Managing side effects

Thursday 1 October, 2015

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On this page: TirednessBowel problems | Bladder problems | Lymphoedema | Menopause | Osteoporosis and heart disease | Sexuality issues | Key points


It may take some time to recover from treatment for cervical cancer. As well as causing physical changes, you may find that cancer affects you emotionally.

Side effects of treatment vary from person to person. Some women don’t experience any side effects; others may experience a few. Side effects may last from a few weeks to a few months or, in some cases, many years or permanently. Fortunately, there are ways to reduce or manage the discomfort that side effects cause. 

Tiredness 

Many women who are treated for cervical cancer find that tiredness is a major issue, particularly if they have radiotherapy and chemotherapy. The tiredness may continue for several months, or even a year or two, after treatment has finished. 
Coping with tiredness
  • Plan your day so you have time to rest regularly.
  • 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.
  • Read Cancer Council’s booklets Living Well After Cancer and Cancer, Work & You for more tips.

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. Find out more about our support services.

Bowel problems

After surgery or radiotherapy, some women notice changes in their bowel habits. You may experience constipation or diarrhoea, or feel pain in your abdomen.

The following tips may help you to manage these side effects:

  • 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.
  • Limit spicy and greasy foods, as these can make diarrhoea and constipation worse.
  • Talk to your doctor or a dietitian about making changes to your diet, or to ask whether taking medication is an option.
For more information, call Cancer Council on 13 11 20 for a free copy of the booklet Nutrition and Cancer.

Bladder problems

Bladder control may change after surgery or radiotherapy. Somewomen 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. There are ways to manage and treat urinary incontinence. Ask your doctor to refer you to a continence nurse or physiotherapist at your hospital. You can also call the National Continence Helpline on 1800 33 00 66 or visit continence.org.au.

The blood vessels in the bowel and bladder can become more fragile after radiotherapy. 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.

Lymphoedema

If lymph nodes have been damaged or removed during surgery, lymph fluid may not drain properly from your legs. This causes the fluid to build up and the legs to swell, which is called lymphoedema. This can occur during treatment or after treatment has finished.

It is important to manage lymphoedema symptoms as soon as possible. Gentle exercise, compression stockings, and a type of massage called manual lymphatic drainage can all help to reduce the swelling. 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 website. Cancer Australia's booklet Lymphoedema - what you need to know is also a good source of information.  

Menopause

If you’ve had radiotherapy to your ovaries or surgery to remove them, your body will no longer produce the hormones oestrogen and progesterone. When these hormones are no longer made by the body, women stop menstruating (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 include:

  • hot flushes
  • mood swings
  • trouble sleeping (insomnia)
  • tiredness
  • vaginal dryness.

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.

For information about dealing with the symptoms of menopause, talk to your doctor or call Cancer Council 13 11 20.

Osteoporosis and heart disease 

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 table below outlines ways to help prevent osteoporosis and heart disease. For more information, talk to your doctor, or visit osteoporosis.org.au and heartfoundation.org.au.

Osteoporosis
  • Eat 3–5 serves of calcium- rich food daily (e.g. yoghurt, milk, tofu, green vegetables).
  • Vitamin D helps the body absorb calcium. The main source of vitamin D is sun exposure. Visit the SunSmart website or download the SunSmart app for safe times to go out in the sun in your location.
  • Ask your GP whether a calcium or vitamin D supplement might help you.
  • Do weight-bearing exercise, such as walking, dancing or team sports. Ask your GP what is suitable for you.
Heart disease
  • Ask your doctor to check your cholesterol levels. If they are high, ask about medication and/or dietary changes.
  • Eat lots of fruit, vegetables and fibre.
  • Reduce your saturated fat intake. Sources of this fat include processed meats and takeaway foods.
  • Exercise regularly. Your doctor can suggest exercises that are suitable for you.
  • If you smoke, talk to your doctor about quitting or call the Quitline on 13 7848 . 

Sexuality issues

Having cervical cancer can affect your sexuality in different ways. The effects you experience depend on many factors, such as your treatment and its side effects, whether you have a partner, and your overall self-confidence.

