Ovarian cancer symptoms include pain during intercourse, fatigue, back pain, menstrual changes, abdominal swelling, and stomach upset.

Ovarian cancer is devious and deceptive. As it first develops in a woman’s body, it may offer up no indication of its presence. Oftentimes, it doesn’t reveal itself until after it’s progressed, and when it does, many times its warning signs still go unrecognized.

That’s because ovarian cancer symptoms tend to be nebulous, easily mistaken for other, more common problems. Nevertheless, it’s critical not to ignore them. Seeking prompt medical help for potential symptoms of ovarian cancer is your best chance to receive treatment that may save your life.

Ambiguity in Ovarian Cancer Symptoms

Only about one in five ovarian cancers is discovered at an early stage, according to the American Cancer Society (ACS). By the time a gynecologist can feel an enlarged cancerous ovary during a pelvic exam, the cancer is usually advanced. Plus, screening tests—such as transvaginal ultrasound and blood tests for a protein (CA-125) that’s elevated in many women with ovarian cancer—have not proven successful at preventing deaths from the disease.

So, it’s vital to acknowledge any signs of ovarian cancer and report them to your doctor. The disease may cause changes in urinary habits, such as feeling like you have to urinate all the time or more frequently. You also may experience bloating, feeling full quickly when you eat, and abdominal or pelvic pain or pressure. These more common warning signs may be accompanied by other symptoms of ovarian cancer, including pain during intercourse, fatigue, back pain, menstrual changes, abdominal swelling, and stomach upset.

Although early-stage ovarian cancer may cause symptoms, these warning signs are more likely to develop after the disease has spread beyond the ovaries. Compounding the problem is that once you experience these symptoms, they’re more likely to be a result of other medical problems, including several benign conditions and certain other cancers.

For example, ovarian cancer symptoms may be easily mistaken for signs of a digestive disorder. As such, you might visit your primary care physician or see a gastroenterologist without considering that the problem originates in your gynecologic system. Consequently, in many women a diagnosis of ovarian cancer (and treatment for the disease) is often delayed. This delay may partly explain why ovarian cancer is the fifth-leading cause of cancer death among women and accounts for more deaths (about 14,180 a year) than any other gynecologic cancer, according to the ACS.

Sometimes, but not always, the symptoms are more severe when ovarian cancer is the cause. Ovarian cancer symptoms tend to be continual and mark a change from how you normally feel (e.g. the symptoms are new, occur more frequently, or increase in severity). The ACS recommends that you see a doctor—preferably a gynecologist—if you experience signs of ovarian cancer almost daily for a few weeks or more, or more than 12 times a month, and these symptoms can’t be explained by other medical conditions.

Recognize Your Risk

The risk of ovarian cancer rises after menopause and with age, peaking in a woman’s 70s. The disease is more common among Caucasians than African-Americans.

Women who are obese, have a history of breast cancer, or have taken estrogen alone (without progesterone) after menopause appear to be at higher risk of ovarian cancer, research suggests. On the flip side, the odds of developing the disease may be lower in women who have taken birth control pills, have undergone tubal ligation (had their “tubes tied”) or a hysterectomy, or have been pregnant and carried the child to term before age 26, the ACS notes.

Your risk of ovarian cancer is also higher if a first-degree relative (mother, sister, or daughter) has had the disease, and the risk increases with each additional relative diagnosed with ovarian cancer. Researchers also have identified a link between ovarian cancer risk and a family history of colorectal and breast cancer.

As many as one in 10 ovarian cancers may be attributable to inherited cancer syndromes. One of these syndromes is caused by mutations in the BRCA1 and BRCA2 genes, which have been associated with increased risk of cancers of the ovaries, breast, pancreas, and prostate. While an average woman faces a 2 percent lifetime risk of developing ovarian cancer, the risk is 35 to 70 percent for women with BRCA1 mutations and 10 to 30 percent by age 70 for women with BRCA2 mutations, according to the ACS.

If you have a strong family history of ovarian or breast cancer, talk to your doctor about testing for BRCA mutations. If you test positive for BRCA, talk to your gynecologist about ovarian cancer screening. Your gynecologist might discuss having your ovaries removed if you no longer plan to have children.

Originally published in May 2016 and updated.