You have probably seen the teal ribbons every September. You may have a friend, a mother, an aunt, or a coworker who was diagnosed. Or maybe you have simply wondered, quietly, whether ovarian cancer is something you should worry about.
That quiet wondering deserves a real, honest answer. Not a scary one. Not a dismissive one. An evidence-based one.
September is Ovarian Cancer Awareness Month, and this article is not here to alarm you. It is here to inform you. Because the single most empowering thing you can do for your health is understand your personal risk, recognize the signs that warrant attention, and know when to have a conversation with a provider who will actually listen.
If you are looking for a provider who takes your concerns seriously and gives you the time you deserve, learn more about our consultations at hervitalwellness.com.
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Key takeaways
- Ovarian cancer is uncommon, but it is often diagnosed at an advanced stage because early symptoms are vague and nonspecific.
- Knowing your family history is one of the most important things you can do, since approximately 25% of ovarian cancers have a hereditary component.
- There is currently no reliable screening test for ovarian cancer in average-risk women, which makes symptom awareness and risk factor knowledge especially important.
- Several factors may reduce ovarian cancer risk, including oral contraceptive use and opportunistic salpingectomy during pelvic surgery.
- Persistent bloating, pelvic pain, difficulty eating, or urinary changes lasting more than two weeks deserve evaluation, not dismissal.
- A proactive relationship with a provider who knows your full history is one of the best tools you have.
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What is ovarian cancer?
Ovarian cancer refers to a group of cancers that begin in or near the ovaries, fallopian tubes, or the peritoneum (the tissue lining the inside of the abdomen). Approximately 90% of ovarian cancers are epithelial, meaning they arise from the cells on the surface of these organs. The most common subtype, high-grade serous ovarian cancer, accounts for 70% to 80% of cases and is now thought to originate most often in the fallopian tubes rather than the ovaries themselves.
In the United States, approximately 21,000 women receive an ovarian cancer diagnosis each year. The lifetime risk for an average-risk woman is about 1 in 91. While that number is relatively low compared with other cancers, ovarian cancer carries a disproportionately high mortality rate because it is frequently diagnosed at an advanced stage.
Why early detection is so difficult
Unlike breast cancer or cervical cancer, there is no reliable screening test for ovarian cancer in the general population. The US Preventive Services Task Force recommends against routine screening in average-risk, asymptomatic women because studies have shown that screening with transvaginal ultrasound and CA-125 blood tests does not reduce mortality and can lead to harm from false-positive results.
This is not a failure of effort. Researchers have tried extensively. However, the biology of ovarian cancer makes early detection uniquely challenging, since the disease can spread within the abdominal cavity before producing obvious symptoms.
That reality makes two things especially important: knowing your personal risk factors and paying attention to persistent symptoms.
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Who is at risk?
Ovarian cancer risk is shaped by a combination of genetic, reproductive, and medical factors. Understanding where you fall can help guide conversations with your provider.
Family history and hereditary risk
Family history is the strongest known risk factor for ovarian cancer. Approximately 25% of ovarian cancers are hereditary, most commonly linked to inherited variants in the BRCA1 and BRCA2 genes.
The numbers are significant. Women with a BRCA1 variant have an estimated lifetime ovarian cancer risk of 39% to 58%. For BRCA2 carriers, that risk is 13% to 29%. Other genes associated with increased risk include BRIP1, RAD51C, RAD51D, and the mismatch repair genes linked to Lynch syndrome.
However, you do not need a known gene variant to have meaningful hereditary risk. A first-degree relative (mother, sister, daughter) with ovarian cancer at any age increases your risk, as does a family history of breast cancer, particularly early-onset breast cancer.
Reproductive and medical risk factors
Several other factors are associated with ovarian cancer risk:
- Endometriosis (associated with a roughly fourfold increased risk)
- Infertility
- Nulliparity (never having given birth)
- Early menarche (first period at age 12 or younger)
- Late menopause (at age 55 or older)
- Postmenopausal estrogen-only therapy (associated with a modestly increased risk)
What may lower your risk
Research also identifies several factors associated with reduced ovarian cancer risk:
– Oral contraceptive use: A meta-analysis found that ever-use was associated with a 27% lower risk, and use for more than 10 years was associated with a 57% reduction.
