7 Key Symptoms of Adnexal Tumors and Masses You Should Know

Adnexal tumors and masses refer to growths that develop in the adnexa of the uterus, which includes the ovaries, fallopian tubes, and surrounding connective tissues. These masses can range from benign cysts to malignant tumors, and they affect women of all ages. While many adnexal masses are discovered incidentally during routine pelvic examinations or imaging studies, some cause noticeable symptoms that prompt medical evaluation.

Understanding the signs and symptoms of adnexal tumors and masses is crucial for early detection and appropriate medical management. An adnexal mass may be fluid-filled (such as an adnexal cyst), solid, or a combination of both. The symptoms can vary depending on the size, type, and whether the mass is benign or malignant. Some women experience no symptoms at all, while others may have significant discomfort that affects their quality of life.

This article explores the most common symptoms associated with adnexal tumors and masses to help you recognize when to seek medical attention.

1. Pelvic or Abdominal Pain

Pelvic or lower abdominal pain is one of the most frequently reported symptoms of adnexal masses. The pain can manifest in different ways depending on the nature and size of the mass.

Characteristics of the pain:

• Dull, aching pain: Many women experience a persistent, dull ache in the lower abdomen or pelvic region that may be constant or intermittent
• Sharp, sudden pain: If an adnexal cyst ruptures or if the ovary undergoes torsion (twisting), the pain can be sudden, severe, and sharp
• One-sided pain: The discomfort often occurs on one side of the pelvis, corresponding to the location of the affected ovary or fallopian tube
• Pain during activities: Some women notice increased pain during physical activity, sexual intercourse, or bowel movements

The severity of pain does not always correlate with the seriousness of the condition. A small cyst can cause significant pain if it ruptures, while a larger mass might cause only mild discomfort. Persistent or severe pelvic pain should always be evaluated by a healthcare provider to determine the underlying cause and rule out complications.

2. Abdominal Bloating and Distension

Abdominal bloating and visible distension are common symptoms, especially when adnexal masses grow to a larger size. Women often describe feeling full or experiencing a sense of pressure in the abdomen.

How bloating manifests:

• Persistent fullness: Unlike typical bloating from digestive issues that comes and goes, bloating from an adnexal mass tends to be more persistent and progressive
• Increase in abdominal girth: Clothes may feel tighter around the waist, and some women notice their abdomen appears larger or asymmetric
• Early satiety: Feeling full quickly when eating, even after consuming small amounts of food
• Visible swelling: In cases of very large masses or fluid accumulation (ascites), the abdomen may appear noticeably swollen

Large ovarian cysts or tumors can occupy significant space in the abdominal cavity, displacing other organs and causing a feeling of fullness. Additionally, some malignant adnexal tumors can cause fluid to accumulate in the abdominal cavity, further contributing to bloating and distension. Women who experience persistent abdominal bloating that doesn’t resolve with dietary changes should seek medical evaluation.

3. Abnormal Vaginal Bleeding

While not all adnexal masses cause changes in menstrual bleeding, some women experience abnormal vaginal bleeding patterns that may indicate the presence of an adnexal tumor or mass.

Types of abnormal bleeding:

• Irregular periods: Menstrual cycles may become unpredictable, with varying lengths between periods
• Heavy menstrual bleeding: Periods may be significantly heavier than usual, requiring more frequent changes of sanitary products
• Intermenstrual bleeding: Spotting or bleeding between regular menstrual periods
• Postmenopausal bleeding: Any vaginal bleeding occurring after menopause is considered abnormal and requires immediate medical evaluation

Certain types of ovarian tumors, particularly those that produce hormones, can disrupt the normal menstrual cycle and cause irregular bleeding. Hormone-secreting tumors may produce estrogen or androgens, which interfere with the body’s normal hormonal balance. Additionally, large adnexal masses can sometimes affect the uterus indirectly, leading to abnormal uterine bleeding. Any significant change in menstrual patterns should be discussed with a healthcare provider.

