Ovarian cancer is one of the most difficult gynecologic malignancies to detect. Notorious for its sly nature and vague symptoms, oncologists diagnose 58% of patients at an advanced stage (III or IV). Researchers link stage III with a 41% five-year relative survivability and stage IV with 31%, while stages I and II have a survival rate of 93% and 74%, respectively.
If women notice signs of ovarian cancer earlier, they have a much higher chance of successful treatment. But what exactly can women do? For one, consulting a gynecologist when menstrual irregularity persists may save lives.
While irregular menstrual cycles are often dismissed as minor inconveniences or as symptoms of hormonal imbalance, a growing body of research suggests they might be more perilous than previously thought.
For some women, “abnormal” periods could be a sign of gynecologic issues, even signaling a higher risk of ovarian cancer. Understanding this perceived link between menstrual irregularities and ovarian cancer could empower more women to seek early interventions and improve the odds of successful treatment.
What are the ovaries and their functions?
Let’s begin with the basics.
The ovaries are two small, oval-shaped organs in the lower part of a woman’s belly, on each side of the uterus (where a baby develops during pregnancy). These parts of the female reproductive system have two main functions:
- They produce and release eggs each month. If an egg meets a sperm—whether through sexual intercourse or in vitro fertilization (IVF)—it can start a pregnancy.
- They make hormones like estrogen and progesterone, which help manage many aspects of women’s health, including puberty and menstruation.
The ovaries are prone to cystic or tumorous growths. Usually, they’re noncancerous and remain in or on the ovary. In some instances, however, ovarian tumors are cancerous. Some of these tumors cause irregular vaginal bleeding or missed periods, though it’s rare for a missed period to be the only symptom.
What are menstrual irregularities and why do they happen?
“Menstrual irregularities,” “abnormal menstruation,” or “irregular periods” all refer to changes or disruptions in the monthly menstrual cycle.
According to Planned Parenthood, the average cycle is 25 to 30 days, though it can be as short as 21 days or longer than 35. Bleeding lasts two to seven days. It differs from woman to woman, and the number of days in each person’s cycle can change from month to month.
Below are the factors that can alter or disrupt a woman’s cycle.
What are the types of menstrual irregularities?
Menstrual disorders come in different forms, each with its own characteristics and causes:
- Amenorrhea refers to the absence of menstruation. Primary amenorrhea happens when a girl hasn’t started menstruating by 15 years old, while secondary amenorrhea is when menstruation stops for three months or more in someone who had regular periods.
- Oligomenorrhea is when menstrual cycles are consistently longer than 35 days, meaning periods are infrequent.
- Polymenorrhea is the opposite of oligomenorrhea. Cycles are under 21 days, resulting in more frequent periods.
- Menorrhagia refers to unusually heavy or prolonged menstrual bleeding. Those with this condition may experience bleeding that lasts more than seven days or is severe enough to interfere with daily activities (e.g., bleeding through clothes, staining surfaces when sitting or lying down, needing to change sanitary products every hour, and experiencing symptoms such as dizziness or fatigue due to blood loss).
- Dysmenorrhea, or painful periods, often appears with menstrual irregularities because of its impact on well-being and daily life. Although it doesn’t involve changes in cycle length or frequency, intense period pain may signal underlying conditions like endometriosis.
What are the common causes of irregular periods?
While occasional irregularities are usually harmless, persistent or severe menstrual disruptions can be due to:
- Hormonal imbalances: Polycystic ovarian syndrome (PCOS) and thyroid disorders wreak havoc on the body’s hormonal balance. PCOS, for example, affects hormone levels in a way that can prevent ovulation—a phase in the cycle where the ovary releases an egg. When ovulation doesn’t occur, progesterone levels remain low and stop the uterine lining from developing. The result is often a missed period since it is this very lining that sheds (if not pregnant) and causes monthly bleeding.
- Lifestyle factors: High stress, poor nutrition, and drastic weight changes—whether gain or loss—can affect menstrual cycles. Intense physical exercise, especially in athletes and bodybuilders, can also interrupt the regularity of menstruation due to the body’s adaptive response to physical strain. Several studies also confirm that intense exercise can cause oligomenorrhea and amenorrhea.
- Medical conditions: Endometriosis, uterine fibroids, and other reproductive health issues can cause menstrual irregularities. These conditions can lead to painful or heavy periods that often require medical attention.
Understanding and tracking menstrual health is an essential step in recognizing potential issues early, as consistent or recurring period irregularities could be linked to more serious conditions like ovarian cancer.
How do I know if my periods are irregular?
