Red blood cells are a sign of rupture, and white blood cells indicate infection. The timing of ovarian pain is a good indication of whether a cyst has ruptured. Pain in the middle of a woman's menstrual cycle is likely to be associated with ovulation. There is a normal, natural kind of cyst around the egg that bursts just before it is released. This kind of ovulation pain occurs once a month. Intense pain of the kind described just before, during, or just after a woman's period is more likely to be caused by a ruptured, hemorrhagic ovarian cyst.
Another signal that the pain is due to a ruptured ovarian cyst is an unusually short or unusually long period just before the onset of pain, and flow that is either unusually heavy or unusually light. Ovarian cysts don't usually cause major loss of blood. There may be just enough blood loss that the woman feels "woozy" when moving from a seated position to a standing position. When there is major blood loss, the abdomen will feel "springy" or tender. There can be more blood loss inside the uterus that immediately comes out as spotting or leakage. A hemorrhagic ovarian cyst is a medical emergency.
Other conditions that cause similar symptoms, such as ectopic pregnancy, also require immediate medical attention. It is very important that the doctor run a pregnancy test before treatment to make sure the pain is not caused by the implantation of a fertilized egg in the ovary which can occur at the same time a cyst ruptures. If you have a ruptured ovarian cyst, you will almost certainly be given strong pain medication. Before this happens, be sure to discuss with your partner what you want to have done in case medical treatment threatens future fertility.