Ascites Symptoms (Female): What to Look For and When to Seek Care
Ascites is the medical term for fluid buildup in the abdomen. While it can affect anyone, women may notice symptoms differently due to hormonal changes, menstrual cycles, pelvic anatomy, and conditions like ovarian cancer that are unique to females.
This guide explains the common symptoms of ascites in females, why it develops, and when to see a doctor.
What Is Ascites?
Ascites occurs when too much fluid builds up in the abdominal cavity. The most common cause of ascites is cirrhosis, a condition marked by severe scarring of the liver. This severe scarring leads to high pressure, known as portal hypertension, in the portal vein and blood vessels that supply the liver. Portal hypertension is a major cause of ascites, as it causes fluid to leak from blood vessels into the abdominal cavity. The fluid accumulates between the layers of a tissue called the peritoneum, which lines and covers the abdominal organs.
Ascites can also be caused by chronic hepatitis, hepatitis B, hepatitis A, severe liver disease, liver failure, liver damage, blood clots in the blood vessels draining the liver, recurrent cancer, advanced or recurrent cancer, and cancer cells releasing fluid into the abdomen. Heart failure, kidney problems such as nephrotic syndrome, and severe malnutrition can also cause ascites due to fluid retention or low protein levels in the blood. In women, ascites is often linked to advanced or recurrent ovarian cancer, especially when a pelvic mass is present. Infections such as tuberculosis can mimic ascites caused by ovarian malignancy but may resolve with appropriate treatment. Liver function is often impaired in these conditions, and identifying the underlying cause of ascites is essential for proper treatment.
In women, it may be mistaken for:
-
Bloating
-
Premenstrual swelling
-
Weight gain
-
Pregnancy
-
Ovarian or uterine conditions
Understanding the symptoms helps distinguish ascites from other causes of abdominal swelling.
Early Symptoms of Ascites in Females
In the beginning, symptoms may be subtle.
Early signs include:
-
Mild abdominal bloating
-
A sensation of fullness or tightness
-
Clothing fitting tighter around the waist
-
Slight weight gain
-
Increased gas or indigestion
Other symptoms of ascites can include belly swelling, a sense of fullness, bloating, and nausea. As fluid accumulates, it can cause trouble breathing due to pressure on the diaphragm. Swelling in the ankles or lower legs can also occur due to fluid retention. Women may experience trouble eating as abdominal swelling and pressure increase. Ascites symptoms include bloating, belly pain, shortness of breath, nausea, weight gain, and leg swelling. While symptoms are similar between genders, the underlying causes may differ.
Women may attribute these symptoms to PMS, constipation, or dietary changes, leading to delayed evaluation.
Moderate Symptoms
As fluid accumulates, symptoms become more noticeable.
Common moderate symptoms include:
-
Visible abdominal swelling
-
Feeling full after small meals (early satiety)
-
Nausea or loss of appetite
-
Pressure in the lower abdomen
-
Shortness of breath when bending or lying flat
-
Back pain due to abdominal pressure
Abdominal discomfort is a common symptom as abdominal fluid builds up. As abdominal fluid increases, abdominal discomfort and trouble eating or breathing may become more pronounced, making it difficult to eat, drink, breathe, and move around comfortably.
Some women also experience increased urination due to pressure on the bladder.
Severe Symptoms
When ascites becomes advanced, discomfort increases significantly.
Severe symptoms include:
-
Marked abdominal distension
-
Difficulty breathing or walking
-
Severe pressure or pain
-
Swollen ankles or legs (edema)
-
Umbilical or groin hernias
-
Rapid weight gain from fluid
In severe cases, abdominal swelling from ascites may lead to trouble breathing. A procedure called paracentesis may be needed to remove fluid (ascitic fluid) from the abdomen. During paracentesis, a fluid sample is often taken to check for infection or cancer. In some cases, if liver function is severely impaired, a liver transplant may be necessary.
These symptoms require immediate medical attention.
Symptoms Unique or More Noticeable in Females
Because of female anatomy and hormonal patterns, some symptoms may appear differently.
Ascites in women is often linked to advanced or recurrent ovarian cancer, especially when a pelvic mass is present. Cancer cells can release fluid into the abdomen, leading to ascites, and recurrent cancer is a significant cause of ascites in women.
1. Pelvic Pressure
Fluid buildup can press on reproductive organs, causing:
-
Pelvic heaviness
-
Cramping
-
Pain during menstruation
2. Menstrual Cycle Changes
While ascites doesn’t typically alter hormones, severe illness may cause:
-
Irregular periods
-
Missed periods
-
Increased fatigue during menstruation
3. Confusion with Ovarian Conditions
Ascites can resemble symptoms of:
-
Ovarian cysts
-
Ovarian hyperstimulation
-
Ovarian cancer
This overlap often leads gynecologists to order imaging for clarification.
Causes of Ascites in Females: The Role of Liver Disease
Common causes include:
-
Cirrhosis, severe scarring, and chronic liver disease (including chronic hepatitis, hepatitis B, and hepatitis A)
-
Ovarian cancer or peritoneal cancer
-
Heart failure
-
Kidney disease or nephrotic syndrome, and patients on kidney dialysis (as underlying kidney failure can lead to fluid accumulation)
-
Blood clots in the portal vein or other blood vessels
-
Pancreatitis
-
Severe infections (such as tuberculosis)
Severe malnutrition can also result in ascites due to low protein levels in the blood. Infections such as tuberculosis can mimic ascites caused by ovarian malignancy but may resolve with appropriate treatment.
In women, ovarian cancer is one of the top cancer-related causes of ascites.
