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dermoid ovarian cyst

A few months ago I was experiencing some pelvic pain on the right side, which was only felt while lying on a flat, hard surface on my back. When i went for my annual I told the nurse practitioner; she did not feel anything unusual but she ordered an ultrasound just to be on the safe side.  the ultrasound found a small dermoid cyst on the right ovary.
  She ordered a followup after two cycles to look for any changes.  
Over the next couple of months the pain became more frequent.  I had the followup which showed the cyst had an increase in echogenicity, suggesting fat within the dermoid cyst.
The nurse suggested I go elsewhere to see an OBGYN because this office does not have one.  She said it was likely i would need surgery and should have a doctor evaluate it further.
After this I experienced sharp pelvic pains during my most recent menstrual cycle.  I laid down on the couch until it went away a couple of hours later.
I made an appointment with an obgyn and he came into the exam room, saw my ultrasound results and exclaimed, "This is so small! this is nothing. It even shrunk"  I explained my symptoms but he didn't seem very concerned.  
My concern is if it is so small why do I have pain?  If the ovary has shrunk, why has my pain gotten worse?  This doctor also did not talk about the increased echogenicity, is this not a big deal?

Some other symptoms i've been living with over the last half a year:  urge to frequently urinate, constipation (i eat very healthy and was always very regular before) and pain on the right pelvic region when trying to go to the bathroom.  

I also used to be on birth control pills but i missed two periods in a row and was not pregnant.  I stopped taking birth control and my periods returned to normal.  The nurse practitioner and the doctor both said this was normal with birth control pills.

What I want to know is if the cyst is so small then why do i always feel it there and why is it causing these symptoms?  what does the increased echogenicity mean health-wise and why would this happen while the cyst has shrunk?  I am also curious if anyone has had a similar experience and if they opted for surgery even though the cyst is small.

thanks.
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