Treatment will cause some physical and emotional changes. Some women experience many side effects, while others have few. Most side effects are temporary but some may be permanent. This section explains ways to manage the discomfort that side effects may cause.
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 women 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. For some women, it may take up to 1–2 years 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. It may help to see a dietitian.
- Regular light exercise has been shown to reduce fatigue. Even a walk around the block can help.
- Talk to your doctor about the amount and type of exercise suitable for you or ask for a referral to a physiotherapist or exercise physiologist.
Surgery or radiation therapy for ovarian cancer will mean you are unable to conceive children. Before treatment starts, ask your doctor or fertility specialist about what options are available to you. Women under 40 who have stage I ovarian cancer may be able to have surgery that leaves the uterus and one ovary in place. They will, however, 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. You can find more information in Fertility and Cancer or call Cancer Council 13 11 20.
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. 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, dry or itchy skin, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. These symptoms are usually more severe 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 hormone replacement therapy (HRT). If taken after natural menopause, HRT containing oestrogen may increase the risk of some diseases. If you were already on HRT when the cancer was diagnosed, you will need to weigh up 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. Osteoporosis Australia has more information – visit osteoporosis.org.au or call 1800 242 141.
- Cholesterol levels can change after menopause, which 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 about ways to relieve the symptoms of menopause.
Impact on sexuality and intimacy
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.
Treatment can cause physical side effects such as vaginal dryness, scarring, internal scar tissue ( pelvic adhesions), and narrowing of the vagina. These side effects can make sexual penetration painful, and you may have to explore different ways to orgasm or climax. The experience of having cancer can also reduce your desire for sex (libido).
For most women, 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.
Look Good Feel Better runs workshops to help people manage the appearance-related effects of cancer treatment – go to lgfb.org.au or call 1800 650 960.
Tips for managing sexual changes
- Give yourself time to get used to any physical changes. Let your partner know if you don't feel like having sex, or if you find penetration uncomfortable.
- Show affection by touching, hugging, massaging, talking and holding hands.
- 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 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 of getting 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 physical activity to boost your energy and mood. Talk to your GP if your low libido is caused by depression.
- See Sexuality, Intimacy and Cancer or call Cancer Council 13 11 20.
- Cancer Australia's booklet Intimacy and sexuality for women with gynaecological cancer – starting a conversation is a good source of information.
After surgery or during chemotherapy or radiation therapy, some women notice bowel problems. 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 often these bowel changes are temporary.
Ask your doctor, nurse or dietitian for advice about eating and drinking, and see the tips below for suggestions on preventing or relieving these side effects.
Tips for managing bowel changes
- Drink plenty of liquids to replace fluids lost through diarrhoea or to help soften stools if you are constipated. Warm and hot drinks work well, but avoid alcohol and caffeinated drinks.
- 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 as diarrhoea can be exhausting.
- If you are constipated, do some gentle exercise such as walking.
- See Nutrition and Cancer or call Cancer Council 13 11 20.
Treating a blockage in the bowel
Surgery for ovarian cancer sometimes causes the bowel to become blocked (bowel obstruction). A bowel obstruction can also occur if the cancer comes back. Because waste matter (faeces) cannot pass through the bowel easily, symptoms may include feeling sick, vomiting, or stomach discomfort and pain.
To relieve the symptoms, you may have a small tube (stent) put in that helps keep the bowel open. The stent is inserted through the rectum using a flexible tube called an endoscope.
Occasionally, the blockage in the bowel is treated with a stoma. A stoma is a surgically created opening in the abdomen that allows faeces to leave the body. Part of the bowel is brought out through the opening and stitched onto the skin. A small bag is worn on the outside of the body to collect the waste. This is called a stoma bag or appliance. The stoma may be reversed when the obstruction is cleared or it may be permanent.
There are two types of stomas for a bowel obstruction:
- colostomy – made from part of the colon (large bowel)
- ileostomy – made from the ileum (part of the small bowel).
People often have many questions after a stoma. A specially trained stomal therapy nurse can show you how to look after the stoma. For more information, contact the Australian Association of Stomal Therapy Nurses at stomaltherapy.com, visit the website of the Australian Council of Stoma Associations at australianstoma.com.au, or call Cancer Council 13 11 20.
Internal scar tissue (pelvic adhesions)
Tissues in the pelvis may stick together after a hysterectomy (known as an adhesion). These can be painful or cause bowel problems such as constipation. Rarely, adhesions to the bowel or bladder may need to be treated with further surgery.