– Multiparity: Each additional birth is associated with approximately a 19% lower risk.
– Breastfeeding: Associated with a 28% lower risk.
– Opportunistic salpingectomy: Removal of the fallopian tubes during pelvic surgery for other reasons (such as hysterectomy) is associated with a 42% to 80% reduction in ovarian cancer risk, according to multiple observational studies. Both ACOG and the European Society of Gynaecological Oncology support considering this approach for eligible women.
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What are the signs of ovarian cancer?
This is where awareness matters most. Ovarian cancer does produce symptoms, but they are often vague and easy to attribute to other causes. In practice, many women and even some providers initially assume these symptoms are related to digestive issues, stress, or perimenopause.
Symptoms to watch for
A prospective case-control study found that the following symptoms were significantly more common in women with ovarian cancer compared with women without it:
- Bloating (70% vs. 38%)
- Increased abdominal size (64% vs. 19%)
- Urinary urgency or frequency (55% vs. 32%)
- Abdominal pain (50% vs. 30%)
- Pelvic pain (41% vs. 26%)
Additional symptoms may include difficulty eating or feeling full quickly, unexplained weight loss, fatigue, and changes in bowel habits.
When symptoms should raise concern
The key distinction is persistence and pattern. Research suggests that symptoms occurring more than 12 times per month and present for less than one year are more likely to be associated with ovarian cancer than occasional or longstanding symptoms. A symptom index using this framework showed a sensitivity of nearly 80% for advanced-stage disease.
Importantly, 89% of women with early-stage ovarian cancer and 97% with advanced-stage disease reported symptoms before diagnosis. The symptoms were present. They simply were not always recognized.
If you are experiencing persistent bloating, pelvic or abdominal pain, urinary changes, or difficulty eating that is new and does not resolve within two to three weeks, that deserves a conversation with your provider. Not panic. A conversation.
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Why your family history matters more than you might think
In a survey of women diagnosed with ovarian cancer, many did not know their family history in enough detail to understand their risk beforehand. Yet family history remains the single most actionable piece of information for ovarian cancer prevention.
What to look for in your family tree
The NCCN recommends genetic testing for ovarian cancer susceptibility genes in the following situations:
- A personal history of epithelial ovarian cancer at any age
- A first- or second-degree blood relative with epithelial ovarian cancer at any age
- A personal or family history suggestive of hereditary breast and ovarian cancer syndrome (including early-onset breast cancer, male breast cancer, or pancreatic cancer in the family)
- Ashkenazi Jewish ancestry (which carries a higher prevalence of BRCA1/2 founder mutations)
What genetic testing can tell you
Genetic testing does not diagnose ovarian cancer. Instead, it identifies whether you carry a gene variant that significantly increases your lifetime risk. For women who test positive, evidence-based risk-reduction options exist, including:
– Risk-reducing bilateral salpingo-oophorectomy (surgical removal of the ovaries and fallopian tubes), which reduces ovarian cancer risk by approximately 81% in BRCA1/2 carriers. The NCCN recommends this between ages 35 and 40 for BRCA1 carriers and 40 to 45 for BRCA2 carriers.
– Oral contraceptives for ovulation suppression, which have been shown to reduce ovarian cancer risk in BRCA carriers as well.
– Salpingectomy with delayed oophorectomy, an evolving approach currently under study for women who are not yet ready for full oophorectomy.
For women who undergo risk-reducing surgery before natural menopause, the effects of surgical menopause (including impacts on bone health, cardiovascular health, and quality of life) should be discussed, and hormone therapy is generally not contraindicated for those without a personal history of breast cancer.
If you are unsure whether your family history warrants genetic counseling, that is exactly the kind of question a knowledgeable provider can help you sort through.
You deserve a provider who takes the time to review your full history, not just your current symptoms. Schedule a consultation at hervitalwellness.com.
