“I’m just bloated all the time — must be my age or IBS”

Persistent (not fluctuating) bloating/distension, early satiety, pelvic/abdominal pain and urinary urgency/frequency — especially frequent and in a woman ≥50 — is the classic symptom cluster of OVARIAN CANCER, which notoriously hides as "IBS" or "getting older". A key NICE NG12 caution: NEW IBS-type symptoms presenting for the first time over age 50 should be investigated (ovarian AND bowel cancer), not labelled IBS. The pathway is to examine for a mass/ascites, measure serum CA-125, arrange an urgent direct-access abdominal/pelvic ultrasound if CA-125 is at or above the age-specific threshold (31 IU/mL at 50–59 since April 2026; the old single 35 IU/mL cut-off is superseded), and refer on a suspected cancer pathway straight away if examination finds ascites and/or a pelvic or abdominal mass (not obviously fibroids) or the ultrasound suggests ovarian cancer — after a video call the examination needs a face-to-face appointment — the very presentation NG12 exists to catch, so prescribing peppermint for it is the dangerous error. The examinable hidden agenda is minimisation ("it’s silly, just my age") masking a real, unspoken fear (an aunt’s "ovarian trouble"); surface and validate it, affirm she was right to come rather than "making a fuss", balance honesty with reassurance (most such symptoms aren’t cancer; we test to be thorough), and ensure the work-up happens.