Is my pelvic pain from an ovarian cyst or endometriosis?

It’s common for ovarian cyst pain and endometriosis pain to overlap, and some people have both at the same time. Cyst-related pain is often more one-sided and can feel like pressure, heaviness, or a sharper flare that may come on suddenly or worsen with certain movements. Endometriosis pain more often follows a cyclical pattern and may include deep pain with sex, bowel or bladder symptoms, or a more diffuse, tender pelvic ache that doesn’t match what imaging shows.

Ultrasound or MRI can be helpful for identifying many cysts, but normal imaging doesn’t rule out endometriosis elsewhere in the pelvis. In our practice, we look at your symptom pattern, exam findings, and imaging together to narrow down the most likely pain drivers and whether a cyst is truly the main issue. If a cyst appears suspicious, persistent, or clearly correlated with your symptoms, a cystectomy may be appropriate—but we also consider whether endometriosis could be contributing so the next step actually addresses the full picture.