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Managing side effects of treatment for ovarian cancer
Treatment can cause physical and emotional changes. Some people experience many side effects, while others have few. Most side effects are temporary, but some may be permanent. It is important to tell your treatment team about any new or ongoing side effects you have, as they will often be able to help you manage them.
It is common to feel very tired and lack energy during or after treatment. Fatigue for people with cancer is different from tiredness as it doesn’t always go away with rest or sleep. Most people who have chemotherapy start treatment before they have had time to fully recover from their operation. Fatigue may continue for a while after chemotherapy has finished, but it is likely to gradually improve over time. In some cases, it may take a year or two to feel well again.
Tips for managing fatigue
- Plan your day. Set small, manageable goals and rest before you get too tired.
- Ask for and accept offers of help with tasks such as cleaning and shopping.
- Eat nutritious food to keep your energy levels up.
- Regular light exercise has been shown to reduce fatigue. Even a walk around the block can help.
- Talk to your doctor about what type of exercise would be suitable for you or ask for a referral to a physiotherapist or exercise physiologist.
In most cases, surgery or radiation therapy for ovarian cancer will mean you are unable to conceive children. Before cancer treatment starts, ask your doctor or fertility specialist to explain the options available to you. If you have stage 1 ovarian cancer and have not yet reached menopause, you may be able to have surgery that leaves the uterus and one ovary in place (unilateral salpingo-oophorectomy). You will need to avoid pregnancy while on chemotherapy.
Many women experience a sense of loss when told that their reproductive organs will be removed or will no longer function. You may feel extremely upset if you cannot 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 a sense of loss and grief.
If you have a partner, you may find it helpful to talk to them about your feelings. Speaking to a counsellor or gynaecological oncology nurse may also help.
If you were still having periods (menstruating) before surgery, having your ovaries removed will mean you no longer produce the hormones oestrogen and progesterone, and you will stop menstruating. This is called menopause. When menopause occurs naturally, it is a gradual process that starts between the ages of 45 and 55, but menopause after surgery is sudden.
Symptoms of menopause can include hot flushes, dry or itchy skin, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. These symptoms are usually more intense after surgery than during a natural menopause, because the body hasn’t had time to get used to the gradual decrease in hormone levels.
Tips for managing the symptoms of menopause
- Vaginal moisturisers available over the counter from chemists can help with vaginal discomfort and dryness.
- Talk to your doctor about the benefits and risks of menopause hormone therapy (MHT), previously called hormone replacement therapy (HRT). If taken after natural menopause, MHT containing oestrogen may increase the risk of some diseases. If you were on MHT when cancer was diagnosed, you’ll need to consider whether to continue.
- Menopause can increase your risk of developing thinning of the bones (osteoporosis). Talk to your doctor about having a bone density test or taking medicines to prevent your bones becoming weak. Regular exercise will help keep your bones strong. For more information, visit Osteoporosis Australia or call them on 1800 242 141.
- Cholesterol levels can change after menopause, and this can increase your risk of heart disease. Regular exercise and a balanced diet may help improve cholesterol levels. If not, talk to your doctor about cholesterol-lowering drugs.
- Meditation and relaxation techniques may help reduce stress and lessen symptoms.
- Talk to your doctor or call Cancer Council 13 11 20 for more ways to relieve the symptoms of menopause.
Ovarian cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on many factors, such as treatment and side effects, your self-confidence, and whether you have a partner.
It is important to feel that your sexuality is respected when discussing how cancer treatment will affect you. Whatever your sexual orientation, your medical team should be able to openly discuss your needs and support you through treatment. Try to find a doctor who helps you feel at ease talking about sexual issues and relationships.
Treatment can cause physical side effects such as vaginal dryness, scarring and internal scar tissue (pelvic adhesions). These side effects can make sexual penetration painful, and you may have to explore different ways to climax (orgasm). The experience of having cancer can also reduce your desire for sex (libido).
For most people, sex is more than arousal, intercourse and orgasms. It involves feelings of intimacy and acceptance, as well as being able to give and receive love. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.
Changes to your body can affect the way you feel about yourself (your self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. Give yourself time to adapt to any changes. Try to see yourself as a whole person (body, mind and personality) instead of focusing on the parts that have changed.
Tips for managing sexual changes
- Give yourself time to get used to any physical changes after cancer treatment.
- Show affection by touching, hugging, massaging, talking and holding hands.
- Let your partner know if you don’t feel like having sex, or if you find penetration uncomfortable.
- Talk to your doctor about ways to manage side effects that change your sex life. These may include using vaginal dilators, lubricants and moisturisers.
- If you find that vaginal dryness is a problem, take more time before and during sex to help the vagina relax and become more lubricated.
- Extra lubrication may make intercourse more comfortable. Choose a water-based or silicone-based gel without perfumes or colouring.
- Spend more time on foreplay and try different ways to become aroused.
- Try different positions during sex to work out which position is the most comfortable for you.
- If you can’t enjoy penetrative sex, explore other ways to climax, such as oral and manual stimulation.
- Talk about your feelings with your sexual partner or doctor, or ask your treatment team for a referral to a sexual therapist or psychologist.
- Do some regular physical activity to boost your energy and mood. Talk to your GP about managing any depression as it may be affecting your libido.
