

Prior to the menopause, the ovaries are normally about the size of a small walnut and during the examination, can be felt on either side of the uterus. Abnormally large ovaries usually indicate the presence of cysts, benign tumors or, very rarely, cancer. The fallopian tubes are so soft and mobile that they are normally not detected during the examination. Tenderness in the area of the tube sometimes indicates infection. If endometriosis or scar tissue from previous infection or surgery is present near the tubes, tenderness may also be present during the examination.


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