Sometimes ovarian cancer can cause fluid to build up in the body.
This is when fluid collects in the abdomen. It causes swelling and pressure, which can be uncomfortable and make you feel breathless. Your doctor will inject a local anaesthetic into the abdomen and then insert a needle to take a sample of the fluid. This is called paracentesis or ascitic tap. The fluid sample is sent to a laboratory to be examined 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.
For some women, fluid may build up in the area between the lung and the chest wall (pleural space), which can cause pain and breathlessness. The fluid can be drained using a procedure called thoracentesis or pleural tap. You will have a local anaesthetic and a needle will be inserted into the pleural space to drain the fluid.
Some women 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 drain back into circulation properly and builds up in the legs. Radiation therapy in the pelvic area may also cause lymphoedema. Lymphoedema may appear at the time of treatment or months or years later.
Lymphoedema may make movement and some types of activities difficult. It is important to seek help with lymphoedema symptoms as soon as possible. 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, visit the Australasian Lymphology Association website at lymphoedema.org.au. For tips on preventing and managing lymphoedema, download Cancer Council's Understanding Lymphoedema fact sheet from your local Cancer Council 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.
Feeling low or depressed
It is common and understandable to feel low or anxious after a cancer diagnosis, during treatment or when you are recovering. Some women feel sad because of the changes the cancer has caused. Others are frightened about the future. If you often feel irritable, tense or on edge, experience frequent worries, find it hard to wind down, or have difficulty sleeping, you may be experiencing anxiety.
There is a difference between feeling down and experiencing depression. If you have continued feelings of sadness or emotional numbness on most days for two weeks, or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression.
Talk to your GP, as counselling or medication – even for a short time – may help. Some women are able to get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Your local Cancer Council may also run a counselling program.
The organisation beyondblue has information about coping with depression and anxiety at beyondblue.org.au. If you would like to talk to someone about how you are feeling, call Lifeline on 13 11 14 or beyondblue on 1300 22 4636.
"My advice to other women is: be kind to yourself, this is really tough. Don't feel like you have to be strong all the time. It is okay to be sad at times. You don't always have to `keep it together'." – Patricia
- Some women experience few side effects from treatment, while others have many. There are ways to reduce or manage the discomfort that side effects may cause.
- The most common side effect is fatigue. This may continue for a while after treatment has finished. It may help to plan your activities so you can take regular rest breaks.
- If you are unable to have children (infertility) as a result of treatment for ovarian cancer, you may feel very distressed. Talking about your feelings with your family, friends or a counsellor may be helpful.
- If your ovaries have been removed, you will go through menopause. This means that your periods will stop and it will no longer be possible to become pregnant.
- Treatment for ovarian cancer can have an impact on sexuality and self-esteem. There are things you can do to manage these changes.
- After treatment, some women have bowel problems such as diarrhoea, cramps or constipation. Surgery can also cause a blocked bowel (bowel obstruction).
- Sometimes fluid can build up in your abdomen, lungs or chest wall. Your medical team will drain the fluid.
- If fluid builds up in the legs (lymphoedema), try gentle exercise and compression stockings, or visit lymphoedema.org.au to find a specialised practitioner.
- Some women feel anxious or depressed during or after cancer treatment. Speak to your GP for support.
Expert content reviewers:
A/Prof Alison Brand, Director, Gynaecological Oncology, Westmead Hospital, and Chair, Australia New Zealand Gynaecological Oncology Group, NSW; Dr Scott Carruthers, Director, Radiation Oncology, Lyell McEwin Hospital, and Deputy Director, Radiation Oncology, Royal Adelaide Hospital, SA; Elizabeth Cooch, Cancer Support Nurse, Ovarian Cancer Australia; Dr Serene Foo, Medical Oncologist, Austin Hospital, Epworth Eastern Hospital, and Mercy Hospital for Women, VIC; Keely Gordon-King, Psychologist, Cancer Council Queensland; Carol Lynch, Consumer; A/Prof Gillian Mitchell, Honorary Medical Oncologist, Familial Cancer Centre, Peter MacCallum Cancer Centre, and The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC; Claire Quenby, Social Worker, King Edward Memorial Hospital for Women, WA; Jan Priaulx, 13 11 20 Consultant, Cancer Council NSW; Hayley Russell, Support Coordinator, Ovarian Cancer Australia.