When to See a Doctor
Seek medical care if you notice:
-
Persistent or worsening abdominal swelling
-
Sudden rapid weight gain
-
Difficulty breathing
-
Swelling in the legs or ankles
-
Fever, chills, or abdominal pain
-
Early fullness that affects eating
-
Unexplained bloating that lasts more than a week
Urgent care is needed if symptoms suggest infection, such as fever or confusion.
How Ascites Is Diagnosed in Women
Your provider may perform:
-
Physical exam to check for fluid waves
-
Ultrasound of the abdomen
-
CT scan or MRI if needed
-
Blood tests (liver, kidney, and infection markers)
-
Paracentesis (fluid removal and testing)
-
Pelvic ultrasound to evaluate reproductive organs
Lab tests, including blood and urine tests, are used to check liver and kidney function as part of the diagnostic process for ascites. A fluid sample, known as ascitic fluid, may be taken from the abdomen using a needle in a procedure called paracentesis to check for infection, cancer, or other diseases. The serum ascites albumin gradient (SAAG) test compares the level of albumin in the blood and ascitic fluid to help determine the cause of ascites. Doctors may also use a physical exam technique called percussion to assess for fluid in the abdomen.
Because ascites can overlap with gynecologic conditions, women often undergo dual evaluation by primary care and gynecology.
Read our guide on: At-Home Liver Tests: A Comprehensive Guide.
Treatment Options
The goal is to treat ascites, relieve symptoms, and prevent ascites from recurring. Treatment focuses on relieving symptoms and targeting the cause.
Key lifestyle changes to manage and prevent ascites include limiting salt intake and avoiding drinking alcohol. A low-sodium diet is a basic treatment for ascites, as reducing salt intake helps control fluid buildup. Water pills (diuretics) are commonly used to help remove excess fluid from the body and relieve abdominal swelling.
Common approaches include:
1. Low-Sodium Diet
Helps prevent fluid retention.
2. Diuretics
Medications called diuretics, also known as water pills, such as spironolactone and furosemide, help the kidneys excrete excess sodium and water to reduce fluid buildup.
3. Paracentesis
Paracentesis is a procedure used to remove fluid (ascitic fluid) from the abdomen in cases of ascites. During paracentesis, a fluid sample may be taken to check for infection or cancer. This procedure helps to relieve discomfort and swelling caused by fluid buildup.
4. Treating Underlying Disease
Such as:
-
Managing liver disease (referral to a liver specialist may be needed for advanced cases)
-
Treating ovarian or abdominal cancers
-
Treating infections
-
Improving heart or kidney function (in severe cases, kidney dialysis may be required if kidney failure develops)
-
In severe cases of ascites due to critically impaired liver function, a liver transplant may be necessary
5. TIPS Procedure
The TIPS procedure reroutes blood flow in the portal vein and blood vessels to reduce portal hypertension and relieve ascites.
6. Lifestyle Changes
-
Avoid alcohol
-
Manage blood pressure and blood sugar
-
Maintain a healthy weight
Complications to Watch For
Untreated ascites may lead to:
-
Infection (spontaneous bacterial peritonitis)
-
Kidney strain or kidney failure
-
Breathing difficulties
-
Hernias
-
Malnutrition
Ascites can lead to abdominal infections called spontaneous bacterial peritonitis, which may cause abdominal discomfort, fever, and confusion. Ascites can also cause kidney failure due to high blood pressure in the liver damaging blood vessels in the kidneys. Increased abdominal pressure from ascites can lead to umbilical or inguinal hernias. Difficulty eating and drinking due to ascites may result in malnutrition or dehydration. Additionally, fluid buildup in the abdomen can lead to significant hernias, especially in men.
These complications require immediate medical care.
The Bottom Line
Ascites in females can cause abdominal swelling, pelvic pressure, bloating, and difficulty breathing. Women may confuse early symptoms with menstrual or digestive issues, leading to delayed diagnosis.
Because ascites is often a sign of a serious underlying condition, early evaluation is essential. Treatment can significantly improve comfort and quality of life.
If you experience persistent bloating, early fullness, or visible swelling, contact a healthcare provider for testing and guidance.
Concerned about abdominal swelling or liver health?
You can take an at-home liver, kidney, and metabolic panel test through Ribbon Checkup for quick and accurate insights.
Explore liver and metabolic tests →
References
Ascites. (2025, May 13). Retrieved November 21, 2025, from Hopkinsmedicine.org website: https://www.hopkinsmedicine.org/health/conditions-and-diseases/ascites
Ascites (swelling of your belly with fluid). (2025, October 10). Retrieved November 21, 2025, from British Liver Trust website: https://britishlivertrust.org.uk/information-and-support/liver-conditions/cirrhosis/ascites/
Ascites | Fluid buildup. (2023). Retrieved November 21, 2025, from Cancer.org website: https://www.cancer.org/cancer/managing-cancer/side-effects/swelling/ascites.html#:~:text=liver%20and%20abdomen.-,What%20are%20the%20symptoms%20of%20ascites?,pee%20more%20often%20or%20urgently
Chiejina, M., Pujitha Kudaravalli, & Samant, H. (2023, August 8). Ascites. Retrieved November 21, 2025, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK470482/
https://www.facebook.com/WebMD. (2016, December 18). Ascites: Causes, Symptoms, and Treatment Options. Retrieved November 21, 2025, from WebMD website: https://www.webmd.com/digestive-disorders/ascites-medref
Metropolis Healthcare Limited. (2024). Ascites: Causes, Symptoms, and Treatments. Retrieved November 21, 2025, from Metropolis India Lab website: https://www.metropolisindia.com/blog/preventive-healthcare/ascites-causes-symptoms-and-treatments