Examples of irregular menstruation include:
- Periods that come closer than 21 days apart or farther than 35 days apart
- Missing three or more consecutive periods
- Notably heavier or lighter menstrual flow than usual
- Bleeding lasting longer than seven days
- Cycle length varies by more than nine days month-to-month (e.g., a 21-day cycle followed by a 35-day cycle, then a 29-day cycle)
- Severe pain, cramping, nausea, or vomiting with periods
- Bleeding or spotting between menses, during or after sex, or while already menopausal
- Soaking through a tampon or sanitary pad within an hour
These symptoms may point to an underlying health problem, including ovarian cancer.
What is ovarian cancer anyway?
Ovarian cancer is the growth of malignant (cancerous) cells in or on an ovary. It has three types, which oncologists classify based on the cells in which they begin:
- Epithelial ovarian cancer is the most common form. It originates in the thin layer of cells covering each ovary.
- Germ cell tumors affect the cells responsible for producing eggs. It’s more common in younger women.
- Stromal tumors begin in the connective tissue holding the ovaries together. They produce hormones and are relatively rare.
Do missed periods increase my risk for ovarian cancer?
For most women, missing a period is nothing to worry about. Pregnancy, strenuous exercise, low body fat, weight gain, hormonal imbalances, and stress can trigger menstrual irregularities.
In rare cases, irregular periods are a sign of a serious health issue. For example, it may increase the risk of developing ovarian cancer. A 2016 study backs the claim, having found that women with a history of irregular menses were twice as prone to developing ovarian cancer. This risk increases as a woman gets older. Leading health organizations like the American Cancer Society also warn that irregularities, including heavier and/or inconsistent monthly bleeding, can be an early sign of ovarian cancer.
What’s the science behind this link?
Research into the relationship between menstrual irregularities and ovarian cancer has revealed some interesting, though complex, findings. Irregular cycles can sometimes signal hormonal imbalances or reproductive disorders, which, in turn, affect overall ovarian health. Yet not all menstrual irregularities lead to ovarian cancer, and understanding the ties between them offers insights into how certain patterns might influence long-term health risks.
How could menstrual irregularities RAISE ovarian cancer risk?
These biological mechanisms might explain the connection between abnormal menstruation and ovarian cancer risk:
- Hormonal pathway disruptions: Irregular cycles often result from hormonal imbalances. Specifically, estrogen and progesterone play a vital role in ovarian health and cancer risk. Disruptions in these hormone levels can create an environment that may either increase or decrease cancer risk, depending on the pattern of irregularities.
- Role of inflammation: Some irregularities, like severe cramps or heavy bleeding, are associated with underlying inflammatory conditions such as endometriosis. Chronic inflammation is a known factor in cancer development, as it can lead to cellular damage over time. This inflammatory process might contribute to a higher risk of ovarian cancer in some women.
But wait; could irregular periods LOWER ovarian cancer risk?
Contrariwise, some researchers suggest that women with consistently irregular cycles may have a lower risk of ovarian cancer than women with regular cycles. This finding might be associated with the “chronic ovulation theory.” When ovulation occurs, the ovaries undergo minor trauma to release an egg. Over many decades, this repeated “wear and tear” could boost the chances of mutations that lead to cancer. But women with irregular cycles, particularly those who ovulate scarcely, may have a lower risk since their ovaries experience less of this physical stress.
So, is an irregular period not a risk factor?
Not exactly.
Given these opposing perspectives, most researchers don’t classify menstrual irregularities as a definitive risk factor for ovarian cancer. Rather, they’ve deduced that irregular menstrual patterns associated with other health issues are responsible for the elevated risk. More and more studies are also concluding that women with irregular cycles have a higher risk of ovarian cancer occurrence and mortality over a 50-year follow-up.
Keep in mind that irregular periods are not the strongest indicators or most common symptoms of ovarian cancer. There are other, more prevalent signs.
What are the other symptoms of ovarian cancer?
Many women do not experience symptoms early on, thus why ovarian cancer is one of the most difficult to detect. When symptoms do present themselves, they may be vague and subtle, often diverting attention to more common conditions like irritable bowel syndrome (IBS).
Aside from abnormal menstrual cycles, these symptoms may occur on and off every month:
- Fatigue
- Upset stomach
- Feeling full fast
- Bowel obstruction
- Backache
- Pain during sex
- Abdominal swelling with weight loss
- Urinary urgency, frequency, or sensation
Early diagnosis improves prognosis. Do not ignore or dismiss these symptoms, especially if they persist.
What are the risk factors for ovarian cancer?
Ovarian cancer does not have one single cause; instead, it develops due to a combination of risk factors. These include:
- Age: Half of ovarian cancers occur in women 63 or older, but incidence among Gen Xers (1965-1980) and Millennials (1981-1996) are also on the rise.
- Weight: Being overweight or obese elevates the risk for many cancers, including ovarian cancer. Excess body fat raises estrogen and insulin levels, which fuel cancerous tumors or help them spread. Obesity is medically delimited as having a body mass index (BMI) of 30 or higher.