4. Urinary Symptoms

Adnexal masses, particularly larger ones, can compress the bladder and urinary tract, leading to various urinary symptoms that affect daily life and comfort.

Common urinary symptoms include:

• Increased urinary frequency: Feeling the need to urinate more often than usual, including frequent nighttime urination
• Urinary urgency: A sudden, strong urge to urinate that may be difficult to postpone
• Difficulty emptying the bladder: A sensation that the bladder is not completely empty after urination
• Urinary hesitancy: Difficulty starting urination or a weak urine stream
• Urinary incontinence: In some cases, leakage of urine may occur, especially with physical activity or sudden movements

These symptoms occur because an enlarged adnexal mass can press against the bladder, reducing its capacity and irritating the bladder wall. The proximity of the ovaries and fallopian tubes to the bladder means that even moderately sized masses can cause urinary symptoms. While these symptoms are often benign, they can significantly impact quality of life and may be confused with urinary tract infections or other bladder conditions, making proper diagnosis important.

5. Gastrointestinal Symptoms

The digestive system can be affected by adnexal masses, particularly when the masses are large enough to compress the intestines or other abdominal organs.

Gastrointestinal manifestations include:

• Constipation: Difficulty passing stools or less frequent bowel movements than normal
• Nausea and vomiting: Feelings of queasiness or actual vomiting, which may be more pronounced with larger masses
• Changes in bowel habits: Alternating constipation and diarrhea, or a persistent change in stool consistency
• Abdominal pressure: A feeling of heaviness or pressure in the abdomen, particularly after eating
• Difficulty with bowel movements: Pain or discomfort during defecation, or a feeling of incomplete evacuation

Large adnexal masses can physically compress the rectum and colon, making it difficult for stool to pass normally. Additionally, some women experience nausea due to the pressure on the stomach and intestines. In cases of ovarian torsion (a complication where the ovary twists on its supporting ligaments), severe nausea and vomiting may occur suddenly along with intense pain. These gastrointestinal symptoms can sometimes be mistaken for primary digestive disorders, which is why comprehensive evaluation including pelvic examination and imaging is important when these symptoms persist.

6. Palpable Abdominal or Pelvic Mass

In some cases, particularly with larger adnexal masses, women or their healthcare providers may actually feel a lump or mass in the abdomen or pelvic region.

Characteristics of palpable masses:

• Self-detected lump: Some women notice a firm or hard area in their lower abdomen while bathing, changing clothes, or lying down
• Size variation: The mass may feel small and localized, or it may be large enough to extend above the pelvic brim into the abdomen
• Mobility: Some masses are mobile and can be felt to move slightly, while others are more fixed in position
• Tenderness: The mass may or may not be tender to touch, depending on whether there is inflammation or complications

During a pelvic examination, healthcare providers routinely palpate (feel) the adnexal regions to check for masses. However, smaller masses may not be detectable by palpation alone and may require imaging studies such as ultrasound for identification. Women who discover a lump in their abdomen or pelvis should seek prompt medical evaluation. While many palpable masses turn out to be benign cysts, proper examination and imaging are necessary to characterize the mass and determine appropriate management.

7. Acute Severe Pain (Complications)

While most adnexal masses cause mild to moderate chronic symptoms, certain complications can result in sudden, severe pain that constitutes a medical emergency.

Emergency complications include:

• Ovarian torsion: When an adnexal mass causes the ovary to twist on its supporting ligaments, cutting off blood supply, it produces sudden, severe, stabbing pain on one side of the pelvis
• Cyst rupture: When an adnexal cyst bursts, it can cause sudden sharp pain, sometimes accompanied by internal bleeding
• Hemorrhage into a cyst: Bleeding into a cyst can cause rapid expansion and acute pain
• Infection: Though rare, an adnexal mass can become infected, causing severe pain, fever, and other signs of infection

Associated symptoms with complications:

• Sudden onset of severe pelvic pain
• Nausea and vomiting
• Fever and chills (in cases of infection)
• Dizziness or fainting (particularly if internal bleeding occurs)
• Rapid heart rate
• Shoulder pain (from internal bleeding irritating the diaphragm)

These complications require immediate medical attention. Ovarian torsion is particularly time-sensitive, as prolonged loss of blood supply can result in loss of the ovary. Any woman experiencing sudden, severe pelvic pain should seek emergency medical care immediately, especially if accompanied by fever, vomiting, or signs of shock.