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What every woman should know
Myth vs. fact
| Myth | Fact |
|---|---|
| A Pap smear screens for ovarian cancer. | Pap smears screen for cervical cancer, not ovarian cancer. There is no equivalent routine screening test for ovarian cancer. |
| Ovarian cancer has no symptoms. | Most women with ovarian cancer do experience symptoms before diagnosis, but the symptoms are nonspecific and often attributed to other conditions. |
| Only women with a family history get ovarian cancer. | While family history is the strongest risk factor, approximately 75% of ovarian cancers occur in women without a known hereditary component. |
| CA-125 is a reliable screening test. | CA-125 can be elevated in many benign conditions and is not recommended as a screening tool for average-risk women. |
| Ovarian cancer only affects older women. | While the median age at diagnosis is 63, ovarian cancer can occur at any age, and women with BRCA1 variants are diagnosed on average 10 years earlier. |
| There is nothing you can do to reduce your risk. | Oral contraceptive use, opportunistic salpingectomy, and knowing your family history are all evidence-based strategies that may reduce risk. |
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When to talk to a provider
Certain situations call for a proactive conversation:
- Persistent symptoms: Bloating, pelvic or abdominal pain, urinary urgency, or difficulty eating that is new, occurs most days, and has lasted more than two to three weeks
- Family history concerns: A first- or second-degree relative with ovarian, breast, or pancreatic cancer, particularly if diagnosed at a younger age
- Interest in genetic counseling: Uncertainty about whether your family history warrants testing
- Upcoming pelvic surgery: An opportunity to discuss whether opportunistic salpingectomy is appropriate for you
- General preventive planning: Wanting to understand your personal risk profile as part of a comprehensive midlife health plan
Red flags that need prompt evaluation
While ovarian cancer is not typically an emergency presentation, certain symptoms warrant more urgent medical attention:
- Rapidly increasing abdominal size or new-onset ascites (fluid in the abdomen)
- A palpable pelvic or abdominal mass
- Unexplained weight loss with abdominal symptoms
- Severe or worsening pelvic pain
These symptoms do not necessarily mean cancer, but they do warrant timely evaluation, ideally with referral to a gynecologic specialist.
What to bring to your visit
- A written list of your symptoms, including when they started, how often they occur, and whether they have changed
- Your family cancer history on both sides, going back at least two generations (include cancer type and age at diagnosis)
- A list of current medications, supplements, and any relevant medical history (including endometriosis, infertility, or prior pelvic surgeries)
- Your questions, written down so you do not forget them
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Looking at the whole picture
Ovarian cancer is not common, and this article is not meant to make you afraid. It is meant to make you informed. Because informed women ask better questions, seek care earlier, and advocate for themselves more effectively.
The most important things you can do are straightforward: know your family history, pay attention to persistent symptoms that are new for you, and build a relationship with a provider who takes your concerns seriously and has the time to listen.
You are not being dramatic for asking about your risk. You are being proactive. And that is exactly the kind of care you deserve.
If you want to discuss your personal risk factors, review your family history, or simply have a thorough conversation about your preventive health plan, book a consultation at hervitalwellness.com.
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Frequently asked questions
Can ovarian cancer be detected early?
Early detection is possible but challenging. There is no reliable screening test for average-risk women, and symptoms are often nonspecific. However, paying attention to persistent changes in bloating, pelvic pain, urinary habits, or appetite and seeking evaluation promptly may lead to earlier diagnosis in some cases.
What does ovarian cancer feel like in the early stages?
Most women with early-stage ovarian cancer report symptoms before diagnosis, including bloating, pelvic or abdominal pain, and urinary urgency. These symptoms are often mild and intermittent at first, which is why they are frequently attributed to digestive issues or stress.
Does a family history of breast cancer increase my ovarian cancer risk?
Yes, it can. BRCA1 and BRCA2 gene variants are associated with both breast and ovarian cancer, and a family history of breast cancer (especially early-onset or male breast cancer) may indicate a hereditary cancer syndrome that also increases ovarian cancer risk.
Should I get genetic testing for ovarian cancer?
Genetic testing is recommended if you have a personal or family history of ovarian cancer at any age, a family history suggestive of hereditary breast and ovarian cancer syndrome, or Ashkenazi Jewish ancestry. A genetic counselor or knowledgeable provider can help determine whether testing is appropriate for you.
