Survivorship After Gynecologic Cancer: Managing Menopause and Treatment Side Effects

Oncology Briefs: Research from the ASCO Educational Book
August 16, 2016
Linda Van Le, MD

The ASCO Educational Book is a collection of articles written by ASCO Annual Meeting speakers and oncology experts. Published annually, each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology such as surgery, radiation therapy, symptom management, health services research, international perspectives, and immunology, among other topics.

In collaboration with Cancer.Net, authors of the ASCO Educational Book have tailored their articles for patients and their loved ones so that they may be similarly informed of the latest science in oncology to improve their care and outcomes.

Dr. Van Le is Director of Gynecologic Oncology Clinical Trials at the University of North Carolina Lineberger Comprehensive Cancer Center. Her research interests have focused on the description of new therapies for the treatment of gynecologic cancers.

The 2 most common gynecologic cancers, uterine and ovarian, mostly occur in women who are in menopause. Survival rates for these cancers have improved in recent years. Seventy-five percent of women survive endometrial cancer, and 40% of women survive stage III ovarian cancer. Many women who survive gynecologic cancer face the added challenge of managing the symptoms of menopause along with cancer treatment-related side effects. These women should receive care tailored to their needs to prevent or reduce the side effects of their cancer treatment.

Menopause is when a woman stops having her monthly menstruation, or period. This usually happens at age 52. A woman has officially gone into menopause once 12 months have passed without menstruation. Cancer treatments such as chemotherapy, radiation therapy, and surgery may cause women to enter menopause earlier. Younger women who have had 1 or both ovaries removed to treat their ovarian cancer, a procedure called oophorectomy, will often go into menopause earlier.

The symptoms of menopause often fall into 1 of 2 different symptom groups: hot flashes and symptoms related to the genital and urinary organs, called genitourinary symptoms. The symptoms of menopause can affect a woman’s quality of life and may affect a woman’s ability to have and enjoy sexual activity.

Eighty percent of postmenopausal women experience hot flashes. Hot flashes, a sudden feeling of warmth, can continue for years. Genitourinary symptoms cover many different symptoms, including burning, pain, painful intercourse, painful or frequent urination, and increased urinary tract infections. There are other symptoms of menopause that do not fit into either of these symptom groups. These symptoms vary but can include sleep disturbances, depression, joint pain, and cognitive changes.

Managing the symptoms

There are many options to assist women with managing menopause symptoms after cancer treatment.

  • Hot flashes. Minor hot flashes can be improved with a few lifestyle changes, such as:

    • Using cooling fans

    • Wearing light nightgowns to bed

    • Using lighter bedding

    • Drinking cool water

    • Turning down the thermostat at night

    Women who suffer from moderate to severe hot flashes may consider estrogen replacement, which can decrease hot flashes by 75%.

  • Genitourinary symptoms. Genitourinary symptoms can be treated with non-hormonal vaginal moisturizers and lubricants. These decrease vaginal irritation and relieve pain during intercourse. Vaginal estrogens may also be used.

  • Side effects from radiation therapy. The side effects of radiation therapy can occur months or years after treatment finishes. These side effects can affect the stomach and the intestines, called gastrointestinal symptoms, and the urinary tract, called urologic symptoms.

    Up to half of women experience some form of gastrointestinal problem after cancer treatment. These include bleeding, diarrhea, incontinence, failure to properly absorb nutrients (known as malabsorption), and pain. There are various ways to treat and soothe these side effects. Antibiotics are commonly used to treat bacterial overgrowth in the small intestine, stool-bulking agents can be used to ease some problems, and hyperbaric oxygen therapy can ease severe rectal bleeding.

    The risk of urologic problems increases over time. Major urinary tract complications are uncommon; however, less serious side effects are relatively common. These less serious symptoms can often be treated with dietary changes. Talk with your doctor about how to manage these side effects or ask for a referral to a dietitian.

What survivors can do

With more and more women surviving gynecologic cancers every year, doctors have an increased awareness of the challenges that can accompany survivorship. share on twitter Survivors should talk with their medical care team to make sure they receive the following:

  • A personalized survivorship care plan

  • Support so they can manage their symptoms

  • Information on the long-term effects of living with and beyond cancer

  • Access to specialized care for the problems that occur after cancer, if needed

More detailed information can be found in the ASCO Educational Book article from which this blog was based.