Periovarian Adhesions: Understanding Your Pathology Report

Section Editor: Kianoosh Keyhanian MD FRCPC
August 31, 2026

Periovarian adhesions are bands of noncancerous (benign) scar tissue attached to the outer surface of the ovary. The prefix “peri” means around, so the term describes scar tissue around the ovary. Your report may also call them fibrous adhesions, surface adhesions, or fibrous tissue adherent to the ovarian surface.

An adhesion forms when two normally separate surfaces become stuck together by scar tissue. Inside the abdomen and pelvis, a smooth, slippery membrane covers the organs and allows them to glide past one another. When that membrane is injured, it heals, and the healing can leave a band of fibrous tissue joining one surface to another.

Periovarian adhesions describe what the pathologist observed rather than a disease in their own right. They are common, they are not cancer, and on their own they usually require no treatment. This article will help you understand what this term means on your pathology report and why it appears there.

What causes periovarian adhesions?

Adhesions form as part of normal healing. When the surface covering an organ is injured, the body lays down a temporary protein mesh to seal the damage. Usually, the body breaks down and clears that mesh within days. If it isn’t, cells called fibroblasts move in and replace it with permanent collagen, resulting in a fibrous band.

Anything that injures or inflames the surface of the ovary or the surrounding tissue can start this process.

Previous surgery — The most common cause. Any operation in the abdomen or pelvis can leave adhesions behind, including a cesarean section, an appendectomy, or previous gynecologic surgery.
Infection — Pelvic inflammatory disease, often following a sexually transmitted infection, inflames the surfaces of the ovary and fallopian tube. A ruptured appendix can do the same.
Endometriosis — Tissue similar to the lining of the uterus growing outside the uterus causes repeated bleeding and irritation, which is a frequent cause of dense pelvic adhesions.
A ruptured cyst — Fluid or blood released into the pelvis when an ovarian cyst bursts can irritate the surfaces and lead to scarring.
Radiation therapy — Previous radiation to the pelvis can cause scarring of the tissues.

In some cases, doctors cannot identify a cause.

What are the symptoms?

Most periovarian adhesions cause no symptoms. They are usually discovered when the ovary, fallopian tube, or uterus is removed and examined for another reason, or when the surgeon notices them during an operation. When adhesions do cause problems, it is usually because they pull on tissue or restrict movement.

Pelvic pain — Ongoing or intermittent pain low in the abdomen, sometimes worse with movement, intercourse, or around the time of a period.
Difficulty becoming pregnant — Adhesions can hold the ovary and fallopian tube apart or wrap around them, which interferes with the tube picking up an egg.
Bowel symptoms — When adhesions also involve the bowel, they can cause cramping, bloating, or, rarely, a blockage.

Adhesions are only one of many possible explanations for pelvic pain, and finding them does not confirm that they were the cause of your symptoms. Discuss this with your doctor rather than assuming either way.

How is the diagnosis made?

Adhesions are difficult to detect on imaging. Ultrasound, CT, and MRI can suggest organs are stuck together, but none reliably shows adhesions. Most are identified by direct inspection during surgery, usually a laparoscopy, when the surgeon sees the bands and describes where they run.

Adhesions reach a pathologist when tissue is removed and sent to the laboratory. Sometimes the surgeon removes the adhesion and submits it. More often, the pathologist describes adhesions attached to the surface of an ovary or fallopian tube that was removed for another reason.

The pathologist examines the adhesion for two purposes: to confirm that it is scar tissue, and to look for a cause within it. Endometriosis is often found inside pelvic adhesions, and identifying it changes what the report says and how you are treated.

What do periovarian adhesions look like under the microscope?

A periovarian adhesion is a band of fibrous scar tissue attached to the surface of the ovary. To the naked eye, it appears as a thin, whitish strand or a sheet of tissue on the ovarian surface. Under the microscope, the pathologist looks for the following features.

Dense fibrous tissue — The adhesion is made mostly of collagen, the protein that gives scar tissue its strength. Your report may describe this as fibrosis or as fibrous tissue.
Chronic inflammation — Scattered immune cells are often present. This kind of inflammation reflects an injury that happened some time ago.
Brown pigment — Deposits left behind by old bleeding are common, particularly when the cause was endometriosis or a ruptured cyst.
Small blood vessels — New vessels grow into scar tissue as it forms, and they remain within it.
Evidence of a cause — The pathologist may find endometriosis, suture material from a previous operation, or the remains of an infection within the adhesion.
No abnormal cells — The tissue contains no tumor cells. Confirming this matters, because tumor spreading over the surface of an ovary can look like an adhesion to the naked eye.

Do periovarian adhesions affect fertility?

They can, though many people with adhesions conceive without difficulty. The fallopian tube is not attached to the ovary. Its fringed end sweeps over the ovary to collect an egg after it is released, and that movement depends on both structures being free to move.

Adhesions can interfere with this in several ways. They may hold the ovary away from the end of the tube, wrap around the fringed end so it cannot open properly, or bind the ovary to the pelvic wall. Dense adhesions from endometriosis or a previous infection are most likely to have this effect.

If you are trying to conceive, raise this directly with your doctor. Adhesions found at surgery can sometimes be divided, and where that is not effective, in vitro fertilization bypasses the tubes entirely.

What other findings may be described in the report?

Periovarian adhesions are rarely the only finding in a report. Something else usually prompted the surgery, and that diagnosis guides your care. Findings commonly described alongside adhesions include:

Endometriosis — Often found within or near the adhesions, and reported separately when present.
Ovarian cysts — A follicle cyst, a corpus luteum cyst, or a cortical inclusion cyst. All are noncancerous.
Changes in the fallopian tube — Adhesions frequently involve the tube as well. A blocked, fluid-filled tube is called hydrosalpinx and is reported as a separate diagnosis.
Trapped fluid — When adhesions enclose a space around the ovary, fluid can collect inside it. This is sometimes called a peritoneal inclusion cyst, and it is noncancerous.
A separate tumor — If a tumor was the reason for surgery, it is described in detail and separately. That diagnosis, not the adhesions, determines what happens next.

What happens after this finding?

Periovarian adhesions are not cancer, not precancerous, and do not turn into cancer over time. On their own, they need no treatment and no follow-up. What happens next depends on the other findings in your report and whether the adhesions were causing symptoms. Points your doctor may raise include:

No treatment for adhesions alone — Adhesions found incidentally in removed tissue require nothing further.
Dividing adhesions — When adhesions cause pain or affect fertility, a surgeon can cut them, a procedure called adhesiolysis. Results vary, and it helps some people more than others.
Adhesions can come back — Surgery is itself a cause of adhesions, so they may re-form after being divided. Surgeons weigh this when deciding whether to operate.
Treating the underlying cause — If endometriosis or infection caused the adhesions, treating that condition is usually more useful than treating the scar tissue.
Future surgery — Adhesions can make later operations more difficult. It is worth knowing they were found and mentioning it if you have surgery in the future.

Questions to ask your doctor

Were adhesions the only finding, or was something else found?
What do you think caused the adhesions?
Was endometriosis found in or near the adhesions?
How extensive were the adhesions, and which organs were involved?
Could the adhesions explain the pain I have been having?
Were the adhesions divided during my surgery?
Could the adhesions affect my chances of becoming pregnant?
Is there anything I can do to reduce the chance of them coming back?
Was my fallopian tube affected as well?
Do I need any treatment or follow-up for this finding?
Should I mention this if I need surgery in the future?
What symptoms should prompt me to contact you?