Does a Pap smear detect ovarian cancer?
No. A Pap smear screens for cervical cancer only. There is currently no equivalent routine screening test for ovarian cancer. This is one reason why symptom awareness and family history knowledge are so important.
Can oral contraceptives reduce ovarian cancer risk?
Research consistently shows that oral contraceptive use is associated with a significant reduction in ovarian cancer risk, with greater protection seen with longer duration of use. This protective effect may persist for decades after discontinuation.
What is opportunistic salpingectomy?
Opportunistic salpingectomy is the removal of the fallopian tubes during a pelvic surgery already being performed for another reason, such as a hysterectomy. Because most high-grade serous ovarian cancers are now thought to originate in the fallopian tubes, this approach may reduce ovarian cancer risk by 42% to 80%. ACOG supports discussing this option with eligible patients.
Is bloating a sign of ovarian cancer?
Persistent bloating that is new, occurs most days, and lasts more than two to three weeks can be associated with ovarian cancer, though it is far more commonly caused by benign conditions. The key is persistence and pattern rather than occasional bloating after meals.
At what age should I start worrying about ovarian cancer?
The median age at diagnosis is 63, but women with BRCA1 variants may be diagnosed a decade earlier. Rather than a specific age to “start worrying,” the more useful approach is to know your family history, discuss your risk factors with a provider, and pay attention to persistent new symptoms at any age.
Can ovarian cancer be prevented?
Ovarian cancer cannot be completely prevented, but several strategies may meaningfully reduce risk. These include oral contraceptive use, opportunistic salpingectomy during pelvic surgery, and risk-reducing bilateral salpingo-oophorectomy for women with high-risk gene variants. Knowing your family history and discussing it with a provider is the first step.
Is ovarian cancer hereditary?
Approximately 25% of ovarian cancers have a hereditary component, most commonly linked to BRCA1/2 gene variants. However, the majority of ovarian cancers occur in women without a known hereditary predisposition, which is why symptom awareness matters for all women.
What is CA-125, and should I ask for it?
CA-125 is a blood protein that can be elevated in ovarian cancer, but it can also be elevated in many benign conditions, including endometriosis, fibroids, and even menstruation. It is not recommended as a screening tool for average-risk women without symptoms. Your provider can help determine whether it is appropriate in your specific situation.
(Telehealth appointments are currently available for patients located in Arizona and New York.)
This information is educational and not a substitute for personalized medical care.
References
- 1. US Preventive Services Task Force. Screening for ovarian cancer: USPSTF recommendation statement. JAMA. 2018;319(6):588-594.
- 2. ACOG Committee Opinion No. 774. Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. Obstet Gynecol. 2019;133(4):e279-e284. PMID: 30913199.
- 3. NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Version 4.2026.
- 4. NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. Version 3.2026.
- 5. ACOG Committee Opinion No. 716. The role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer in women at average risk. Obstet Gynecol. 2017;130(3):e146-e149.
- 6. Caruso G, Weroha SJ, Cliby W. Ovarian cancer: a review. JAMA. 2025;334(16):1391-1404.
- 7. Piek JM, Schauwaert J, Ellis LB, et al. Opportunistic salpingectomy for prevention of tubo-ovarian carcinoma: the European Society of Gynaecological Oncology consensus statements. JAMA. 2026;335(5):467-476.
- 8. Goff BA, Mandel LS, Drescher CW, et al. Development of an ovarian cancer symptom index. Cancer. 2007;109(2):221-227. PMID: 17154394.
- 9. Kim JH, Hwang IS, Lee SJ, et al. Reproductive shifts and ovarian cancer risk in women aged 40 years or older. JAMA Netw Open. 2026;9(2):e2457312.
- 10. Sun Q, Ji J, Chen J, et al. Oral contraceptives exposure may reduce the risk of ovarian cancer: a meta-analysis based on cohort studies. Front Pharmacol. 2025;16:1505678. PMID: 41993581.
- 11. Karlsson T, Johansson T, Höglund J, Ek WE, Johansson Å. Time-dependent effects of oral contraceptive use on breast, ovarian, and endometrial cancers. Cancer Res. 2021;81(4):1153-1162.