If you see your doctor for pelvic pain or bleeding, you'll be checked for a number of conditions, including an ovarian cyst, that may be causing your symptoms. Your evaluation will include a pelvic exam, a history of your symptoms and menstrual periods, a family history, and a transvaginal ultrasound (which uses a narrow wand placed in the vagina). See a picture of ovarian cysts .

If your doctor discovers an ovarian cyst during a routine pelvic exam, a transvaginal or abdominal ultrasound can help show what kind of cyst it is.

When is further testing necessary?

If an ultrasound shows that you have a fluid-filled functional ovarian cyst, and it isn't causing you severe pain, your doctor will probably suggest a watchful waiting period. You can then have the cyst checked 6 to 8 weeks later to see whether it is changing in size. Most cysts go away without treatment in 1 to 2 months or after 1 to 2 menstrual periods. ³

Your doctor will recommend further testing or treatment if:

• Initial ultrasound doesn't clearly show what kind of cyst or growth is present, or both ovaries are affected.
• You are not ovulating during your initial examination (because you are either a postmenopausal woman or a girl not yet menstruating). Without ovulation, a new functional cyst would be highly unlikely, so other possible conditions are explored.
• You have moderate to severe pain or vaginal bleeding.
• A diagnosed functional ovarian cyst does not get smaller or go away in 2 to 3 months.
• An ovarian growth or cyst (mass) is larger than 3in.
• You have risk factors for ovarian cancer. The higher your risk of ovarian cancer, the more likely aggressive testing will be recommended to find out the cause of an ovarian mass.

Further testing

• Laparoscopy allows a surgeon to look at the ovary through a lighted viewing instrument and take a sample of the growth ( biopsy). After testing the sample, the surgeon can decide whether to surgically remove the cyst (cystectomy) or the entire ovary (oophorectomy). If there is concern about ovarian cancer, a laparotomy (instead of a laparoscopy) may be done. Then, if cancer is found, the surgeon can safely remove the ovaries.
• CA-125 (cancer antigen) test is only recommended for women with a very high risk for ovarian cancer. These are women with a significant family history of the disease. This blood test result is combined with ultrasound results, because it doesn't give a highly dependable diagnosis on its own.