By Ashley Mateo

The stirrups... the speculum... the jelly that your gyno never seems to get totally cleaned up. Yeah, Paps are a (somewhat literal) pain, but cervical cancer was once the number-one leading cause of cancer death in America, according to the Centers for Disease Control and Prevention. Now, thanks to Paps, which can ID issues before they become cancerous, it doesn't even crack the top 10.

Still, the American Cancer Society estimates that 13,240 new cases of invasive cervical cancer will be diagnosed in 2018—31 percent of which will be fatal. And the CDC reports that six out of every 10 cervical cancers occur in women who have never received a Pap test or have not been tested in the past five years. (FYI, all women between the ages of 21 and 65 years old should be getting a Pap smear every three years from 21 to 30, and every five years from 30 to 65, according to the CDC.)

“In fact, one of the biggest risk factors of getting cervical cancer is not having had a Pap smear within the past five years," says Eloise Chapman-Davis, M.D., a gynecological oncologist at Weill Cornell Medicine and New York-Presbyterian.

However, she notes that you shouldn’t just rely on a Pap to flag any issues. It's also important to watch out for cervical cancer symptoms, which can develop in cases of more developed cancer growths. Translation: If you spot any symptoms of cervical cancer, it's worth talking to your gyno and getting checked out asap.

1. Totally Not-Normal Vaginal Bleeding

“One of the most common symptoms of cervical cancer is vaginal bleeding, whether it’s in between your periods, after sex, or after menopause,” says Taraneh Shirazian, M.D., a gynecologist at NYU Langone Health. Abnormal vaginal bleeding is generally a symptom of advanced cervical cancer, because it means that a tumor on the cervix is spreading to affect nearby tissue, Chapman-Davis adds. Call your gyno asap.

2. Periods That Are Heavy AF

This isn’t about your period lasting a day longer or suddenly seeming a bit darker. “Rather, it’s your period all of sudden lasting two weeks instead of four days, or having two periods in one month,” says Shirazian. But to play it safe, it you have any changes in your cycle that last for at least two cycles (heavier, lighter, whatever!), it's worth talking to your gynecologist, she says.

3. WTF-Worthy Vaginal Discharge

Discharge is totally normal, but the type of discharge you experience could be an indicator of a number of different vaginal health issues. “With cervical cancer, you might notice a discharge that’s foul-smelling and pink, brown, or bloody, potentially with chunks of tissue, or what we call necrotic material,” says Shirazian. And because “masses and tumors secrete fluid, that could contribute to a continuous, watery discharge that seems to occur for no reason,” says Chapman-Davis. Go ahead and give your gyno a call.

4. Pelvic, Back, or Leg Pain

Pelvic pain could be an indicator of changes to the cervix, but advanced cervical cancer can even spread to the bladder, intestines, or even the lungs and liver, says Chapman-Davis. “Then you might have things like back pain or leg pain,” she says. “But that’s typically associated with very advanced cases because the cervix isn’t really affecting a lot of nerves.” Talk to your primary care doc to rule out cervical cancer as well as other potential nerve causes.

5. Major Fatigue

Because most cervical cancer symptoms don’t come along until it enters more advanced stages, it does share some symptoms with all cancers. "Fatigue is definitely one of those symptoms," says Shirazian. One reason why: Abnormal vaginal bleeding, one of the major symptoms of cervical cancer, can actually lower the amount of red blood cells and oxygen in the body, causing you to feel utterly exhausted all the time, usually with no other explanation. If you are dealing with chronic fatigue, your doctor will likely check your iron and red blood cell levels. check out these five signs

6. Feeling Like You're Going To Barf—All The Time

A persistent feeling of nausea or indigestion can be a sign of cancer, and that includes cervical cancer, says Shirazian. That's because, when advanced, cervical cancer can cause the cervix to swell into the abdominal cavity, compressing the gastrointestinal tract and stomach to cause or even acid reflux, she says. Since nausea can be a sign of cervical cancer as well as other issues, talk to your primary care physician before opting for gyno input.

7. Out-Of-Nowhere Weight Loss

The same factors that can cause cervical cancer-related nausea can cause unintended weight loss, says Shirazian. (Think: a compressed stomach that can't hold very much food.) Plus, if you're constantly feeling nauseated, you probably aren't going to even want to try to eat. If you lose up to 5 or 10 percent of your bodyweight over the course of six months without trying, go ahead and call your primary care doc.