In premenopausal women, midcycle pain suggests ovulation or mittelschmerz. Pain following intercourse may be related to a ruptured follicular or corpus luteum cyst. Pain during intercourse is suggestive of endometriosis. Abdominal or pelvic pain in the setting of an adnexal mass and a positive pregnancy test is almost always due to an ectopic pregnancy. Sudden onset of severe pain or intermittent severe pain, often associated with nausea and vomiting, implies ovarian torsion.
Menstrual disturbances are an important element of the history.
Severe dysmenorrhea and menorrhagia can signify endometriosis or leiomyomas. A history of prolonged amenorrhea followed by menorrhagia and the finding of multicystic ovaries is characteristic of polycystic ovarian syndrome. Bleeding in the premenarchal or postmenopausal patient with a solid ovarian mass increases the likelihood of a granulosa cell tumor. Other important symptoms are dyspepsia, early satiety, a sensation of abdominal bloating or fullness, and constipation or a change in the caliber of the stool. Patients with ovarian carcinoma frequently present with vague gastrointestinal symptoms.