When is laparoscopy warranted?

I am a 35 year old female with 2 kids.  For the past 2 months, I have been having excessive flatulence and belching.  I have had some issues with constipation off and on for years, but these symtoms (symptoms) are completely new.  I had a transabdominal pelvic ultrasound that showed a 2.8 cm complex cyst on my right ovary.  The radiologist noted this may represent a hemorrhagic cyst.  The gyn does not seem concerned but ordered a CA-125 to reassure me.  My CA-125 was 20 which she said was normal.  I am having a follow-up pelvic ultrasound ( this time transvaginal) in 2 weeks.  In the mean time, I also have an appt with a gastro dr.  I understand that cysts are overwhelmingly benign and at my age I am at low risk for ovarian cancer, but the sudden onset of my symptoms along with the cyst has me very alarmed.  Also, my grandmother & great grandmother on my father's side died of breast cancer and my dad has prostate cancer, so that worries me about a genetic predisposition. At what point would laparoscopic surgery be warranted as I understand that is the most definitive way to rule out ovarian cancer?

[Annekathryn Goodman, M.D.]

Hi There
I think you should have a laparoscopy to rule out a gyn origin of your symptoms.
I am sorry for your distress. I hope it is sorted out quickly for your

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I have two new symptoms that just showed up last night.  I am having some mild lower back pain on my right hand side...similar to the feeling I get when I have cramps but slightly different and only on the right. Twice when I urinated I also noticed some blood on the tissue.  I can't be positive the blood didn't come from my urinary tract, but since I have no other symptoms of a UTI and haven't had a UTI since I was a kid, I assume this was spotting.  Even if it is a UTI, that concerns me since that would be very coincidental.  I often have a little spotting before before my period but this is a few days early and in the past I have never had cramps or pain before a period.

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Due to the pain, I did have a follow-up ultrasound earlier.  Looks like the hemorrhagic cyst ruptured as there was some fluid in the cul-de-sac and only a 1.3 cm simple cyst showed up.  The bleeding seems to have been my period although much lighter than normal.  Still having some mild pain 3 days later.  Docs feel certain this is not cancer, but I still find it to be a huge coincidence that my GI symptoms started 2 months ago and then I discovered a complex cyst that had symptoms when it ruptured for the first time in my life.  Should I do any additional follow-up?