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Managing the symptoms and side effects of treatment for cervical cancer
It will take some time to recover from treatment for cervical cancer. You may find the cancer affects you physically and emotionally. Some women experience many side effects, while others don’t experience any. Side effects may last from several weeks to a few months or, less commonly, many years or permanently. Fortunately, there are ways to reduce or manage the discomfort that side effects cause.
Bladder control may change after surgery or radiation therapy. Some women find they need to pass urine more often or in a hurry. Others may experience involuntary loss of urine when they cough, sneeze, laugh, strain or lift. This is called urinary incontinence.
Strengthening the muscles needed for urinary control can help manage urinary incontinence. Using continence pads can help you manage any leakage and prevent any loss of dignity. A continence nurse or physiotherapist can develop a bladder training program – ask your doctor for a referral, or contact the National Continence Helpline on 1800 33 00 66.
The blood vessels in the bladder can become more fragile after radiation therapy. This can cause blood to appear in urine or stools, even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment.
After surgery or radiation therapy, some women notice changes in their bowel habits. You may experience constipation or diarrhoea, or feel pain in your abdomen from trapped wind.
If radiation therapy has damaged the lining of the rectum, it can cause 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). The risk of developing radiation proctitis is low, but you may develop some of these symptoms for other reasons. Talk to your treatment team if you develop any of these symptoms. If you have ongoing bowel problems, they may refer you to a gastroenterologist.
The blood vessels in the bowel can become more fragile after radiation therapy. This can cause blood to appear in urine or stools, even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment.
Tips for managing bowel changes
- Drink peppermint or chamomile tea to reduce abdominal or wind pain.
- Drink plenty of liquids (except alcohol and caffeinated drinks) to replace fluids lost through diarrhoea or to help soften stools if you are constipated.
- See a women’s health physiotherapist for information about exercises to strengthen your pelvic floor and anal sphincter. These exercises can help you control your bowels.
- Limit spicy and greasy foods, as these can make diarrhoea and constipation worse.
- Talk to your doctor or a dietitian about dietary changes, or to ask about suitable medicines. They may suggest you take a soluble fibre supplement to help avoid constipation, diarrhoea and loss of bowel control.
Many women who are treated for cervical cancer find that tiredness is a major issue, particularly if they have both radiation therapy and chemotherapy. The tiredness may continue for several months, or even a year or two, after treatment has finished.
Feeling tired is not only a side effect of the treatment itself. Travelling to hospitals and clinics for treatment can be exhausting. If you work during your treatment or if you have a family to care for, this can make you feel especially tired.
It may be frustrating if other people don’t understand how you’re feeling.
Tips for managing fatigue
- Plan to do things at the time of day when you feel less tired. Keep a journal to track your “good times”.
- Talk with your family and friends about how you’re feeling and discuss things they can help you with, e.g. housework and shopping.
- 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.
- Limit daytime naps to 30 minutes so they don’t make it hard to sleep at night.
- 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.
After surgery or radiation therapy to the pelvic area, some women may find that one or both legs become swollen. This is known as lymphoedema. Lymphoedema may appear during treatment or months or years later.
It is important to avoid pressure, injury or infection to the lower limbs, and to manage lymphoedema symptoms as soon as possible. Mild lymphoedema is usually managed with exercise, skin care and a compression stocking or sleeve. A physiotherapist trained in lymphoedema management will be able to give you further advice.
To find a practitioner who specialises in the management of lymphoedema, visit the Australasian Lymphology Association’s website and click on “Find a Practitioner”.
If your ovaries have been damaged by radiation therapy or chemotherapy, or they’ve been surgically removed, your body will no longer produce the hormones oestrogen and progesterone. When these hormones are no longer made, women 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.
Symptoms of menopause can include hot flushes, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. You may also have a decreased interest in sex (low libido).
Menopause may cause other changes in the body. For example, over time, your bones may become weak and brittle, and break more easily. This is called osteoporosis. Your cholesterol levels may rise, which can increase your risk of heart disease.
The symptoms of sudden menopause are usually more severe than a natural menopause, because the body hasn’t had time to get used to a gradual decrease in the levels of oestrogen and progesterone. Oestrogen-alone hormone replacement therapy (HRT) has been shown to be an effective treatment for menopausal symptoms and to help prevent osteoporosis. For more information about dealing with the symptoms of menopause and whether HRT is right for you, talk to your doctor or ask for a referral to a specialist menopause clinic.
Tips for managing symptoms of menopause
- Talk to your doctor about having a bone density test or taking medicines to prevent osteoporosis.
- Regular exercise will help keep your bones strong. Visit Osteoporosis Australia for more information or call them on 1800 242 141.
