This year, journalist and 2023 NZ Geographic Photographer of the Year Becki Moss (they/she) underwent a third emergency ovarian surgery – a surgery that was almost entirely preventable with a planned procedure last year that was cancelled without any explanation. Becki knows she’s not alone in this – an estimated 80% of referrals at Christchurch Women’s Hospital have been declined due to lack of resources. Becki writes for Capsule about what it’s like to have your ‘optional’ procedure cancelled and the impact of having to live with an agonising condition that can strike without warning – a condition that has now led to early menopause at 29.
It’s just before midnight on the 6th of January 2025 and I’m being wheeled into my third emergency surgery in the last 20 months for ovarian torsion, a surgery I will spend three days in hospital recovering from. And I’m writing today to talk about how this could have been prevented.
It was back in May 2023 when I first went to the Auckland City Hospital Emergency Department with severe abdominal pain. I’m no stranger to pain, but this pain was new, and excruciating. After five hours in ED, a doctor still hadn’t seen me so I chose to go home where I could take pain medication and attempt to sleep it off. The next morning, I was in an ambulance heading back to the hospital, getting an internal ultrasound and being sent to emergency surgery. I was terrified.
‘The interim 10 hours were some of the most excruciating moments of my life. I was bleeding internally and in 9/10 pain while in a wheelchair in the waiting room.’
What had happened is known as ovarian torsion. This is when the ligaments that loosely hold the ovary are twisted, leading to arterial compression and sometimes resulting in the death of the ovarian tissue. Ovarian torsion is a medical emergency as missing the diagnosis would lead to irreversible damage in the form of necrosis of the affected ovary, possible sepsis, and eventual death of the patient.
Ovarian torsions are rare events and more commonly observed in children and adolescents or people who are pregnant or undergoing fertility treatment. I have had four of them, and in every case, they have been caused by a large cyst on my ovary.
Fast forward to exactly three weeks later and it’s the morning after I’ve arrived in Manchester, England. I wake up to the same excruciating pain but this time on my right side. I was travelling with my sister and her partner, and they managed to get us to Sheffield where our family was. That trip was a blur, but I can remember trying not to vomit as a result of the pain.
I was in hospital for two days before I eventually had emergency surgery. It turned out that a haemorrhagic cyst had caused the torsion of my right ovary and I was experiencing internal bleeding. While waiting for a CT and MRI scan, I was having my blood tested every two hours as my blood count kept dropping. I was scared; the word ‘cancer’ was used far more times than I would like. I woke up to find that they’d removed the entire right ovary (which measured 10cm across) as it was completely necrotic. They apologised for the surgery hadn’t happened when I arrived in hospital days earlier.
I had experienced what is known as Asynchronous Bilateral Ovarian Torsion (where both ovaries twist independently within weeks from each other). Ovarian torsion is a rare condition (estimated to be the cause of 2-5% of gynaecological procedures) but asynchronous or synchronous bilateral torsion or repeated ovarian torsion is much rarer.
In April 2024, my left ovary torted again but fortunately untwisted itself overnight in hospital before I was due to go into surgery the following morning. A note was put on my file to do an oophoropexy if or when I needed another ovarian surgery. An oophoropexy is a procedure where the ovary or ovaries are moved out of their usual position and stitched somewhere else (commonly the abdominal wall) and is often used to preserve a patient’s fertility while undergoing radiotherapy treatment for cancer in nearby tissue. It is also a preventative measure used to treat recurrent ovarian torsions.
In July 2024, I finally saw my gynaecologist (the same one who had done my hysterectomy in 2022,) and we planned a 3-month trial of progesterone and for me to undergo a preventative oophoropexy later in the year as an outpatient. All going to plan, this would have meant a day trip to Greenlane Clinical Centre and a quick recovery, with less of a cost to the taxpayer and the medical system.
By early October, I had finished my progesterone trial (which contributed to my anxiety being through the roof) and was awaiting the planned phone call with my gynaecologist.
It never came.
Almost two months later when my GP and I had still heard nothing, she re-referred me to gynaecology only to be declined. I was devastated. I had the paperwork confirming that I would have a follow-up appointment and the surgery, only to be dropped by the speciality altogether with no explanation. I’m not alone in this.
In July last year, Te Matatika/The Press reported on the mounting number of people being declined for gynaecological procedures. With an estimated 80% of referrals in Canterbury being denied, Dr Richard French, the chief medical officer at Health NZ Waitaha Canterbury said, “The gynaecology unit at Christchurch Women’s Hospital has, for over two years, been unable to accept any referrals unless there is a suspicion of possible cancer due to “capacity constraints”. Conditions like endometriosis, fibroids, prolapse and heavy bleeding are all medical issues that can have a severe impact on a patient’s quality of life and can worsen if left untreated.
In cases such as mine where I ended up having emergency surgery in the middle of the night and then staying in the hospital for four days, this has not only been a cost to my health but a far more significant cost to the taxpayer in comparison to a relatively quick outpatient surgery.
This leads me to the 6th of January 2025. I arrived at Waikato Hospital at 1 pm and was wheeled into surgery just before midnight that same day. The interim 10 hours were some of the most excruciating moments of my life. I was bleeding internally and in 9/10 pain while in a wheelchair in the waiting room. I couldn’t speak or move but because I wasn’t in a hospital bed, I wasn’t given IV pain medication or fluids. And because I wasn’t at Auckland Hospital, the doctors didn’t have accss to my files.
I was desperately trying to email the doctor as many records as I could find from my phone while hunched over in pain. The cyst was removed, the blood from the internal bleeding was drained from my abdomen and my ovary was detorted that night. But crucially they were unable to perform an oophoropexy. This was because the damage to my ovary left it, as the surgeon said “like jelly” or as I later thought of, looking at the images, like “a pile of boba balls at the bottom of a half-drunk bubble tea”. They warned me that at 29 years old, I’d likely enter menopause soon, even with my ovary semi-intact. Within weeks this fear came true and mood swings, hot flushes and waking up every hour at night became part of my life as the symptoms of early menopause hit me like a bus.
This most recent emergency surgery could have been prevented and until I have that procedure my left ovary could twist again at any time, anywhere in the country.
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