9 Endometrial Cancer Treatment Side Effects, and How to Manage Them
Endometrial cancer treatment can cause uncomfortable side effects, but you can manage them with medications and lifestyle tips.
Endometrial cancer treatments can save your life, but they can also cause some unpleasant side effects. Everyone reacts to cancer treatment differently, and the side effects you experience may be different from those of someone else getting the same care.
Treatments for endometrial cancer (uterine cancer) can include surgery, radiation, chemotherapy, hormone therapy, and targeted therapy. Side effects depend on treatment type, and it’s important to tell your healthcare provider if you notice any.
“Patients should be familiar with what signs and symptoms to monitor and feel encouraged to call their care team early, as interventions work best when started early in the side effects course,” says Mitchell Clark, MD, gynecologic oncologist and assistant professor at Yale University School of Medicine.
1. Hot Flashes
Removal of the uterus, fallopian tubes, and ovaries is the first treatment for most people with endometrial cancer, and this surgery causes immediate menopause, says Ryan Kahn, MD, gynecologic oncologist at Miami Cancer Institute. Hot flashes happen in up to 74 percent of women going through menopause, and 65 percent have this symptom for over two years.
Your provider may recommend medications for hot flashes, including hormone therapy. Certain drugs for depression, seizures, and blood pressure may also help improve hot flashes, even if you don’t have those conditions.
Lifestyle changes and other strategies can also help lessen hot flash occurrence and intensity:
Write down hot flash triggers as they happen, so you can avoid them in the future.
Avoid common triggers like spicy food, alcohol, caffeine, and hot environments.
Drink ice water when you feel a hot flash starting.
Dress in layers so you can get cool quickly.
Use a fan at home, at work, and while sleeping.
Take slow, deep breaths during a hot flash, which can shorten them.
2. Blood Clots
After surgery, you will have a higher risk of blood clots, says Dr. Kahn. In one study of 355 people, about 1 in 9 had a deep vein thrombosis (blood clot in the leg) after laparoscopic surgery. Comparatively, deep vein thrombosis only happens in about 1 in 1,000 people in the general population.
After surgery, you may be prescribed blood thinners, such as heparin, to lessen your risk of clots. Your care team will also:
Encourage you to get out of bed as soon as possible after surgery
Place compression stockings on both legs
Apply compression devices to your legs, which inflate and deflate to keep blood moving
3. Vaginal Narrowing, Dryness, and Irritation
Menopause symptoms after surgery and radiation therapy can cause vaginal side effects.
“Over time [radiation] therapy can lead to shortening and narrowing of the vagina,” says Robert DeBernardo, MD, section head of the department of gynecologic oncology at Cleveland Clinic. It can also lead to vaginal irritation and discharge, says Kahn, and severe irritation can cause open vaginal sores.
Vaginal dryness from radiation therapy happens more often in patients who get vaginal brachytherapy — a targeted type of radiation that involves placing a radioactive object near the tumor. Some women experience vaginal dryness after endometrial cancer surgery, which can make sex painful. One large study review found that symptoms like vaginal dryness, irritation, and itching happen in up to 87 percent of women after menopause.
Dryness and narrowing of the vagina can be treated with vaginal estrogen therapy, which comes in gel, cream, cervical ring, or suppository forms. Your doctor may also recommend these therapies:
Pelvic floor physical therapy can relax vaginal muscles and help with narrowing.
Vaginal dilators can prevent narrowing after cancer treatment.
During sex, use a water-based lubricating gel, try different positions, spend extra time on foreplay, and communicate any pain to your partner right away.
4. Frequent Urination
Endometrial cancer surgery can affect the muscles of your bladder, so you may feel the need to urinate more often after surgery. Radiation can also irritate the bladder and cause frequent urination, which typically improves or resolves in a few weeks after finishing therapy, says Dr. DeBernardo.
In a study of 247 women who’d had a hysterectomy, 47 percent had pelvic floor symptoms such as urinary frequency, and another study found that radiation therapy after surgery increased that risk compared with those who’d only had surgery.
Some medications, like oxybutynin (Oxytrol), can help calm an overactive bladder, but you can also manage frequent urination with these tips:
Keep your bladder healthy with lots of fluids — between 11.5 to 15.5 cups a day.
Avoid caffeine, alcohol, spicy foods, and tobacco.
Wear cotton underwear and loose fitting pants to avoid urinary tract infections.
5. Fatigue
Fatigue can happen with any cancer treatment, including those used for endometrial cancer, says Dr. Clark. This side effect can start soon after beginning radiation therapy and often gets worse when given in combination with chemotherapy, says Kahn. Immunotherapy also has similar side effects.
“The most common side effects following these treatments include feeling tired or weak,” says Kahn. Over 80 percent of people with cancer report fatigue with chemotherapy or radiation, and up to 71 percent getting immunotherapy notice this side effect.
“Most of these symptoms can be managed with medication and dietary changes,” says DeBernardo. “Fortunately, these symptoms resolve within a few weeks after completing therapy.”
Researchers are studying possible medications for cancer treatment–related fatigue, including psychostimulants, bupropion (Wellbutrin), and steroids. In addition to medications, your team may recommend:
Respiratory therapy for breathing problems that can cause fatigue
Physical therapy to increase strength and function
Chemotherapy kills cancer cells, but it can also damage your hair follicles. This collateral damage makes hair loss one of the most common side effects of chemo, says DeBernardo. About 65 percent of patients who receive chemotherapy have hair thinning or complete hair loss, called chemotherapy-induced alopecia.