- Ask your doctor to check your cholesterol levels. If they are high, regular exercise and a balanced diet may help them improve. If not, talk to your doctor about cholesterol-lowering drugs.
- Your doctor can suggest dietary changes and suitable exercises.
- If you smoke, talk to your doctor about quitting or call the Quitline on 13 7848.
- Try meditation and relaxation techniques to help reduce stress and lessen symptoms.
Surgery or radiation therapy for cervical cancer may mean you are unable to conceive children. Before treatment starts, ask your doctor or a fertility specialist about what options are available to you.
Many women experience a sense of loss when they learn that their reproductive organs will be removed or will no longer function. You may feel extremely upset if you are no longer able to have children, and may worry about the impact of this on your relationship or future relationships. Even if your family is complete or you were not planning to have children, you may feel some distress. If you have a partner, talk to them about your feelings. Speaking to a counsellor or gynaecological oncology nurse may also help.
Ways to preserve fertility
- If you have not already been through menopause, ask about ways to preserve your fertility. One option may be to store eggs or embryos for use in the future.
- Having a trachelectomy, where only the cervix is removed, is an option for some women. It will still be possible to become pregnant after this procedure, but you will be at higher risk of having a miscarriage and having the baby prematurely. Your doctor can discuss these risks with you.
- If you require radiation therapy but your ovaries do not need to be treated, one or both of the ovaries may be surgically moved higher in the abdomen and out of the field of radiation. This is called ovarian transposition or relocation (oophoropexy), and it may help the ovaries keep working properly.
Having cervical cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on many factors, such as your treatment and its side effects, whether you have a partner, and your overall self-confidence.
Low libido – A lack of interest in sex or loss of desire is common because of the experience of having cancer and the side effects of treatment. If you do not feel like having sexual intercourse, or if you find it uncomfortable, let your partner know. It normally takes some time for sex to be comfortable again. You can also explore other ways to be intimate, such as massage and cuddling.
Vaginal changes – The main side effect of treatment for cervical cancer will be to the vagina. If the ovaries have been affected by surgery or radiation therapy, they will no longer produce oestrogen. This will cause your vagina to become very dry and it may not expand easily during sexual intercourse.
Radiation therapy to the pelvic area can also cause vaginal tissue to lose its elasticity and shrink, narrowing the vagina (vaginal stenosis). These side effects can make sexual penetration difficult or painful, and you may have to explore different ways to orgasm or climax. If you need more support resuming sexual activity, ask your doctor for a referral to a sexual therapist or psychologist.
Coping with impact on sexuality – Sexual changes
- Give yourself time to get used to any physical changes.
- Talk to your doctor about ways to manage side effects that change your sex life. This may include using hormone creams and vaginal moisturisers to help with vaginal discomfort and dryness.
- Hormone creams are available on prescription, while vaginal moisturisers are available over the counter from pharmacies.
- Discuss changes to your libido with your partner so they understand how you’re feeling and don’t feel rejected.
- Consider touching, hugging and kissing. This is a chance to feel close to your partner without expectations of sexual penetration.
- Explore other ways to climax, such as caressing the breasts, inner thighs, feet or buttocks.
- Use water- or silicone-based vaginal lubricants without perfumes, oils or glycerines.
Coping with impact on sexuality – Changes to the vagina
- Your doctor may suggest you use a vaginal dilator to help keep the walls of the vagina open and supple.
- Dilators are tube-shaped devices made from plastic or silicone that are designed to gently stretch the vagina. They come in different sizes – it is
important to seek advice from a health professional about the correct size for you.
- Make sure any soreness or inflammation has settled before you start using a dilator. This is usually 2–6 weeks after your last session of radiation therapy.
- Used with lubricant, the dilator is inserted into the vagina for short periods of time.
- Using a dilator can be challenging. Your doctor or a physiotherapist can provide practical advice on their use.
- Having regular gentle sexual intercourse can also help widen the vagina. Use a lubricant to prevent discomfort caused by vaginal dryness.
This information is reviewed by
This information was last reviewed in September 2019 by the following expert content reviewers: A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecological Oncologists, TAS; Karina Campbell, Consumer; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; A/Prof Jim Nicklin, Director, Gynaecological Oncology, Royal Brisbane and Women’s Hospital, and Associate Professor Gynaecologic Oncology, The University of Queensland; Prof Martin K Oehler, Director, Gynaecological Oncology, Royal Adelaide Hospital, SA; Dr Megan Smith, Program Manager – Cervix, Cancer Council NSW; Pauline Tanner, Cancer Nurse Coordinator – Gynaecology, WA Cancer & Palliative Care Network, WA; Tamara Wraith, Senior Clinician, Physiotherapy Department, The Royal Women’s Hospital, VIC.