Managing the side effects of treatment for uterine cancer

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, aching joints, vaginal dryness, weight gain and bladder problems. You may also have a decreased interest in sex (low libido).

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.

Menopause may cause other changes in the body. For example, your cholesterol levels may rise, which can increase your risk of heart disease. Over time, your bones may become weak and brittle, and break more easily. This is called osteoporosis. Radiation therapy to the pelvis can also weaken the bones.

Managing menopausal symptoms

• Vaginal moisturisers available over the counter at pharmacies can help with vaginal discomfort and dryness.
• Ask your doctor if you need to avoid products containing oestrogen. They can suggest non‑hormonal medicines to relieve the symptoms of menopause.
• If your menopausal symptoms are severe, talk to your doctor about the risks and benefits of taking menopause hormone therapy (MHT), previously called hormone replacement therapy (HRT). MHT is not usually used for uterine cancer because oestrogen may cause the cancer to grow. If you were already on MHT 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, visit Osteoporosis Australia or call 1800 242 141.
• Have your cholesterol levels checked. If they are high, regular exercise and a balanced diet may help. If not, talk to your doctor about cholesterol-lowering drugs.
• Learn meditation and relaxation techniques, which may reduce stress and lessen some of the symptoms of menopause.
• Ask your doctor for a referral to a specialist menopause clinic if needed.
• Cognitive behaviour therapy (CBT) has been shown to help with many of the effects of menopause, including anxiety. Exercise can also help with mood changes and energy levels.
• You can also call Cancer Council 13 11 20 to talk to a health professional about your concerns.

Surgery or radiation therapy for uterine cancer may mean you are unable to become pregnant. Before treatment starts, ask your doctor or a fertility specialist about what options are available to you.

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 a cancer 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.
•  Do some light exercise, such as walking or stretching, to help increase your energy levels. Ask your doctor if these activities are suitable for you. You can also ask for a referral to an exercise physiologist or physiotherapist.
• Ask for and accept offers of help from family and friends, e.g. with shopping, housework and driving. Contact your local council to see what services they offer.
• Learn to recognise signs of tiredness before you feel exhausted.
• Talk to your employer about taking time off, reducing hours or working from home.
• Don’t expect to be able to instantly do everything you used to do. Your body is still recovering and it will take time for your energy levels to return.

Download our fact sheet ‘Fatigue and Cancer’

Treatment for cancer of the uterus can cause bladder problems. Most bladder side effects are temporary or can be managed. Talk to your treatment team for more information.

Urinary incontinence – This is when urine (wee) leaks from your bladder without your control. Some people find they need to pass urine more often or feel that they need to go in a hurry. Others may leak a few drops of urine when they cough, sneeze, strain or lift. The pelvic floor muscles control the flow of urine, so strengthening them can help manage urinary incontinence. You can find a guide to exercising the pelvic floor muscles in our Exercise for People Living with Cancer booklet. Using continence pads can help you manage any leakage and prevent any embarrassing accidents. A  continence nurse or women’s health physiotherapist can develop a bladder training program – ask your doctor for a referral or contact the National Continence Helpline on 1800 33 00 66 or at continence.org.au.

Radiation cystitis – Radiation therapy can irritate the lining of the bladder. You may feel like you want to pass urine often or have a burning sensation when you pass urine. This is known as radiation cystitis. Try to drink plenty of water to make your urine less concentrated. Urinary alkalisers are available over the 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. Keep in mind that it may not be related to your treatment.

Surgery, radiation therapy and medicines can cause changes to the way the bowels work. These changes are usually temporary, but for some people, 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 having a bowel movement 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 faeces (poo) from the bowels. A dietitian can suggest changes to your diet to reduce the number of bowel movements.

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 movements; frequent passing of loose, watery faeces (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.

Blood in bowel movements – Blood vessels in the bowel can become more fragile after radiation therapy. This can cause blood to appear in your faeces, even months or years after treatment. Always seek advice from your specialist or GP if you notice any new or unusual bleeding.

Managing bowel changes

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.
• Avoid drinking alcohol.
• Do some gentle exercise, such as walking. Check with your doctor about the amount and type of exercise that is right for you.
• 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.

Diarrhoea

• Drink plenty of fluids such as water, herbal teas, sports drinks and electrolyte-replacing fluids. Avoid alcoholic drinks.
• Eat fewer high-fibre foods, e.g. wholegrain breads and cereals, raw fruits and vegetables, legumes.
• Eat more low-fibre foods, e.g. white rice, white pasta, white bread, potatoes.
• Limit spicy, fatty and greasy foods, as these can make diarrhoea worse.
• Cut down on coffee, cola and other drinks that contain caffeine.
• Choose low-lactose or soy-based dairy products (small amounts of cheese and yoghurt are usually okay).
• Ask your doctor about suitable medicines for diarrhoea. Take as directed.

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 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 sexual intercourse regularly) some weeks after radiation therapy ends.

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, then 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.

Cancer of the uterus can affect your sexuality in both physical and emotional ways.

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 (climax). Your treatment team may also advise using vaginal dilators, lubricants, moisturisers or hormone creams.

You may lose interest in intimacy and sex (low libido) because of 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. Closeness and sharing can still be part of your relationship.

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.

Give yourself time to get used to any changes. If you have ongoing concerns about how treatment has affected your sexuality, talk to your GP or gynaecological oncologist or ask for a referral to a sexual therapist.

Download our booklet ‘Sexuality, Intimacy and Cancer’

After surgery or radiation therapy to the pelvic area, you may find that one or both legs become swollen. This is known as lymphoedema. It can happen if lymph fluid doesn’t circulate properly and builds up in the legs. The swelling may appear during treatment or months or years later.

Lymphoedema can make movement and some types of activities difficult. It is important to maintain a healthy body weight, avoid pressure, injury or infection to the legs, and manage lymphoedema symptoms as soon as possible.

Mild lymphoedema is usually managed with exercise, skin care and a compression stocking. To find a health professional who specialises in the management of lymphoedema, speak to your treatment team or visit the Australasian Lymphology Association at lymphoedema.org.au.

The skin of the legs may become infected more easily after lymph glands are removed. A common skin infection is called cellulitis. Signs of cellulitis include redness, painful swelling in the legs, warm skin and fever. If you have any symptoms, see your GP as soon as possible.

Keep the skin healthy and unbroken to reduce the risk of infection. Exercise regularly and avoid tight-fitting clothing. Use moisturiser and sunscreen, and avoid scratches, cuts, burns, insect bites, and injections in your legs. Also keep your feet clean and dry to avoid fungal infections.

Download our fact sheet ‘Understanding Lymphoedema’