- Race: Ovarian cancer incidence differs significantly across racial and ethnic groups. The highest age-standardized rates in the United States are in non-Hispanic White women, intermediate rates in Hispanic women, and the lowest rates in African American women. However, as with disparities seen in colon cancer among African Americans, healthcare inequities could be a factor in this data.
- Family history: About 20% of ovarian cancer cases occur due to genetics or mutations in specific genes. Specifically, women with BRCA mutations have a 54% chance of getting ovarian cancer in a lifetime, as well as breast and pancreatic cancer.
- Fertility drugs: A 2019 analysis of 12 studies from the United States found that women who took fertility drugs had a high risk of ovarian cancer. The risk was greater in women who used these meds but never gave birth, compared to those who had given birth to more than one child.
- Menstrual pain: As many as 80% of women experience period pains at some point in life. Some studies have linked it to a heightened risk of ovarian cancer, though not all studies agree. Also, researchers haven’t fully uncovered whether this link varies by the specific types of ovarian cancer, as there hasn’t been enough data to do so.
- Reproductive history: Those who have their first full-term pregnancy at age 35 or older, or never carried a pregnancy to term, have a high risk of ovarian cancer. The risk is lower among women who become pregnant before age 26, and this risk decreases with each full-term pregnancy and with breastfeeding.
- HRT: Women taking estrogen-only hormone replacement therapy (HRT) for a decade or longer have a 60% greater risk of getting ovarian cancer.
- No birth control: The pill reduces ovarian cancer risk by 30% to 50%. The longer someone takes it (most American teens start at 16 years old), the lower their risk, which continues long after they stop taking oral contraceptives. Please note that not everyone who takes birth control pills is sexually active. Many do so for health reasons, including managing menstrual irregularities, reducing symptoms of conditions like endometriosis and PCOS, and controlling severe acne. If you’re a parent, acknowledging the medical reasons behind the pill can improve your teenage child’s well-being and strengthen your relationship.
How do doctors diagnose and screen for ovarian cancer?
Diagnosing ovarian cancer is challenging, especially in those with irregular cycles, as symptoms may overlap with other gynecological or digestive issues. While menstrual irregularities are not a telltale sign of ovarian cancer, they often accompany conditions that heighten one’s risk, prompting doctors to look for subtle warning signs.
Currently, there’s no universally recommended screening approach for ovarian cancer in women without symptoms, including those with menstrual irregularities. The following tests are used in high-risk cases or when symptoms arise:
- Pelvic exam: During a pelvic exam, doctors check for abnormalities in the size, shape, or position of the ovaries and surrounding organs. However, this exam alone often fails to detect early-stage ovarian cancer, as tumors can be difficult to feel until they grow larger.
- Transvaginal ultrasound (TVUS): TVUS uses sound waves to produce images of each ovary and the pelvic area, helping detect any unusual growths or masses. Although it’s helpful for identifying cysts or larger masses, it cannot definitively distinguish between benign and malignant tumors.
- CA-125: This blood test measures a protein that’s often higher in suspected ovarian cancer patients. Unfortunately, CA-125 levels can also be high in women with conditions like endometriosis or pelvic inflammatory disease (PID), making it an unreliable standalone screening method. Still, it can be useful in combination with other tests or for monitoring other ovarian conditions.
Healthcare providers rely on symptom tracking and a comprehensive medical history to assess risks. For women with persistent or worsening symptoms, regular follow-ups are crucial to rule out ovarian cancer or catch it as soon as possible.
As for women with a family history of ovarian or breast cancer, or who carry genetic mutations like BRCA1 or BRCA2, they may benefit from more personalized screening approaches, including genetic testing and counseling.
Is it possible to diagnose ovarian cancer early?
Currently, only 20% of all malignant ovarian tumors are found early. There’s a dedicated pursuit to develop a screening technique for ovarian cancer, but progress has been slow.
When should I consult a doctor about my symptoms and fears?
Seek medical care as soon as a new or unusual symptom develops, especially if it persists. To recap, the warning signs of ovarian cancer may include ongoing abdominal discomfort, bloating, feeling full quickly, urinary changes, backache, pain with or without bleeding after intercourse, and/or abnormal menstruation. These signs, though more likely benign, need medical evaluation to rule out ovarian cancer and other reproductive health concerns.
What if I get diagnosed with ovarian cancer?
In the face of an ovarian cancer diagnosis, consider getting treatment at New Hope Unlimited in Sonora, Mexico, where we offer precision oncology. Our personalized treatment options include immunotherapy, which uses immune checkpoint inhibitors to block certain proteins and allow T cells to attack cancer cells effectively, without compromising healthy cells. Connect with us to explore individualized care designed to make a meaningful difference in your health.
