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Managing the side effects of treatment for uterine cancer

It will take some time to recover from the physical and emotional changes caused by treatment. Treatment side effects can vary – some women experience many side effects, while others have few. Side effects may last from a few weeks to a few months or, in some cases, years or permanently. This section includes ways to reduce or manage the discomfort that side effects may cause.

Once cancer treatment finishes, many women worry about the cancer coming back. For more information about recurrence or call Cancer Council 13 11 20 to talk through your concerns.

The ovaries produce the hormones oestrogen and progesterone. If both ovaries have been removed or if you’ve had radiation therapy to the pelvic area, you will no longer produce these hormones and you will stop having periods. This is called menopause. For most women, menopause is a natural and gradual process that starts between the ages of 45 and 55. If you have not already entered menopause, these treatments will cause sudden menopause. If you have already been through menopause, the symptoms of menopause may come back.

Menopausal symptoms include hot flushes, night sweats, dry or itchy skin, mood swings, trouble sleeping (insomnia), tiredness, vaginal dryness, weight gain, and bladder problems.

The symptoms of menopause caused by cancer treatment are usually more severe than during a natural menopause because the body hasn’t had time to get used to the gradual decrease in hormone levels.

A loss of oestrogen at menopause may cause bones to weaken and break more easily. This is known as osteoporosis. Radiation therapy to the pelvis can also weaken the bones.

Cholesterol levels can change after menopause. This can increase your risk of heart disease, so these levels will need to be monitored.

Tips for managing menopausal symptoms

  • Try vaginal moisturisers from pharmacies to help with vaginal discomfort and dryness.
  • Ask your doctor if you need to avoid products containing oestrogen. They can suggest non-hormonal medicines for menopausal symptoms.
  • If your menopausal symptoms are severe, talk to your gynaecological oncologist about the risks and benefits of taking hormone replacement therapy (HRT) to reduce the symptoms. HRT is not usually used in women with uterine cancer because oestrogen may cause the cancer to grow. If you were already on HRT when the cancer was diagnosed, you may need to consider stopping its use.
  • Talk to your doctor about having a bone density test or taking medicine to prevent your bones from becoming weak. Regular exercise will also help keep your bones strong. For more information, see Osteoporosis Australia or call 1800 242 141.
  • Try to improve cholesterol levels with regular exercise and a balanced diet. You can also discuss cholesterol-lowering medicines with your doctor.
  • Learn meditation and relaxation techniques, which may reduce stress and lessen some of the symptoms of menopause.
  • Ask for a referral to a specialist menopause clinic if needed.

Although most women are older and postmenopausal when they are diagnosed with uterine cancer, it does occasionally affect younger women who have not yet been through menopause. If premenopausal women have surgery or radiation therapy for uterine cancer, they will be unable to have children.

If you may want to have children in future, it is important to talk to your doctor before your treatment starts. It may be possible to preserve the ovaries and sometimes the uterus so you can still have children. However, this is not standard treatment and is an option only in certain cases. If it is an option for you, your doctor will explain the risks and benefits.

Learning that your reproductive organs will be removed or will no longer function and that you won’t be able to have children can be devastating. Even if your family is complete or you did not want children, you may still experience a sense of loss and grief. These reactions are not unusual.

Speaking to a counsellor or an oncology nurse about your feelings and individual situation can be helpful. You can also call Cancer Council 13 11 20 to talk to a health professional about your concerns.

Download our booklet ‘Fertility and Cancer’

It is common to feel very tired and lack energy during and after treatment. This can be a side effect of the treatment itself or a symptom of menopause. Travelling to hospitals and clinics for treatment and appointments can be exhausting. Dealing with your emotions can also cause fatigue. Your tiredness may continue for a while after treatment has finished.

Fatigue may affect your ability to keep working or care for your home and family. It may help to talk with your family and friends about how you feel, and discuss ways they can help you.

Tips for managing fatigue

  • Plan your day. Set small, manageable goals so you can rest regularly, and allow yourself plenty of time to get to appointments.
  • Ask for and accept offers of help from family and friends, e.g. with shopping, housework and driving.
  • Learn to recognise signs of tiredness before you feel exhausted.
  • Talk to your employer about taking time off, reducing your hours or working from home.
  • Do some regular exercise − even a walk around the block can boost energy levels. Evidence shows that exercise reduces cancer-related fatigue, so talk to your specialist or GP about what activities are right for you. You can ask for a referral to an exercise physiologist or physiotherapist.
  • Eat nutritious foods to keep your energy levels up, and limit your alcohol intake.

