It will take some time to recover from the physical and emotional changes caused by treatment. Treatment side effects can vary – some people experience many side effects, while others have few. Side effects may last from a few weeks to a few months or, in some cases, years or permanently. 

Some treatment side effects, called late effects, may not show up for many months or years.

Menopause

If both ovaries have been removed or if you’ve had radiation therapy to the pelvic area, you will no longer produce oestrogen and progesterone 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, some treatments will cause sudden menopause. If you have already been through menopause, the symptoms of menopause may come back. These 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.
• Your doctor 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). 
• 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.
• Ask your doctor for a referral to a specialist menopause clinic if needed.
• Have your cholesterol levels checked. If they are high, regular exercise and a balanced diet may help. Cholesterol-lowering drugs are also available.
• Learn meditation and relaxation techniques, which may reduce stress and lessen some of the symptoms of menopause.
• Several types of psychological therapies have been shown to help with menopause-related anxiety, low mood, sleep troubles and the impact of hot flushes.
• Exercise can also help with mood changes and energy levels.

Fertility issues

Surgery or radiation therapy for cancer of the uterus may mean you are unable to become pregnant. 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.

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 on 13 11 20 to talk to a health professional about your concerns.

Fatigue

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.

Managing fatigue

• 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.
• Plan your day. Set small, manageable goals so you can rest regularly, and allow yourself plenty of time to get to appointments.
• 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. 

Bladder changes

Treatment for cancer of the uterus can cause bladder problems. Most bladder side effects are temporary or can be managed.

Urinary incontinence

Radiation cystitis

Blood in urine

Bowel changes

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.

Constipation

Diarrhoea

Radiation proctitis

Blood in bowel movements

Lymphoedema and cellulitis

After surgery or radiation therapy to the pelvic area, one or both legs, and/or the vulvar area, may become swollen This is known as lymphoedema. It can happen if lymph fluid doesn’t circulate properly and builds up. 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.

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.

Vaginal narrowing and dryness

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.

Even if you don't plan to have sex again, your doctor will need to do regular pelvic examinations after treatment. 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.

Impact on sexuality

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, which can make sexual penetration difficult or painful. Also, removal of the uterus, cervix and ovaries can change how you experience sexual pleasure and orgasm. Your treatment team may also advise using vaginal dilators, lubricants, moisturisers or hormone creams. It may be helpful to explore ways of orgasm (climax) without penetration or to use masturbation to see what might work for you.

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. 

Follow-up appointments

After treatment ends, you will have regular appointments with your specialists to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread.

During check-ups, you will usually have a pelvic examination and you may have imaging scans.