Ovarian cancer is relatively rare, with a lifetime risk of about 1 in 91 for women in the general population. But it’s often picked up at a later stage because the symptoms are vague. Ovarian cancer symptoms—like persistent bloating, abdominal pain, and bowel or bladder changes—can also be caused by a lot of other things, and most of them don’t include the alarming word “cancer.” This creates a tricky situation: It can make the condition hard to spot early, when it’s most treatable. But it can also make your worry meter shoot up, even when no worry is needed.
So, what signs of ovarian cancer should you look out for, and how is ovarian cancer diagnosed? Here, we’ll lay out the major symptoms to watch for, what increases your risk of ovarian cancer, and when it’s time to talk with a professional.
Every year, around 21,000 American women will receive a diagnosis of ovarian cancer. Luckily, effective treatments can cure the condition when it’s found in early stages.
But ovarian cancer symptoms aren’t always easy to recognize because they overlap with lots of other causes—and many of those causes aren’t serious. Plus, signs like bloating, abdominal pain, and fatigue are super common among women.
When these symptoms are new and persistent, especially if they’re bugging you on most days for several weeks, it’s definitely time to talk with a healthcare professional about what you’re experiencing.
Keep reading to learn more about what causes ovarian cancer symptoms, why those same symptoms can be related to menopause, and when to schedule a visit wit
The Most Common Ovarian Cancer Symptoms
One simple way to remember the major signs of ovarian cancer is to think of an acronym that some clinicians use: BEACH. This stands for:
- bloating or swelling that doesn’t resolve
- early satiety, or feeling full quickly, after eating a normal amount of food
- abdominal pain or pressure
- changes to bowel or bladder habits, including new urinary urgency or frequency, diarrhea, or constipation
- heightened fatigue that’s not explained by your sleep schedule, stress, or other medical conditions
If these core symptoms give you any concern, talk with a clinician. The American Cancer Society suggests doing this if you experience symptoms more than 12 times per month.
Other symptoms that might be related to ovarian cancer can include pain during sex, unexpected vaginal bleeding, and unexplained weight loss.
Why ‘Silent’ Is the Wrong Word
Clinicians previously thought that ovarian cancer didn’t have symptoms—some even called it a “silent” disease. Today, we know that’s not accurate. Groundbreaking research in the early 2000s found that more than 70% of women who received a diagnosis of ovarian cancer had symptoms—but the symptoms just weren’t recognized quickly enough as signs of the condition.
Symptoms may be overlooked or not even noticed because they’re things (like bloating or fatigue) that lots of people experience every now and then. We might brush them off, thinking that they’re due to stress, a busy schedule, something we ate, menstruation, or menopause, for example.
Because the ovaries are deep within the abdominal cavity, it may contribute to some of the vagueness around these symptoms (meaning, you may not have a specific sensation in a specific place). That’s why it’s important to pay attention to how long any of these signs of ovarian cancer stick around.
Is It Perimenopause or Something Else?
When you’re bloated, exhausted, or experiencing urinary changes, it’s easy to lump those together with other midlife changes and assume they’re perimenopause symptoms—not potential signs of cancer. And to be very clear, they’re usually not signs of cancer.
But it’s important to suss out whether persistent changes are related to perimenopause or not. Some clues:
Bloating
The bloating experienced due to ovarian cancer is persistent. That’s different from perimenopausal bloating, which typically fluctuates with your menstrual cycle. Bloating might be a concern if you feel it most days for 2 weeks.
Urinary changes
Women with ovarian cancer might experience new and persistent changes to their bladder habits, namely the urgent need to urinate, even if you’re only peeing a small amount. These symptoms are similar to those of a urinary tract infection (UTI). But if there’s no evidence of infection and these symptoms persist for 2 to 3 weeks, it’s worth talking with a clinician.
Genitourinary syndrome of menopause (GSM) can also cause urinary frequency or urgency, but it’s typically accompanied by vaginal dryness and irritation, as well as painful sex.
Pelvic pain
If a tumor is pressing on any of the organs in your pelvis or abdomen, you may experience persistent pelvic or abdominal pain. Like other signs of ovarian cancer, it will likely show up most days over several weeks.
During perimenopause, you might experience pelvic pain that feels more like menstrual cramps. You might also experience pelvic discomfort if you have a benign ovarian cyst; this can feel very similar to what someone with ovarian cancer experiences. However, ovarian cancer is much rarer. Fibroids are more likely to cause gradually increasing pressure in your abdomen than sudden or severe pain.
Bowel changes
Diarrhea and constipation can be signs of ovarian cancer, but they can also be due to many other causes, such as irritable bowel syndrome (IBS)—or that sketchy salad bar lunch. But since IBS is more common before midlife, if you receive a diagnosis after age 50 it’s actually a red flag that something else might be causing the symptoms.
How Long Is Too Long? A Clear Threshold
“Persistent symptoms” isn’t always a helpful metric. How long should symptoms last before you talk with a clinician?