Some medications can help restore hair growth after treatment finishes, including topical options like minoxidil (Rogaine) and oral drugs like spironolactone (Aldactone), but more research is needed to know how well they work.
Cold cap therapy can help prevent hair loss from chemotherapy. “This involves wearing a specially designed cap that cools the scalp, typically before, during, and after chemotherapy sessions,” says Kahn. Its effectiveness may vary based on the length of chemotherapy and how long they can keep the cap on, Kahn says.
Some tips for coping with hair loss include the following:
Wear wigs, scarves, and other scalp coverings to help yourself feel more comfortable while your hair grows back.
Wash your hair with mild baby shampoo and brush it gently.
Avoid hairstyles that pull, like ponytails or braids.
Wear a sleep cap to lessen the friction between your scalp and pillow.
Don’t use chemicals to bleach, color, relax, or perm your hair.
Let your hair air-dry, and avoid heated styling devices.
7. Nausea and Diarrhea
Chemotherapy, radiation, and immunotherapy can cause gastrointestinal upset, including nausea, vomiting, and diarrhea. Up to 80 percent of people who have chemotherapy experience nausea and vomiting.
One study review found that up to 42 percent of people who had radiation for gynecological cancers reported diarrhea, while another study found that it affected up to 37 percent of people who received immunotherapy.
“Nausea is well managed for most patients with supportive anti-nausea medications that are generally highly effective, allowing patients to have better quality of life during treatment,” says Clark. Typical nausea-relieving medications include ondansetron (Zofran), prochlorperazine (Compazine), promethazine (Phenergan), and metoclopramide (Reglan), but some psychiatric medications or even steroids can be used for stubborn nausea.
For severe diarrhea, your provider may recommend medications like loperamide (Imodium), a diphenoxylate and atropine combination (Lomotil), or probiotics.
Along with medications, you can try some integrative therapies to lessen nausea, vomiting, and diarrhea:
Drink fluids to prevent dehydration. Even if you can’t drink the recommended daily amount because of your symptoms, try to sip on water, broth, ginger ale, tea, or sports drinks as much as you can.
Choose nausea-friendly foods and drinks like popsicles, pudding, toast, crackers, and ginger tea. To slow diarrhea, eat low-fiber foods like pasta, white bread, and canned fruit.
Avoid greasy, fried, spicy, fatty, or sweet foods that may aggravate your nausea.
Eat five to six smaller meals per day instead of three big ones, and try to stay relaxed while eating.
Include foods that are high in minerals such as potassium and sodium, which can get low with diarrhea. You can get these minerals from potatoes, bananas, applesauce, and salted crackers.
Discover your nausea and diarrhea triggers by recording what you ate right before your symptoms started.
8. Leg Numbness and Swelling
Chemotherapy can cause peripheral neuropathy, a type of nerve damage, in up to 85 percent of people who have chemotherapy. This side effect causes symptoms like weak, achy muscles, tingling or numbness in your feet or hands, a dulled sense of touch, and muscle twitching.
Treatments such as surgery can also damage lymph nodes in up to 70 percent of people with gynecologic cancers. “Following lymph node procedures, you may be at an increased risk of lymphedema (swelling) of the lower extremities,” says Kahn. This risk increases if you have radiation after your procedure.
Sometimes neuropathy disappears after cancer treatment, but for others it lasts longer. If you have this side effect, your provider may recommend numbing patches or cream, a nerve medicine called gabapentin (Neurontin), the antidepressant duloxetine (Cymbalta), or opioids for severe pain. You can also exercise to support circulation, which can decrease neuropathy symptoms.
Lymphedema isn’t treated with medication, but you can try several techniques to improve symptoms:
Elevate your legs while resting to drain extra fluid.
Exercise to boost blood flow and fluid drainage.
Avoid cuts or injuries to your feet and legs, which can make lymphedema worse.
Ask about manual lymphatic drainage, a type of massage done by a trained therapist.
Wear custom compression garments that provide pressure to your legs so fluid can’t collect there.
9. Higher Infection Risk
Some cancer treatments, such as immunotherapy and chemotherapy, can affect your immune system. “Since [immunotherapy] essentially ‘activates’ the immune system, it can cause a plethora of other symptoms and problems, some of which can be life threatening,” says DeBernardo.
Chemotherapy lowers the amount of white blood cells in your body, which help protect against infection. With a suppressed immune system, you are at an increased risk of any kind of infection. How many people get infections during cancer treatment depends on the type of treatment they get, and your healthcare team will monitor for this side effect during therapy and treat you if needed, says DeBernardo.
Medications to treat or prevent infections can include antibiotics, antivirals, antifungals, and growth factors that can boost white blood cell production.
You can also help avoid infections with these habits:
Wash your hands with soap and warm water often, especially before you eat.
Clean your teeth often and check for sores or redness every day.
Avoid seeing people who are sick or who have just had a live vaccine, such as one for chicken pox, polio, or measles.
Cook all meat and eggs thoroughly before eating.
The Takeaway
Endometrial cancer treatments such as surgery, chemotherapy, radiation, and immunotherapy can cause a range of side effects.
The most common endometrial cancer treatment side effects include hot flashes, blood clots, vaginal dryness, hair loss, urinary and gastrointestinal issues, and a higher risk of infection.
You can manage these symptoms with medications prescribed by your healthcare provider. There are plenty of lifestyle changes or home remedies that can also help lessen their effects.
