How Ovarian Cysts Are Diagnosed

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Ovarian cysts may be diagnosed during your annual pelvic examination or through other diagnostic tests, including an ultrasound, laparoscopy, and blood tests.

This article discusses how physical exams, laboratory blood tests, and imaging help diagnose ovarian cysts and other conditions that may cause similar symptoms.

Ultrasound exam.

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Self-Checks/At-Home Testing

There are no at-home tests or self-checks that can diagnose ovarian cysts. However, being aware of the symptoms of ovarian cysts can help you communicate concerns to your healthcare provider and lead to an accurate diagnosis. Some of the more common symptoms of ovarian cysts are:

  • Sharp or dull aching in the abdomen
  • Pressure in the abdomen
  • Bloating
  • Pain during intercourse
  • Delayed, irregular, or painful periods

If you are experiencing any of these symptoms, talk to your healthcare provider to be properly assessed.

Physical Examinations

Several physical examinations can help your healthcare provider make an accurate diagnosis.

Pelvic Exam

Pelvic exams are conducted as routine preventive care during gynecologic checkups or can be used to diagnose certain conditions, including ovarian cysts.

During a pelvic exam, your healthcare provider will evaluate internal and external organs in your pelvis, including the vagina, vulva, uterus, cervix, ovaries, rectum, and fallopian tubes.

An obstetrician-gynecologist (ob-gyn), physician's assistant, or nurse practitioner may perform a pelvic exam.

What to Expect

The part of the pelvic exam in which your provider checks for cysts is called the bimanual exam. They will insert two fingers into the vagina and place pressure on your abdomen, feeling for abnormalities.

This physical examination of the ovaries can detect ovarian cysts and other conditions, such as fibroid tumors.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that is performed under general anesthesia. A pelvic laparoscopy can be performed to detect and remove ovarian cysts.

During a pelvic laparoscopy, a camera is inserted through a small incision near the belly button, allowing healthcare providers to visually examine the ovaries. If cysts are detected, they may be removed during the same procedure.

Labs and Tests

Ovarian cysts can't be diagnosed through blood tests, but your healthcare provider may want to order blood tests to rule out other conditions.

Blood Test

Though ovarian cysts cannot generally be diagnosed through blood tests, certain types (i.e., malignant or cancerous cysts) may require blood work. If your healthcare provider suspects your cysts indicate ovarian cancer, they may order a test that measures the level of cancer antigen-125 (CA-125) in your blood.

However, high CA-125 levels can be caused by conditions other than cancer, such as endometriosis, and the test is prone to false results (negatives and positives).

Imaging

Ultrasonography is considered the gold standard in diagnosing ovarian cysts.

Ultrasound

A pelvic ultrasound can detect cysts as well as aid in categorizing cysts by type, size, shape, and location. Understanding the type of ovarian cyst present is critical in creating a comprehensive and effective treatment plan. 

Your healthcare provider will perform a transvaginal ultrasound to help diagnose ovarian cysts. In this procedure, a wand-like instrument called a transducer is inserted in the vagina, emitting sound waves that produce an image called a sonogram. A healthcare provider will interpret the scan and make a diagnosis, including the type, size, shape, and location of the ovarian cyst.

While a transvaginal ultrasound can cause some discomfort, it is a relatively painless and low-risk procedure that usually lasts only a few minutes.

Differential Diagnosis

The symptoms caused by ovarian cysts, including abdominal pain and bloating, irregular and painful periods, and pain during intercourse may be attributed to several other conditions. Tests can help diagnose ovarian cysts, but your healthcare provider may want to perform additional testing to rule out other conditions, such as the following:

  • Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. PID is usually caused by the spread of a vaginal or cervical infection, including an untreated sexually transmitted infection (STI).
  • Endometriosis is a condition in which the lining of the uterus, or the endometrium, grows outside the uterus. This can result in chronic pelvic pain, painful periods, and infertility.
  • Ectopic pregnancy happens when a fertilized egg implants outside the uterus, often in the fallopian tube. This is a serious condition that must be treated immediately.
  • Appendicitis is inflammation of the appendix, a small structure in the lower abdomen. Appendicitis can cause severe abdominal pain, bloating, and other symptoms. The treatment for appendicitis is an appendectomy, or the removal of the appendix.
  • Urinary tract infection (UTI) can affect the kidneys, bladder, and urethra. This common infection can cause pelvic pain and may be treated with antibiotics.

Summary

Ovarian cysts are a relatively common issue for women of reproductive age. They may be diagnosed during a routine pelvic exam, through laparoscopic surgery, or a transvaginal ultrasound.

Laparoscopy and ultrasonography can help determine your ovarian cysts' size, shape, type, and location. A blood test may help rule out ovarian cancer by measuring the level of CA-125 in your blood. If you are experiencing symptoms of ovarian cysts, talk to your healthcare provider to get proper testing and diagnosis. 

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By Rebecca Valdez, MS, RDN
Rebecca Valdez is a registered dietitian nutritionist and nutrition communications consultant, passionate about food justice, equity, and sustainability.