Generally, experts recommend contacting your clinician about any symptoms that are new to you and then show up on most days over 2 to 3 weeks. It’s fine to give yourself a little time to see whether anything eases up on its own, but after a couple of weeks, it’s best to figure out what might be going on. When you’re concerned, it’s never “overreacting” to bring it up with your clinician.
It can be helpful to both you and your clinician to keep a record of your symptoms. Mark all the days when you have any of the BEACH symptoms above, plus any other new and notable ones.
Who Is at Higher Risk?
Part of how a healthcare professional determines whether you should be evaluated for ovarian cancer is by assessing your risk of the condition. These factors increase the risk of ovarian cancer:
- Age: Ovarian cancer is more common in midlife and later.
- Family history: You’re more likely to develop ovarian cancer if a close family member like your grandmother, mother, or sister had or have it.
- Genetic variants: Inherited gene variants, including BRCA1 and BRCA2, raise ovarian cancer risk, as does an inherited condition called Lynch syndrome.
- History of past cancer: Women who have had breast, uterine, or colorectal cancer also have a higher risk of ovarian cancer, mainly if the cancer is due to a hereditary syndrome.
- Reproductive history: If you’ve never given birth, had trouble getting pregnant, or started menstruating early, your ovarian cancer risk is higher.
- Endometriosis: This condition causes tissue similar to the lining of the uterus to grow elsewhere in your body, and it increases your risk of a certain type of ovarian cancer.
If you were ever pregnant or breastfed a child, even years ago, this is associated with a lower risk of ovarian cancer. Same if you used oral birth control over a long period.
What about hormone replacement therapy (HRT, now commonly referred to as menopause hormone therapy, or MHT)—does that affect your risk? There is evidence suggesting that systemic hormone therapy may modestly increase the risk of ovarian cancer. But that evidence is almost entirely observational, the absolute increase in risk is small, and there are important uncertainties about causation, how long someone uses hormone therapy, and the type of ovarian cancer.
What’s more, the Society of Gynecologic Oncologists (SGO) has stated that there’s no evidence that HRT impacts survival from ovarian cancer, so the treatment is generally thought to be safe—although the organization does recommend avoiding HRT in low-grade serous and endometrioid subtypes of ovarian cancer, because those types are often treated with anti-estrogen therapies.
It's important to share any cancer history with your clinician when talking about menopause treatments. Together, they can help you come up with the safest and most effective option for you.
Why There’s No Routine Screening Test
This may be surprising: There’s no routine screening test for ovarian cancer. The major healthcare organizations that create guidelines around cancer screenings (like the U.S. Preventive Services Task Force) have found that when women who are at average risk of the disease are regularly screened for it, it doesn’t reduce death rates.
You may wonder why certain tests you’ve heard of don’t help:
- A Pap test screens only for cervical cancer, not ovarian cancer.
- A CA-125 test (a blood test) is sometimes helpful when someone has symptoms of ovarian cancer and imaging tests show potential reason to be concerned. But it isn't a reliable screening test, since levels can be elevated by many other conditions—like endometriosis—and false positives can lead to unnecessary surgery. After someone has been diagnosed with ovarian cancer, though, the CA-125 test can be very helpful for monitoring for a recurrence.
- A transvaginal ultrasound can help identify changes to an ovary, but it can’t typically detect ovarian cancer early enough that it would make a difference in treatment. It can also lead to false positives or unnecessary treatment.
Some clinicians might offer CA-125 or transvaginal ultrasound screenings to women who have a high genetic risk for ovarian cancer. But these tests haven’t been shown to be effective at lowering the risk of dying from ovarian cancer, even among high-risk women, according to the American Cancer Society.
Researchers and companies are working on better screening tests. But for now, being aware of persistent ovarian cancer symptoms and bringing them up with a clinician is the most useful tool there is.
What Happens at an Evaluation
If you’re concerned about ovarian cancer symptoms, you might be wondering: How is ovarian cancer diagnosed?
During a visit with a Midi clinician, they will start by talking with you about your medical and family history and your symptoms. They might recommend an in-person evaluation for some of the following tests:
- pelvic exam, which can locate growths or enlarged organs
- imaging tests, such as a transvaginal ultrasound that can spot masses (tumors) but can’t determine whether they’re cancerous or benign
- a CT or MRI may be recommended to better evaluate findings, and sometimes a PET scan may be recommended to evaluate the extent of a cancer
- blood tests for tumor markers like CA-125 can be used to help identify ovarian masses that are more likely to be cancerous and to follow for recurrence of ovarian cancer
- surgical evaluation to remove the growth or ovary so lab experts can examine the full tissue sample under a microscope and give a clear, accurate answer on whether it’s cancerous
These tests can, understandably, bring on a fair amount of anxiety. Keep in mind that most evaluations find some benign reason for your symptoms. Still, it’s better to know for sure rather than wondering and worrying—especially if it turns out you need treatment. The ovarian cancer survival rate is higher when the condition is diagnosed at earlier stages.
