Bloating, feeling full after a few mouthfuls, a dull ache low in your tummy, needing the loo more often. If you're in your late forties or fifties, it's easy to file all of that under menopause, a dodgy gut or simply getting older. Usually, that's exactly what it is.
Occasionally, though, the same handful of symptoms is the only early warning of ovarian cancer. It isn't common, and this isn't meant to frighten you. But ovarian cancer is far easier to treat when it's caught early, and the main thing that makes the difference is a woman noticing that her symptoms are new, persistent and not going away, and asking for the right test.
There's no lump to find, and early symptoms are vague and overlap with very common problems: irritable bowel syndrome, constipation, urine infections, hormonal bloating and the gut changes of perimenopause. Many women, and sometimes their doctors, put symptoms down to one of these, and months can pass.
Ovarian cancer is most common after menopause. Most cases are diagnosed in women over 50, and the risk keeps rising with age. In the UK, roughly 7,500 women are diagnosed each year; in the US, the figure is around 20,000.
The four main symptoms are:
Other symptoms can include a change in bowel habit, unexplained tiredness, back pain and unexplained weight loss.
The pattern matters more than any single symptom. Everyday bloating tends to come and go, often with your cycle, certain foods or stress. The symptoms that need checking are those that are new for you, happen most days, and persist for more than a few weeks. UK guidance asks doctors to test women who have these symptoms persistently or frequently, particularly more than 12 times a month, especially if they are 50 or older.
One point surprises many women. Irritable bowel syndrome very rarely starts for the first time after 50. So if you're over 50 and you develop what looks like IBS, with bloating, tummy pain and a change in bowel habit, UK guidance says you should be tested for ovarian cancer first, rather than simply being given an IBS diagnosis.
That doesn't mean new gut symptoms in your fifties are likely to be cancer. Most of the time they aren't. It just means they shouldn't be labelled IBS without that simple check.
If you go to your GP with these symptoms, the first test in the UK is usually a blood test called CA125. CA125 is a protein that can be raised in ovarian cancer.
CA125 can also be raised by non-cancerous conditions, including endometriosis, fibroids, pelvic infection and even a period, which is one reason the test is less useful before menopause. In the US, doctors often go straight to a transvaginal ultrasound alongside CA125.
An important myth to clear up: cervical screening does not detect ovarian cancer. It checks for HPV and changes in the cervix only. (What it does look for is explained in cervical screening after 40.)
It seems obvious that regular CA125 tests or scans would catch ovarian cancer early. Unfortunately, that's not what the evidence shows. A huge UK trial, UKCTOCS, followed more than 200,000 women for a median of about 16 years. Screening found some cancers earlier, but it did not reduce the number of women who died from ovarian cancer. For women at average risk, that's why there's no national screening programme, and why knowing the symptoms matters so much.
Most women who develop ovarian cancer have no strong family history. But some factors raise the risk:
Some things lower the risk, including having used the combined contraceptive pill, which offers protection that lasts for decades after stopping, having had children, and breastfeeding.
Women with a BRCA gene change are offered specialist advice, which can include having their ovaries and fallopian tubes removed once they have completed their family. If that applies to you, our guide to surgical menopause explains what to expect afterwards.
A raised CA125 or an abnormal scan is frightening, but it isn't a diagnosis. Many women with a raised result turn out to have a harmless cyst, fibroids, endometriosis or another benign condition. The next steps are designed to find out quickly.
In the UK, you'll usually be seen by a gynaecology team on the urgent suspected cancer pathway. You may have a CT scan to look at the rest of the abdomen and chest, more blood tests, and a discussion of whether a biopsy or an operation is needed to confirm what's going on. Specialists often use a score that combines your CA125 result, the ultrasound findings and whether you've been through menopause, to estimate how likely it is that a mass is cancer.
If ovarian cancer is confirmed, treatment usually involves surgery to remove as much of the cancer as possible and chemotherapy, sometimes before surgery. Newer medicines called PARP inhibitors have made a real difference for many women, particularly those with BRCA gene changes, by helping to keep the cancer from coming back after chemotherapy. In the UK, most women diagnosed with the common types of ovarian cancer are offered genetic testing, because the result can affect both their treatment and their relatives.
Outcomes are far better when the cancer is found at an early stage, which is the whole point of knowing the symptoms. If you're going through tests, it can help to bring someone with you to appointments and to ask for a named specialist nurse who you can contact with questions.
Many women with ovarian cancer say they saw a doctor more than once before the possibility was raised. You can make it much easier for your GP to act:
Most women who are tested will not have cancer. But a few minutes of reassurance is a good trade for months of uncertainty.
How do I know if my bloating is hormonal or something more serious?
Hormonal bloating usually comes and goes, often with your cycle or certain foods. Bloating that is new, there most days and getting worse over a few weeks should be checked, especially after 50. Our article on hormonal bloating covers the everyday kind.
Can you get ovarian cancer after a hysterectomy?
Yes, if your ovaries were left in place. Even after both ovaries have been removed, a rare, closely related cancer called primary peritoneal cancer can still occur, so the same symptoms are worth taking seriously.
Does a normal ultrasound mean I don't have ovarian cancer?
A normal scan together with a normal CA125 is very reassuring. If your symptoms continue, though, go back, as they still need explaining.
Is ovarian cancer linked to ovarian cysts?
Most ovarian cysts, particularly before menopause, are harmless and go away on their own. Cysts found after menopause are more often monitored or investigated, usually with a CA125 test and repeat scans.
Sources: NICE, Ovarian cancer: recognition and initial management (CG122) · NICE, Suspected cancer: recognition and referral (NG12) · Menon U et al, The Lancet, 2021, UKCTOCS ovarian cancer screening trial · Collaborative Group on Epidemiological Studies of Ovarian Cancer, The Lancet, 2015, on HRT and ovarian cancer · Cancer Research UK, ovarian cancer statistics · American Cancer Society, Cancer Facts & Figures · Educational only, not medical advice. See your GP about any new symptoms that persist.
Keep reading: Hormonal bloating · Bleeding after menopause · Cervical screening after 40 · Endometriosis · The truth about HRT · Take the free Hormone Quiz