The ovaries are paired female gonads of the reproductive and endocrine systems. They lie within the ovarian fossa on the posterior wall of the true pelvis. 

The ovaries are ovoid in shape and measure approximately 1.5-3.0 cm x 1.5-3.0 cm x 1.0-2.0 cm (length x width x thickness) (1.2-9.4 cm3). An ovary weighs 2-8 g. They double in size in pregnancy. 

The suspensory ligament of the ovary, a peritoneal fold, runs from the side wall of the pelvis to the ovary. The ovarian vessels run in this ligament, crossing over the external iliac vessels.

Each ovary is attached to the back of the broad ligament by the mesovarium, which is continuous with its outer coat. A fourth attachment, the ovarian ligament, which is a continuation of the round ligament and attaches the ovary to the side of the uterus.

Despite all its attachments, the ovary is very mobile, especially in women who have had children. it is frequently found behind the uterus in the pouch of Douglas and has a variable relationship with the uterus:

  • anteflexed uterus: lateral or posterolateral
  • retroflexed uterus: superolateral
  • anteriorly: broad ligament, mesovarium, ovarian vessels, obliterated umbilical artery
  • posteriorly: ureter, internal iliac vessels, pelvic wall
  • superiorly: external iliac vessels
  • inferiorly: levator ani
  • medially: ovarian ligament
  • laterally: obturator vessels and nerves 3,4
  • the lymphatic vessels travel with the ovarian vessels and drain into pre-aortic nodes
  • first line investigation
  • homogenous echotexture with a central echogenic medulla
  • volume on ultrasound can be calculated with the following formula 5
    • 0.523 x length (cm) x width (cm) x depth (cm)
    • volume is expressed in cubic centimeters (cm3)
  • can be difficult to identify or may be confused with enlarged lymph nodes 5
  • its position may be determined by the following techniques 5
    • anterior or anterolateral to the pelvic ureter if in a typical position
    • tracking the ovarian vein from the IVC or left renal artery anterior to the psoas major to the region where the ovary lies
    • suspensory ligament of the ovary
      • usually, extends from the ovary to the external or common iliac vessels; most easily identifiable pelvic ligament
  • the ovary can be differentiated from lymph nodes, which are extraperitoneal and displace the ureter medially or anteromedially or efface the common iliac vessels when enlarged 5
Anatomy: Abdominopelvic
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Article information

rID: 4539
System: Gynaecology
Section: Anatomy
Synonyms or Alternate Spellings:
  • Ovaries

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