Listen to our ‘Managing Cancer Fatigue’ podcast

 

Radiation therapy to the pelvic area can cause vaginal tissue to lose its elasticity and shrink, narrowing the vagina (vaginal stenosis). If your ovaries were removed, your vagina may also become very dry. These side effects may make vaginal examination by a doctor uncomfortable or difficult, and may make it painful to have sex.

Your treatment team may recommend using a vaginal moisturiser or lubricant (available over-the-counter from pharmacies) or a hormone cream (available on prescription and safe with many uterine cancers). They may also advise you to start using vaginal dilators (or have regular sexual intercourse) some weeks after radiation therapy ends.

Tips for using vaginal dilators

  • Vaginal dilators are tube-shaped devices made from plastic or silicone. They come in different sizes and may help keep the vaginal walls open.
  • Ask your treatment team if they will provide the dilators or where you can buy them. Your team will explain when and how to start using the dilators.
  • Make sure any soreness or inflammation has settled down before you start using dilators. This will usually be 2−6 weeks after your last session of radiation therapy.
  • Start with the smallest dilator and move up sizes as each becomes more comfortable.
  • Find a private place. Using a water-based lubricant, slowly insert a dilator into the vagina. Leave it for 5–10 minutes. Do this once or twice a day for the first few months, and then 2−3 times per week for several months after that, as advised by your team.

After treatment for cancer of the uterus, some women experience bladder problems. Most bladder side effects are temporary or can be managed.

Urinary incontinence –  Some women find they need to pass urine more often, or feel that they need to go in a hurry. Others may leak urine when they cough, sneeze, strain or lift. For information about how to manage accidental or involuntary loss of urine (urinary incontinence), talk to the hospital continence nurse or a women’s health physiotherapist. They will explain how to do exercises to strengthen your pelvic floor muscles. You could also visit the Australian Government’s bladder and bowel website or contact the Continence Foundation of Australia or on 1800 33 00 66.

Radiation cystitis – Radiation therapy can irritate the lining of the bladder, causing a burning sensation when you urinate and the need to pass urine more often than usual. This is known as radiation cystitis. Try to drink plenty of water to make your urine less concentrated. Urinary alkalisers (e.g. Ural) are available overthe-counter from pharmacies and can help by making the urine less acidic. Your doctor may also prescribe medicine to treat cystitis.

Blood in urine − The blood vessels in the bladder can become more fragile after radiation therapy. This can cause blood to appear in your urine, even months or years after treatment. Always let your doctor know if you notice new or unusual bleeding.

Surgery, radiation therapy and medicines can cause changes to the way the bowels work. These changes are usually temporary, but for some women, they are permanent and can have a significant impact on quality of life. It is important to talk to your treatment team if you are finding bowel issues difficult to manage.

Constipation − Constipation is when you have difficulty passing a bowel motion regularly or often. It is important to avoid constipation, especially in the days after surgery, because it may lead to more discomfort or cause you to strain when you’re sitting on the toilet. Talk to your dietitian or doctor about making changes to your diet or taking medicines if you are experiencing constipation.

Diarrhoea − Diarrhoea is the frequent passing of loose, watery stools (faeces) from the bowels. A dietitian can suggest changes to your diet to reduce the number of bowel motions.

Radiation proctitis − Radiation therapy can damage the lining of the rectum, causing inflammation and swelling known as radiation proctitis. This can cause a range of symptoms including blood in bowel motions; frequent passing of loose, watery stools (diarrhoea); the need to empty the bowels urgently; and loss of control over the bowels (faecal incontinence).

Talk to your treatment team about your risk of developing radiation proctitis. If you have any ongoing bowel problems, they may refer you to a gastroenterologist.

