After a hysterectomy, your ovaries remain attached to the pelvic sidewall by a structure called the suspensory ligament (also known as the infundibulopelvic ligament). This ligament is the ovary’s primary anchor once the uterus is gone. Before surgery, the ovaries had additional support from the uterus itself and from the broad ligament, a sheet of tissue that draped over the uterus, fallopian tubes, and ovaries. With the uterus removed, the suspensory ligament becomes the main tether keeping each ovary in place.
The Suspensory Ligament: Your Ovary’s Main Anchor
The suspensory ligament is a fold of tissue that runs from each ovary outward to the lateral pelvic wall. It does more than just hold the ovary in position. Bundled inside it are the ovarian artery, ovarian vein, nerve fibers, and lymphatic vessels. This means the ligament is also the ovary’s lifeline, carrying its entire independent blood supply directly from the aorta, the body’s largest artery.
This matters because one common concern after hysterectomy is whether the ovaries will still get enough blood flow. The ovaries actually have two blood supply routes: the ovarian artery (running through the suspensory ligament) and a branch from the uterine artery. During hysterectomy, the uterine artery is cut. But the ovarian artery remains intact within the suspensory ligament, so the ovaries continue to receive blood and function normally in most cases.
What Changes Without the Uterus
Before surgery, the ovaries sat in a relatively stable pocket of tissue. The broad ligament acted like a curtain on both sides of the uterus, covering the fallopian tubes and ovaries. A smaller ligament called the ovarian ligament connected each ovary directly to the uterus. When the uterus is removed, the ovarian ligament loses its attachment point, and portions of the broad ligament are disrupted.
The result is that the ovaries have more freedom to shift around in the pelvis than they did before. They’re still tethered to the pelvic wall by the suspensory ligament, but they can settle into slightly different positions. On imaging scans after hysterectomy, ovaries sometimes appear in unexpected locations within the pelvic cavity, which can confuse radiologists who aren’t aware of the patient’s surgical history. This repositioning is usually harmless.
How Hysterectomy Affects Ovarian Function
Even when ovaries are deliberately preserved during hysterectomy, the surgery can temporarily reduce their function. One study measured Anti-Müllerian Hormone (AMH), a marker of ovarian reserve, before and after surgery. AMH levels dropped by roughly 14% within three days of a laparoscopic hysterectomy. This dip likely reflects minor disruption to blood flow during surgery.
The good news is that this effect appears to depend on the surgical approach. In women who had an open abdominal hysterectomy, AMH levels showed no significant change before and after surgery, and longer-term follow-up at 6 and 12 months confirmed stable ovarian function. So while the ovaries may take a short-term hit from certain surgical techniques, they generally recover and continue producing hormones on their normal timeline until menopause.
Ovarian Torsion: A Rare but Real Risk
With less tissue holding them in place, preserved ovaries carry a small risk of twisting on their suspensory ligament, a condition called ovarian torsion. This occurs in roughly 8 out of every 1,000 hysterectomies. It can happen months or even years after surgery. In reported cases, torsion has appeared anywhere from 7 months to 4 years post-hysterectomy, and it’s more commonly associated with laparoscopic procedures than open surgery.
The symptoms are sudden, sharp pelvic pain, often accompanied by nausea and vomiting. Because these symptoms overlap with many other conditions and because patients (and sometimes their doctors) don’t expect ovarian problems after a hysterectomy, torsion can be tricky to diagnose. If you’ve had a hysterectomy with ovaries preserved and develop acute pelvic pain, it’s worth mentioning your surgical history so torsion can be considered.
When Surgeons Deliberately Reposition Ovaries
In certain situations, surgeons intentionally move the ovaries to a new location and stitch them in place, a procedure called oophoropexy. This is most common when pelvic radiation is planned, such as for cervical cancer, and the goal is to move the ovaries out of the radiation field. Surgeons mobilize the ovaries upward and suture them to the tissue lining the abdominal wall, sometimes as high as the lowest rib. Common positions include the paracolic gutters (the spaces along the sides of the abdomen), in front of the psoas muscle above the pelvic rim, or in a far lateral position still within the pelvis.
Oophoropexy can also be performed specifically to prevent torsion in patients considered at higher risk. Surgeons may attach the ovary at multiple angles to limit how much it can rotate, reducing the chance of the blood supply getting cut off. These repositioned ovaries can look unusual on later CT or ultrasound scans, so radiologists need to know about the procedure to avoid mistaking a healthy transposed ovary for an abnormal mass.