Genetic Testing and Family History
If you have a family history of ovarian cancer (and certain other cancers), a healthcare professional might recommend having genetic testing, and they may refer you to a genetic counselor. Before that meeting, try to gather information about anyone in your family who had cancer, including what kind of cancer they had and how old they were when they received a diagnosis.
Typically, genetic testing for ovarian cancer is most appropriate for women with:
- a strong family history of breast and ovarian cancers
- a personal history of breast, ovarian, fallopian tube, or primary peritoneal cancer
- a known BRCA genetic mutation in the family
If you inherit a copy of the BRCA1 or BRCA2 gene that has a harmful change (called a mutation or a variant), your risk of breast and ovarian cancer is higher than the general population.
Up to 58% of women with a BRCA1 variant and up to 29% of women with a BRCA2 variant will go on to develop ovarian cancer. (In comparison, only about 1% of women without these genetic changes will develop it.) Because of this, women with a BRCA1 and BRCA2 variant are typically followed differently than other women:
- Your clinician may talk with you about the use of oral contraceptives, which have been shown to lower the risk of ovarian cancer. Women who are finished having children (or childbearing isn’t a concern) may also consider having their fallopian tubes removed, a procedure called bilateral salpingectomy. Researchers think ovarian cancer begins in the tubes, and studies are underway to see whether removing them can prevent the disease.
- For now, though, the recommendation is risk-reducing surgery to remove both the tubes and ovaries, generally between ages 35 and 40 for BRCA1 carriers and 40 and 45 for BRCA2 carriers, depending on your family history and the age at which relatives were diagnosed. This surgery has been shown to save lives in women with BRCA mutations, but it also causes immediate surgical menopause.
Talk to a Midi clinician about treatment options for managing menopause symptoms. As long as you are healthy and haven’t had breast or certain types of ovarian cancer, HRT will likely be an option for you.
How to Advocate for Yourself
Because ovarian cancer symptoms are so easily missed until the condition has progressed, getting your concerns addressed can require some effort on your part. Talk with a healthcare professional about any bloating, feelings of fullness, abdominal pain, bowel or bladder symptoms, and fatigue that have changed recently and persisted for the last 2 to 3 weeks. Share your log of these symptoms with them.
If your healthcare professional doesn’t bring up ovarian cancer, ask whether it’s been considered and ruled out. If you feel like you’re not being heard, seek a second opinion, especially if you haven’t been given an explanation for your symptoms.
Remember: Even though clinicians are the medical experts, you are the expert on your own body. If you feel that something is off, trust the feeling and keep speaking up until you get the care you deserve. Truth is, having an informed clinician who listens to you and puts your needs at the center—like Midi clinicians do—is a reassuring gift to give yourself.
Key Takeaways
- Ovarian cancer symptoms overlap with symptoms of many other conditions, so the condition often isn’t diagnosed until later stages, when treatment can be more difficult.
- It’s important to recognize signs of ovarian cancer, such as persistent bloating, feeling full quickly after eating a regular amount of food, abdominal pain or pressure, changes to bowel or bladder habits, and heightened fatigue. An important factor is whether the symptoms have stuck around for a while.
- Some of the symptoms of ovarian cancer overlap with common symptoms of perimenopause, including fatigue, bloating, and urinary changes.
- Clinicians don’t routinely screen healthy women for ovarian cancer, but if they’re concerned about your symptoms, they may do diagnostic tests, including a pelvic exam, blood tests, genetic testing, transvaginal ultrasound, or surgery to rule out or diagnose ovarian cancer.
Frequently Asked Questions (FAQs)
What are the symptoms of stage 1 ovarian cancer?
Stage 1 ovarian cancer might not cause any symptoms. If it does, these signs might include persistent bloating, feeling full sooner than usual, fatigue, abdominal pain, and any bowel or bladder changes.
What is the first ovarian cancer symptom?
There isn’t one single first symptom of this type of cancer. Bloating, abdominal pain, getting full quickly, changes to bladder or bowel habits, and increased fatigue are among the most common first symptoms of ovarian cancer.
What is the biggest indicator of ovarian cancer?
The biggest indicators of ovarian cancer include feeling full shortly after eating, changes to bladder or bowel habits, fatigue, bloating, and abdominal pain.
Can you live 20 years after ovarian cancer?
Yes, you can live 20 years after ovarian cancer. Ovarian cancer survival rates usually depend on whether and how much the cancer has spread when it’s diagnosed.
How fast does ovarian cancer go from stage 1 to stage 4?
The rate at which ovarian cancer progresses varies for everyone and depends on the type of cancer.
If you’re in perimenopause or menopause and want guidance from clinicians who specialize in women’s midlife health, book a virtual visit with Midi today.
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