Tips to manage constipation

  • Drink more water – aim for at least 8 glasses during the day.
  • Eat regular meals throughout the day.
  • Try to eat more fibre-rich foods, e.g. wholegrain breads and cereals, legumes such as beans and lentils, vegetables, fruits, nuts and seeds.
  • Reduce your alcohol intake.
  • Do some gentle exercise, such as walking.
  • Cut down on sweets, soft drinks, takeaway food, fried foods, potato chips and other savoury snacks. Limit foods containing added sugars and salts.
  • Take medicines for constipation as directed by your doctor.

Tips to manage diarrhoea

  • Drink plenty of fluids such as water, herbal teas, sports drinks and electrolytereplacing fluids. Avoid alcohol.
  • Eat fewer high-fibre foods such as wholegrain breads and cereals, raw fruits and vegetables, and legumes.
  • Cut down on coffee, cola and other caffeinated drinks.
  • Choose low lactose or soybased dairy products; small amounts of cheese and yoghurt are usually okay.
  • Ask your doctor about suitable medicines for diarrhoea. Take as directed.

Lymphoedema is a swelling of part of the body, usually a leg in the case of uterine cancer. If lymph nodes have been damaged by radiation therapy or removed during surgery, it may prevent lymph fluid from draining properly. This causes fluid build-up and swelling. In some cases, the swelling can take months or years to develop, and some women who are at risk never develop lymphoedema. Although lymphoedema may be permanent, it can usually be managed.

The skin of the legs is more susceptible to infection after removal of the lymph glands. This inflammation is called cellulitis. Signs of cellulitis include redness, painful swelling in the legs, warm skin and fever. If you have any of these symptoms, see your GP as soon as possible.

How to prevent and manage lymphoedema

  • Ask for a referral to a lymphoedema practitioner, who can suggest ways to help lymph fluid circulate, such as self-massage, exercises, and compression bandages or stockings. To find a practitioner, visit lymphoedema.org.au.
  • Move lymph fluid out of the affected area by doing leg exercises and gently massaging the swollen leg towards your heart. Elevate your legs when resting.
  • Keep the skin healthy and unbroken to reduce the risk of cellulitis. Use moisturiser and sunscreen, and avoid scratches, cuts, burns, insect bites, and injections in your legs. Keep your feet clean and dry to avoid fungal infections.
  • Talk to your GP about ways to stay or become a healthy weight for your height.

Download our fact sheet ‘Understanding Lymphoedema’

Cancer of the uterus can change your body and how you feel about yourself, and both can affect sexuality. Some treatments for cancer of the uterus can cause dryness and narrowing of the vagina. If this makes sexual penetration difficult or painful, you may have to explore different ways to orgasm or climax. Your treatment team may also advise using vaginal dilators, lubricants, moisturisers or hormone creams. Other physical and emotional factors may affect your desire for sex (libido). These include the hormonal changes of menopause, the stress of the cancer experience, the fatigue caused by treatment, and changes in how you feel about your body (body image).

It may help to remember that for most people, sex is more than arousal, intercourse and orgasm. It involves feelings of intimacy and acceptance, as well as being able to give and receive love. Give yourself time to get used to any physical or emotional changes. If you have a partner and do not feel like having sexual intercourse, or if you find it uncomfortable, talk openly with them about how you’re both feeling, and take things slowly by starting with hugs or a massage rather than penetrative sex. You may both need to be patient – things often improve with time and practice.

If you have ongoing concerns about how treatment has affected your sexuality, you can talk to your GP or gynaecological oncologist or ask for a referral to a sexual therapist.

Download our booklet ‘Sexuality, Intimacy and Cancer’

This information is reviewed by

This information was last reviewed March 2019 by the following expert content reviewers: A/Prof Alison Brand, Director, Gynaecological Oncology, Westmead Hospital, NSW; Kate Barber, 13 11 20 Consultant, Cancer Council Victoria; Prof Jonathan Carter, Director, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; Dr Robyn Cheuk, Senior Radiation Oncologist, Royal Brisbane and Women’s Hospital, QLD; Dr Alison Davis, Medical Oncologist, Canberra Region Cancer Centre, The Canberra Hospital, ACT; Kim Hobbs, Clinical Specialist Social Worker, Westmead Hospital, NSW; Nicole Kinnane, Nurse Coordinator, Gynaecology Oncology, Peter MacCallum Cancer Centre, VIC; Jennifer Loveridge, Consumer; Pauline Tanner, Gynaecology Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, North Metropolitan Health Service, WA.