When ovarian cancer is detected before it spreads beyond the ovaries, the chances of survival are high. But diagnosis can be delayed since early signs, like indigestion and bloating, may not seem like symptoms.

The American Cancer Society reports that 1 in 91 females will receive a diagnosis of ovarian cancer in their lifetime.

According to information from the Surveillance, Epidemiology, and End Results (SEER) database, the 5-year relative survival rate for early stage invasive epithelial ovarian cancer is at least 93%.

However, 4 out of 5 people with this cancer are not diagnosedin the early stages because the signs of ovarian cancer can be easy to miss.

So, what are the early signs of ovarian cancer? This article takes a closer look at symptoms that are often overlooked or dismissed.

In its early stages, ovarian cancer may not present any noticeable signs.

When symptoms appear, they are often the kinds you normally associate with more common conditions, such as irritable bowel syndrome and urinary tract infections.

For many people, this means that ovarian cancer isn’t detected until it has spread. This, ultimately, can lower the survival rate for this type of cancer.

Many early symptoms of ovarian cancer overlap with symptoms of other common conditions.

However, you are the expert on your body. Trust your intuition if something feels wrong or different, and follow up with a doctor or medical professional as soon as possible.

Let’s take a closer look at seven early signs of ovarian cancer that are often ignored or overlooked.

1. Bloating

It’s typical to feel bloated around your menstrual period or when you’ve eaten certain foods. But bloating that doesn’t go away is a common symptom of ovarian cancer.

Around 72% of those with ovarian cancer say they experienced bloating. Here’s how some people describe the bloating:

  • It feels as though you’re pregnant.
  • It makes your clothes dig into your waist.
  • It makes it hard to button or zip your pants.

Bloating is often related to the buildup of fluid in your abdomen. It happens partly due to changes in your abdominal blood supply and your body’s ability to drain fluids.

This fluid buildup is a concern because free-floating cancer cells can move through the fluid from one area of your body to another.

2. Abdominal or pelvic pain

One of the most commonly reported symptoms among people with ovarian cancer is pain in their abdomen and pelvis. In one study, around 39% of women with ovarian cancer had experienced abdominal pain.

What the pain feels like can vary from person to person. Some say it feels like intense pressure. Others say it feels like menstrual cramping, as though you’re being gripped or squeezed from within.

Exactly what’s causing the pain can also differ. As tumors grow, they can put pressure on other parts of your body, including your bowels, bladder, rectum, and spine.

3. Change in your bathroom habits

A 2020 study involving 202,638 postmenopausal women between the ages of 50 and 74 found that about 20% of study participants with ovarian cancer noticed constipation, diarrhea, or other bowel pattern changes.

Roughly 7% of the study participants with ovarian cancer also experienced urinary problems, such as more frequent urination or a greater sense of urgency about needing to pee, before their diagnosis.

In addition to urination frequency and urgency changes, some people with ovarian cancer may also feel a burning sensation during urination, while others may feel that their bladder is still full even after urinating.

4. Back pain

Back pain is a common condition that affects millions of people every year. Most of the time, back pain is caused by injury, not cancer.

If you haven’t injured your back or your back pain isn’t getting better with treatments, talk with a healthcare professional. Back pain can be a symptom of ovarian cancer.

5. Appetite changes

For some people, ovarian cancer causes a loss of appetite. Others may feel full even after eating just a small amount. Some have indigestion, nausea, or vomiting after they eat. These appetite changes can lead to unintended weight loss.

It’s not uncommon for these symptoms to be misdiagnosed at first as acid reflux or a similar digestive condition.

6. Menstrual changes

If you have menstrual periods, ovarian cancer can affect your period in a number of ways. It may cause you to:

  • miss a period
  • bleed more heavily than usual
  • have spotting or bleeding when you’re not having a period
  • experience vaginal discharge that’s different from what you’re used to

In fact, research has found that a change from a regular to an irregular menstrual cycle can be a risk factor for ovarian cancer.

If you are postmenopausal, talk with your doctor if you experience vaginal bleeding. Bleeding after menopause is sometimes a sign of ovarian cancer.

Anytime your periods change, discussing what’s happening with a gynecologist, primary doctor, or another medical professional you trust is a good idea.

7. Pain during sex

Pain during sex is a lesser-known sign of ovarian cancer. It can be caused by several other conditions, including:

If sex is painful, a medical professional can help you find out what’s causing the pain. Even if it’s not ovarian cancer, diagnosing and treating the problem can help you avoid emotional distress and physical symptoms.

You may be at higher risk for ovarian cancer if you have:

  • a family history of ovarian cancer
  • a history of breast, gynecological, or colon cancer
  • BRCA1 or BRCA2 genetic mutations and the mutations that cause Lynch syndrome
  • obesity
  • never had a pregnancy
  • used hormone therapies or fertility drugs, though the research on this is not conclusive
  • have endometriosis

Unlike other types of cancer, there’s currently no screening test to detect ovarian cancer at an early stage.

There’s also no single test to detect ovarian cancer. Instead, your doctor will use several tests to look for a tumor in your ovaries and then test it to determine whether it’s benign or malignant (cancerous).

The diagnostic tests most often used to detect ovarian cancer include:

  • Pelvic exam. Your doctor will feel your lower abdomen and pelvis to check for changes to the size and shape of your ovaries and uterus.
  • Transvaginal ultrasound. This involves inserting an instrument into your vagina which uses sound waves to create a picture of the inside of your fallopian tubes, ovaries, and uterus.
  • CA-125 blood test. This test detects higher levels of a protein sometimes produced by tumors.
  • CT scan. This test can visualize larger cancerous tumors and determine if the cancer has spread elsewhere.