Main Causes of Adnexal Tumors and Masses

Adnexal masses can develop from various causes, ranging from benign functional cysts to malignant tumors. Understanding the underlying causes helps in assessing risk and determining appropriate evaluation.

Common causes include:

• Functional ovarian cysts: These are the most common type of adnexal masses, formed during the normal menstrual cycle. Follicular cysts develop when a follicle doesn’t release an egg, while corpus luteum cysts form after ovulation. Most functional cysts resolve on their own within a few menstrual cycles.
• Benign ovarian tumors: Non-cancerous growths including dermoid cysts (teratomas), cystadenomas, and endometriomas (chocolate cysts associated with endometriosis). These masses typically grow slowly and may require surgical removal if they become large or symptomatic.
• Ovarian cancer: Malignant tumors of the ovary can develop at any age but are more common in postmenopausal women. Types include epithelial ovarian cancer (most common), germ cell tumors, and sex cord-stromal tumors.
• Tubal masses: Conditions affecting the fallopian tubes, including hydrosalpinx (fluid-filled tube), tubo-ovarian abscess (from pelvic inflammatory disease), and fallopian tube cancer (rare).
• Endometriosis: This condition occurs when tissue similar to the uterine lining grows outside the uterus, often affecting the ovaries and forming endometriomas or chocolate cysts filled with old blood.
• Ectopic pregnancy: When a pregnancy develops in the fallopian tube instead of the uterus, it can present as an adnexal mass and is a medical emergency.
• Polycystic ovary syndrome (PCOS): This hormonal disorder causes multiple small cysts to develop on the ovaries, along with other metabolic and reproductive symptoms.
• Paratubal or paraovarian cysts: Benign fluid-filled cysts that develop near but separate from the ovary or fallopian tube.

Risk factors that increase the likelihood of developing adnexal masses:

• Age (different types are more common at different life stages)
• Family history of ovarian or breast cancer
• Genetic mutations (BRCA1, BRCA2, Lynch syndrome)
• Reproductive history (nulliparity, early menarche, late menopause)
• Endometriosis
• Hormone replacement therapy
• Obesity
• Previous pelvic infections

Prevention Strategies

While not all adnexal masses can be prevented, certain strategies may help reduce the risk or enable early detection when masses do develop.

Risk reduction measures:

• Regular gynecologic examinations: Annual pelvic exams allow healthcare providers to detect adnexal masses early, before they become large or cause complications. Women over 40 or those with risk factors may benefit from more frequent evaluations.
• Oral contraceptives: Birth control pills have been shown to reduce the risk of ovarian cancer by up to 50% when used for several years. They also help prevent functional ovarian cysts by suppressing ovulation. However, the decision to use oral contraceptives should be made in consultation with a healthcare provider, considering individual health factors.
• Genetic counseling and testing: Women with a strong family history of ovarian or breast cancer should consider genetic counseling. Those who test positive for BRCA mutations or other genetic syndromes may benefit from increased surveillance or preventive surgery.
• Pregnancy and breastfeeding: Having children and breastfeeding are associated with a reduced risk of ovarian cancer, likely due to reduced lifetime ovulation.
• Maintaining a healthy weight: Obesity is associated with an increased risk of various gynecologic conditions, including certain ovarian tumors. A balanced diet and regular exercise can help maintain a healthy body weight.
• Prompt treatment of pelvic infections: Timely treatment of sexually transmitted infections and pelvic inflammatory disease can prevent complications such as tubo-ovarian abscesses.
• Awareness of symptoms: Being familiar with your body and recognizing changes or new symptoms allows for earlier medical evaluation and diagnosis.