Knowing the potential challenges and addressing them early may help you to adjust to these changes. Sexual intercourse may not always be possible, but closeness and communication are vital to a healthy relationship. Talking to a counsellor may help.

Vaginal changes

The main side effect of treatment will be to the vagina. If the ovaries have been affected by surgery or radiotherapy, they will no longer produce oestrogen. This will cause dryness in your vagina, and it may not expand easily during sexual intercourse.

Radiotherapy can also cause the vagina to narrow or shorten (vaginal stenosis). Although vaginal stenosis can make sexual intercourse uncomfortable, it should not affect your ability to reach orgasm. See below for ways to keep your vagina open and more elastic.

Coping with vaginal side effects
  • Your doctor may suggest you use a vaginal dilator to help keep the walls of the vagina open and supple. A dilator is a tube-shaped device that is designed to gently stretch the vagina. Used with lubricant, it is inserted into the vagina for short periods of time. Ask your nurse or radiation therapist for more information about vaginal dilators.
  • Having regular gentle sexual intercourse can also help widen the vagina.
  • Ask your doctor about short-term hormone replacement therapy (HRT), which may help with vaginal dryness.
Low libido

A lack of interest in sex or loss of desire is common because of the physical and emotional 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.

For more information about sexuality issues, call 13 11 20 for a free copy of the booklet Sexuality, Intimacy and Cancer or read more about sexuality and intimacy.

Infertility

Because cervical cancer affects the reproductive organs, some treatments, such as hysterectomy and radiotherapy, will cause infertility. This means it is no longer possible to become pregnant.

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 devastated 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.

For some women, there may be options for having children after treatment. Before treatment starts, ask your doctor or a fertility specialist about what options are available to you. The following list explains some ways you may be able to have children after treatment for cervical cancer.

  • 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.
  • If you require radiotherapy but your ovaries do not need to be treated, you may be able to have a surgical procedure to move the ovaries outside your pelvis and into your abdomen. This is called ovarian transposition or relocation, and it may help to prevent the ovaries being affected by radiation.
  • Having a trachelectomy, where only the cervix is removed, is an option for some women with early-stage cervical cancer. 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.

You can find more information in Cancer Council’s booklet Fertility and Cancer. Call 13 11 20 for a free copy.

Key points

  • Many women experience side effects following treatment for cervical cancer. These may be caused by surgery, radiotherapy or chemotherapy. Side effects can last from a few weeks to many years or permanently.
  • Tiredness is a common side effect. Try to plan activities around your energy levels, and talk to your family and friends about ways they can help you.
  • Bowel and bladder problems may occur after treatment. Your doctor can refer you to a continence nurse or physiotherapist to help you manage these problems.
  • Surgery or radiotherapy to the ovaries can cause menopause. Chemotherapy may also cause temporary or permanent menopause. The symptoms of menopause include hot flushes, mood swings and insomnia. Talk to your doctor about ways to help reduce these symptoms.
  • Menopause increases the risk of osteoporosis and heart disease. Ask your doctor for advice on reducing your risk or managing these problems. Making some simple changes to your diet and lifestyle can help.
  • Sexuality issues following treatment are common. Addressing any challenges early can help you adjust. It can be helpful to talk to a counsellor.
  • Some women are not able to have children after treatment for cervical cancer. This is called infertility and can be very distressing. If you would still like to be able to have children, speak to your doctor before treatment starts about options for preserving your fertility.

Reviewed by: Dr Archana Rao, Gynaecological Oncologist, Royal Hospital for Women, NSW; Danielle Carpenter, Gynaecological Cancer Nurse Consultant, Gynaecology Unit, The Royal Women’s Hospital, VIC; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland, QLD; A/Prof Michael Jackson, Director, Radiation Oncology, Prince of Wales Hospital, NSW; Haley McNamara, Social Worker, Cancer Care Services, Metro North Hospital and Health Service, QLD; Isabelle Rousseau, Consumer.
Updated: 01 Oct, 2015