They do not have to. Ovaries might be naturally large, or they might be enlarged because of like ovarian cysts, or conditions like polycystic ovaries. This would have problems like chronic anovulation, normal to increased testosterone, and lh/fsh ratio. But cancer should be ruled out, especially in older patients with pain, bloating, and weight gain. A ca=125, pelvic exam, and transvaginal us are initial tests.