While the tests noted above can help lead to a diagnosis, a doctor will need a biopsy/tissue sample, or even a sample of fluid from the abdomen, to definitively diagnose ovarian cancer.

A delayed ovarian cancer diagnosis could have an impact on your life.

Because there isn’t a regular screening test to detect early ovarian cancer and the symptoms overlap with other conditions, good treatment outcomes may depend partly on your ability to self-advocate.

This may be especially important if you’re part of a group that’s often overlooked or underdiagnosed because of bias or racial inequities in healthcare.

For example, a 2019 meta-analysis of 41 studies found a decrease of 25% in the receipt of ovarian cancer treatment and an 18% increased risk of mortality from ovarian cancer in Black people compared to people who are white.

Self-advocacy isn’t always easy. It can be hard to talk about your symptoms, especially if you:

  • are a shy or reserved person
  • don’t know or fully trust your healthcare team
  • have depression or anxiety
  • don’t know what to ask for
  • are younger or less educated than your doctor
  • have experienced discrimination or disbelief because of your sex, gender identity, race, or income
  • have never had to advocate for yourself in a medical setting before
ASK FOR WHAT YOU NEED

Here are some words of encouragement: Your symptoms are real. Your health is worth fighting for. It’s OK — it’s more than OK, it’s critical — to ask for what you need.

Most people aren’t born with self-advocacy skills. They’re developed through practice. Think of it as building muscle.

Research involving women with ovarian cancer shows that self-advocacy has powerful effects, including:

  • you’re more likely to feel that your healthcare meets your needs and reflects your values
  • you’ll get more information to help you make better decisions
  • you’re more likely to get help for your symptoms before they become overwhelming
  • you’re more likely to create a supportive network around you
  • your overall well-being — including your mental and emotional health — is likely to improve

Strategies for self-advocacy

  1. Record your symptoms. In the days or weeks leading up to your appointment, document your symptoms to help your doctor understand the frequency and severity of your symptoms.
  2. Communicate your risk. Make sure your doctor knows about your risk factors, including your family history and any BRCA1 and BRCA2 genetic mutations.
  3. Emphasize what’s new. Because many symptoms of ovarian cancer are common, be sure you state clearly which symptoms are new and how long they have been happening.
  4. Educate yourself. Find out everything you can about ovarian cancer and the diagnostic tests to detect it. Know where the tests take place, who orders them, and whether they’re covered by your insurance plan if you have one.
  5. Prepare questions in advance. This step is important if you tend to become anxious in medical settings. To make sure you ask every question that matters to you, keep a notepad or your phone handy in the days before your office visit so you can jot down questions as they occur to you.
  6. Involve your friends. If you have friends or relatives with cancer, ask them for guidance and support. What do they wish they’d done differently? How were they able to self-advocate? Would they be willing to role-play with you? In one study involving Black women with breast cancer, participants said the support they received from friends and family made a big difference in their ability to self-advocate.
  7. Ask for a referral. If you feel your doctor is ignoring or minimizing your concerns, ask for a referral to a specialist. If you have health insurance, you can talk with your plan coordinator to see whether a referral is necessary.
  8. Be polite and firm. A good healthcare partnership is based on two-way respect and trust. Asking may be more effective than demanding.
  9. Find another doctor. Finding a new doctor can be time consuming. Still, if you feel you’re not being heard, it is worth looking for a doctor who sees you, hears you, and gives you person-centered care.

Thinking about ovarian cancer can be frightening, whether you’re just beginning to gather information about your symptoms or are much farther along in the process.

It can be helpful if you have a variety of support systems around you. In addition to the support you have closer to home, here are some resources you may find helpful:

Resources for you

Here are answers to additional questions about ovarian cancer detection and symptoms.

Many people can have no symptoms for many years. In fact, only 20% of ovarian cancer cases are diagnosed at an early stage.

A 2024 review of studies from 2000 to 2022, found that the mean time from ovarian cancer symptom onset to diagnosis ranged from 1.4 to 10.0 months, depending on the type and number of symptoms, road to diagnosis, and diagnostic workup.

The CA-125 blood test can detect a protein called CA-125 in the blood, which could indicate ovarian cancer. However, this is not definitive. A rise in this protein can be caused by other conditions, and not everyone with ovarian cancer will see an increase in this protein in their blood.

It’s worth noting that the CA-125 test cannot be used as a screening tool. It can be used as a helpful part of the picture in a patient with ovarian cancer but it cannot detect ovarian cancer in patients without suspected or confirmed cancer.

Ovarian cancer could cause weight gain. This usually results from the growth of the cancerous tumor or constipation caused by cancer.

Learn more about ovarian cancer and weight gain.

Ovarian cancer doesn’t always have noticeable symptoms in its earliest and most treatable stages. When symptoms do show up, they are often misunderstood because they can mimic the symptoms of other conditions.

Talk with a medical professional if you experience:

  • abdominal pain
  • bloating
  • pain in your back or sides
  • unexpected vaginal bleeding
  • missed periods
  • changes in your bowel habits or appetite
  • increased urgency or frequency of urination
  • painful sex

You may have to ask your doctor about ovarian cancer specifically because these symptoms are sometimes misdiagnosed at first, but do advocate for yourself. Your health depends on an early and accurate diagnosis.