- For ideas about how to discuss sexuality questions with your treatment team, see Cancer Australia’s online resource Intimacy and sexuality for women with gynaecological cancer – starting a conversation.
After surgery or during chemotherapy or radiation therapy, some people notice problems with how their bowel works. You may experience diarrhoea, constipation or stomach cramps. Pain relief medicines may also make you feel constipated. Diarrhoea and constipation can occur for some time, but are usually temporary. Sometimes tissues in the pelvis stick together after surgery (pelvic adhesions). This can lead to ongoing bowel problems and pain and in rare cases may need further surgery. To help manage bowel changes, ask your doctor, nurse or dietitian for advice about eating and drinking.
Tips for managing bowel changes
- Drink plenty of liquids to replace fluids lost through diarrhoea or to help soften faeces (poo) if you are constipated. Avoid alcohol, caffeinated drinks and very hot or very cold liquids.
- Avoid fried, spicy or greasy foods, which can cause pain and make diarrhoea and constipation worse.
- Ask your pharmacist or doctor about suitable medicines to relieve symptoms of diarrhoea or constipation.
- Eat small, frequent meals instead of three big ones.
- Drink peppermint or chamomile tea to reduce stomach or wind pain.
- If you have diarrhoea, rest as much as possible – diarrhoea can make you very tired.
- If you are constipated, do some gentle exercise, such as walking.
Treating a blockage in the bowel
Surgery for ovarian cancer sometimes causes the bowel to become blocked. This is called a bowel obstruction. A bowel obstruction can also occur if the cancer comes back. Because faeces (poo) cannot pass through the bowel easily, symptoms may include feeling sick, vomiting, or a swollen and painful stomach.
A bowel obstruction can sometimes be treated by resting the bowel, which means you have nothing to eat or drink until the blockage clears. Your doctor may also try giving you an anti-inflammatory medicine to reduce the swelling around the obstruction.
Some bowel obstructions require a surgical procedure. If only one area is blocked, you may have a small tube (stent) put in to help keep the bowel open and relieve symptoms. The stent is inserted through the rectum using a flexible tube called an endoscope.
If the bowel is blocked in more than one spot, you may have surgery to create a stoma, an opening in the abdomen that allows faeces to leave the body. A stoma may be a colostomy (made from the colon, part of the large bowel) or an ileostomy (made from the ileum, part of the small bowel). A small bag called a stoma bag or appliance is worn on the outside of the body to collect the waste. A stomal therapy nurse will show you how to look after the stoma. The stoma may be reversed when the blockage is cleared, or it may be permanent.
Sometimes ovarian cancer can cause fluid to build up in different parts of the body.
Ascites – This is when fluid collects in the abdomen. It causes swelling and pressure, which can be uncomfortable and make you feel breathless. If you have ascites, your doctor may inject a local anaesthetic into the abdomen and then insert a needle to take a sample of the fluid. This is called a paracentesis or ascitic tap. The fluid sample is sent to a laboratory to be examined under a microscope for cancer cells. Sometimes, to make you feel more comfortable, the doctor will remove the remaining fluid from your abdomen. It will take a few hours for all the fluid to drain into a drainage bag.
Pleural effusion – This is when fluid builds up in the area between the lung and the chest wall (pleural space). It can cause pain and breathlessness. The fluid can be drained using a procedure called a thoracentesis or pleural tap. Your doctor will inject a local anaesthetic into the chest area, and then insert a needle into the pleural space to drain the fluid.
Some people who have lymph nodes removed from the pelvis (a lymphadenectomy) 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. Radiation therapy in the pelvic area may also cause lymphoedema.
Lymphoedema can make movement and some types of activities difficult. The swelling may appear at the time of treatment or months or years later. It is important to seek help with lymphoedema symptoms as soon as possible because early diagnosis and treatment lead to better outcomes.
Though lymphoedema may be permanent, it can usually be managed. Gentle exercise, compression stockings and a type of massage called manual lymphatic drainage can all help to reduce the swelling.
To find a practitioner who specialises in managing lymphoedema, you can visit the Australasian Lymphology Association website. If your GP refers you to a lymphoedema practitioner, you may be eligible for a Medicare rebate. Talk to your GP about developing a Chronic Disease Management Plan or Team Care Arrangement to help you manage the condition.
Understanding Ovarian CancerDownload resource
This information is reviewed by
This information was last reviewed April 2020 by the following expert content reviewers: A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecologic Oncologists, TAS; Dr Robyn Cheuk, Senior Radiation Oncologist, Royal Brisbane and Women’s Hospital, QLD; Kim Hobbs, Clinical Specialist Social Worker, Gynaecological Cancer, Westmead Hospital, NSW; Sonja Kingston, Consumer; Clinical A/Prof Judy Kirk, Head, Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, and Sydney Medical School, The University of Sydney, NSW; Prof Linda Mileshkin, Medical Oncologist and Clinical Researcher, Peter MacCallum Cancer Centre, VIC; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Support Team, Ovarian Cancer Australia; Emily Stevens, Gynaecology Oncology Nurse Coordinator, Department of Obstetrics and Gynaecology, Flinders Medical Centre, SA; Dr Amy Vassallo, Fussell Family Foundation Research Fellow, Cancer Research Division, Cancer Council NSW; Merran Williams, Consumer.