Perimenopause vs Ovarian Cancer Symptoms: What to Watch For
Perimenopause and ovarian cancer share bloating, pelvic discomfort, and fatigue. Learn the red flags, when to seek urgent assessment, and what tests to request.
Why the Overlap Matters
Ovarian cancer is sometimes called a silent disease, but it is not symptomless. It produces symptoms that are easy to attribute to other common conditions, including perimenopause. Many women with ovarian cancer report that their symptoms were initially put down to hormonal changes, irritable bowel syndrome, or stress. Because early detection dramatically improves outcomes and because the age of onset for ovarian cancer overlaps with the typical perimenopause years, understanding which features might signal something more serious than hormonal change is important for every woman in this age group.
Red Flags That Point More Strongly to Ovarian Cancer
Certain features should prompt faster medical investigation rather than watchful waiting. Persistent bloating that is present on most days and does not improve with diet or digestive interventions is the most important. Feeling full quickly when eating, or a noticeable change in appetite without an obvious explanation, should be investigated. Frequency of urination that is new and persistent, without a urinary tract infection, can indicate pressure on the bladder from a pelvic mass. Unexplained weight loss is not a feature of perimenopause and should always prompt assessment. Any symptom that is new, persistent, and present for more than three weeks warrants a GP visit rather than self-management.
When to Seek Urgent Assessment
Most perimenopause symptoms fluctuate. They change with the menstrual cycle, with stress, and with sleep quality. Ovarian cancer symptoms tend to be more constant and gradually worsening rather than cyclical. If you have new persistent bloating, pelvic pressure, appetite changes, or urinary urgency that has been present most days for three weeks or more, seeing a GP is the right step. You do not need to wait to see if it resolves. NICE guidance in the UK supports GPs in ordering simple investigations when ovarian cancer symptoms are present, and a fast-track referral can be made if initial tests are concerning.
CA-125 and Ultrasound: What to Expect
The two standard first-line investigations for suspected ovarian cancer are a CA-125 blood test and a pelvic ultrasound. CA-125 is a protein that is elevated in many ovarian cancer cases, though it can also be raised by endometriosis, fibroids, pelvic inflammatory disease, and perimenopause itself. A raised CA-125 is not diagnostic on its own, but combined with ultrasound findings it helps guide whether onward referral is needed. Transvaginal ultrasound provides better visualisation of the ovaries than abdominal ultrasound. If both tests are normal and symptoms remain, a repeat assessment or further imaging may still be warranted depending on clinical judgment.
Risk Factors for Ovarian Cancer Worth Knowing
Certain factors increase the risk of ovarian cancer. BRCA1 and BRCA2 gene variants significantly elevate lifetime risk, and women with a strong family history of ovarian or breast cancer may already be under enhanced surveillance. Never having been pregnant is associated with slightly higher risk. Endometriosis, particularly endometrioid and clear cell subtypes, is linked to ovarian cancer risk. Older age at menopause and extended use of ovulation induction medications are other factors. Knowing your family history and discussing it with your GP is worthwhile, as it may affect both cancer screening and decisions about HRT.
Keeping Symptoms in Context Without Catastrophising
The goal of this comparison is not to create anxiety about every bloating episode or period of fatigue. The vast majority of women in perimenopause who experience these symptoms will have a hormonal cause rather than ovarian cancer. The goal is to know the features that make early medical review worthwhile, and to feel empowered to raise concerns rather than dismiss them. Tracking your symptoms over time helps you notice what is cyclical and variable versus what is persistent and progressive. Apps like PeriPlan let you log symptoms and track patterns over time, which gives you a clearer picture of how your body is behaving and supports more confident conversations with your doctor.
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