Screening considerations:

Currently, there is no effective screening test recommended for ovarian cancer in average-risk women. Tests such as CA-125 blood tests and transvaginal ultrasound have not been shown to reduce mortality from ovarian cancer when used for routine screening and may lead to unnecessary interventions. However, women at high risk due to genetic factors may benefit from more intensive surveillance strategies, which should be discussed with their healthcare provider.

Frequently Asked Questions

What is the difference between an adnexal mass and an adnexal cyst?

An adnexal mass is a general term for any lump or growth in the adnexa (ovaries, fallopian tubes, and surrounding tissues). An adnexal cyst is a specific type of adnexal mass that is fluid-filled. Not all adnexal masses are cysts; some are solid tumors or a combination of solid and cystic components. Cysts are often benign and may resolve on their own, while solid masses require more thorough evaluation to determine their nature.

Can adnexal masses be present without any symptoms?

Yes, many adnexal masses, particularly smaller ones, produce no symptoms at all and are discovered incidentally during pelvic examinations or imaging studies performed for other reasons. This is why regular gynecologic check-ups are important. However, larger masses or certain complications are more likely to cause noticeable symptoms.

Are all adnexal masses cancerous?

No, the majority of adnexal masses are benign, especially in premenopausal women. Functional ovarian cysts, dermoid cysts, and endometriomas are common benign masses. However, the risk of malignancy increases with age, particularly after menopause. Certain characteristics on imaging studies, blood test results, and clinical factors help healthcare providers assess the likelihood of cancer.

How are adnexal masses diagnosed?

Diagnosis typically involves a combination of pelvic examination, imaging studies (primarily transvaginal or abdominal ultrasound), and blood tests (such as CA-125 and other tumor markers). MRI or CT scans may be used for further characterization. The appearance of the mass on imaging, combined with clinical factors like age and symptoms, helps determine whether the mass is likely benign or requires surgical evaluation.

When should I see a doctor about pelvic pain or other symptoms?

You should seek medical attention if you experience persistent pelvic or abdominal pain, abnormal vaginal bleeding, persistent bloating that doesn’t improve, a palpable lump in your abdomen, or urinary and bowel symptoms that are new or worsening. Seek immediate emergency care for sudden, severe pelvic pain, especially if accompanied by fever, vomiting, dizziness, or fainting, as these may indicate complications requiring urgent treatment.

Do adnexal cysts always require surgery?

No, many adnexal cysts, particularly functional cysts in premenopausal women, resolve on their own without treatment. Healthcare providers often recommend a period of observation with repeat imaging after a few months to see if the cyst has disappeared. Surgery is typically considered for cysts that are large, persistent, growing, causing significant symptoms, or have characteristics that suggest possible malignancy.

Can adnexal masses affect fertility?

The impact on fertility depends on the type, size, and treatment of the adnexal mass. Small functional cysts typically don’t affect fertility and resolve on their own. However, conditions like endometriomas, large cysts, or masses requiring surgical removal can potentially impact fertility. Polycystic ovary syndrome is specifically associated with fertility challenges. If fertility is a concern, discuss preservation options with your healthcare provider before any surgical intervention.

What is ovarian torsion and why is it an emergency?

Ovarian torsion occurs when an ovary twists on the ligaments that support it, cutting off its blood supply. This is more likely to happen when an adnexal mass is present, as the added weight makes the ovary more prone to twisting. It causes sudden, severe pelvic pain and is a medical emergency because prolonged loss of blood flow can result in death of ovarian tissue, potentially requiring removal of the ovary. Prompt surgical intervention can save the ovary if performed quickly enough.

References:

• American College of Obstetricians and Gynecologists – Ovarian Cysts
• Mayo Clinic – Ovarian Cysts
• National Cancer Institute – Ovarian Cancer
• UpToDate – Evaluation and Management of Adnexal Masses
• National Center for Biotechnology Information – Adnexal Mass
• Radiological Society of North America – Pelvic Imaging