Living after gynaecological cancer treatment

If you had not reached menopause, removal of both ovaries triggers one straight away, and pelvic radiotherapy stops the ovaries working over a few months. Cancer Research UK says hormone levels begin to fall around three months into treatment, and symptoms can include night sweats, hot flushes, mood changes, irritability, vaginal dryness, reduced libido and urinary urgency.

NHS menopause information lists sleep disturbance, concentration changes, palpitations and bone density loss as further possibilities. Cancer Research UK adds that hormone replacement therapy is usually available after most cervical cancer treatments. Whether HRT is suitable depends on cancer type, because some womb and ovarian cancers are hormone sensitive, so ask your oncologist. Non-hormonal options also exist, and bone health deserves attention if menopause comes early.

After pelvic radiotherapy the vagina may become narrower, shorter and drier. Cancer Research UK describes plastic or metal dilators in graded sizes, used for around five to ten minutes about three times a week starting roughly four weeks after treatment, with water-soluble lubricant. Doctors may suggest continuing for two years or more, even if you are having sex.

Macmillan recommends lubricants free of scents, spermicides, preservatives and parabens, and allows time for healing before intercourse after surgery or radiotherapy. Persistent pain, bleeding or tightness should be reported, not endured.

Lymphoedema is swelling caused by a build-up of lymph fluid when nodes are removed or treated with radiotherapy. Macmillan describes early signs as shoes or clothes feeling tighter, heaviness, tightness or fullness, skin changes and aching, and says it may emerge months or years after treatment. It cannot be cured but can usually be controlled, particularly if treated early, according to Cancer Research UK.

Management combines skin care, exercise, weight management, compression garments and specialist massage. The NHS identifies cellulitis, a bacterial skin infection with redness, pain, swelling and fever, as the commonest complication. Redness with aching and swelling could also be a blood clot, so seek urgent help through NHS 111 or A&E rather than waiting.

Cancer Research UK notes that pelvic radiotherapy can cause lasting bowel changes such as looser or more frequent motions, a less elastic bladder with a need to pass urine more often, and occasionally bleeding from fragile blood vessels. Report any bleeding to your team. Skin in the treated area may darken and tissues can tighten.

After surgery, bladder and bowel function can change for a time. Pelvic floor physiotherapy, dietary advice and medicines can help, and a bowel or bladder problem that starts years later should still be mentioned, since it may be a late effect of treatment.

Macmillan notes that tissue, nerves and blood vessels needed for sexual function can be affected, and that loss of sex drive commonly accompanies tiredness, pain and nausea. Body image, a sense of reduced control and fear of pain also play a part. Desire often improves with time and support, according to Cancer Research UK.

Sources of help include your GP, your cancer team, a sex therapist registered with a professional body, pelvic physiotherapists and gynaecologists. Open conversation with a partner helps, and many people find that intimacy takes forms other than intercourse during recovery.

Treatment can end fertility, which is a loss in its own right whether or not you hoped to have children. Cancer Research UK says support is available for the emotional side, and it states that it is common to struggle with mental health during and after cancer. Low mood, anxiety and fear of recurrence are common and treatable.

Follow-up appointments, clinical nurse specialists, cancer charities, support groups, and psychological services give routes to help. Tell your GP or team if you feel persistently low, cannot sleep or have thoughts of harming yourself; in crisis, NHS 111 and 999 are available.