Side effects of radiotherapy for womb cancer

Radiotherapy has side effects. Your vagina may become sore and you will have an increased risk of vaginal infection during your course of treatment and for a few weeks afterwards. Other side effects include

• Diarrhoea
• Irritable bladder (radiation cystitis)
• Feeling sick
• Tiredness

All these side effects usually disappear within a few weeks of finishing your treatment. Your doctor can help with medicines for sickness or diarrhoea. If your bladder is painful, they can give you painkillers to take. Speak to your nurse, radiographer or doctor at the radiotherapy centre if you have problems. Some doctors may ask you to use a vaginal douche from the start of your radiotherapy to keep your vagina clean. Generally this isn't recommended now, although some specialists still suggest it. If you have questions or concerns about douching do talk to your doctor or specialist nurse.

There is detailed information about all these side effects in the radiotherapy side effects section. 

Radiotherapy can have long term effects on your vagina which can affect your sex life. It can make healthy tissues become stiffer and less stretchy. Doctors call this fibrosis. It can shorten and narrow your vagina. To try to prevent or minimise this, it is important to start using vaginal dilators. If you don't use these, it can be difficult to have sex comfortably after your treatment.

Dilators are cone shaped or cylindrical objects, made of plastic or metal. They come in different sizes. You put the dilator into your vagina gently for about 5 to 10 minutes about 3 times a week. It stretches the vagina and helps to stop it from narrowing. It is important not to force this. If you find it difficult to get the dilator in, you should switch to a smaller size. You may find it easier with a water soluble lubricant like Astroglide or Durex lube or KY jelly. You can use the dilator in the bath if you prefer. Moisturisers can also help, you use these 2 or 3 times a week such as Replens.

If you find the dilator you have been using is getting a tighter fit, you may need to use it more often – talk to your doctor or nurse. You may find you have slight bleeding or spotting after using your dilator. This is normal. It isn't normal to have heavy bleeding or pain. If you have either of these, stop and contact your doctor or nurse.

You usually start using your dilator from anything between 2 and 8 weeks after your radiotherapy ends. This varies depending on your radiotherapy centre. You may need to carry on using the dilators for life. If you are having sex at least twice a week, you don't need to continue to use the dilators.

Radiotherapy to the pelvis and vagina causes some lasting side effects to your

• Ovaries, womb or vagina
• Bladder
• Bowel

After your treatment you will find that your

• Ovaries stop working
• Vagina becomes less stretchy and narrower
• Vaginal area becomes drier

If you have already had your menopause, your ovaries will have stopped working before your treatment, so the radiotherapy will not make as much difference to you. If your treatment causes an early menopause, you may want to talk to your specialist about hormone replacement therapy (HRT). 

Some doctors have been concerned that HRT could increase the chance of the womb cancer coming back. Small trials have shown no increase in risk of the cancer coming back with HRT use. There is even some research that showed that HRT might lower the risk of the cancer coming back. But we can't base treatment recommendations on one study and need more research evidence to be sure. A large trial is in progress in the USA. There are no specific recommendations about HRT after womb cancer at the moment. The trials done so far mainly included women with early stage 1 and 2 womb cancers, so there is currently no research evidence about HRT for women who had more advanced cancers.

During and after your treatment, you will probably be given vaginal dilators to use. These gently stretch the vagina and help to stop it from narrowing. If you don't use these, it can be difficult to have sex comfortably after your treatment. There is information about using vaginal dilators on this page.

Radiotherapy can stop the glands lining the vagina from producing mucous. This can cause difficulties during sex and can make vaginal infections such as thrush more frequent. Gels and creams are available that can help with vaginal dryness. Some need to be used daily, and some can be used a couple of times a week. Your hospital nurse or GP practice nurse should be able to advise you.

There is detailed information about these side effects and how to deal with them in the section about radiotherapy, sex and fertility for women.

Rarely, radiotherapy to the area of the womb can affect the bladder or bowel permanently. You may find that your bladder holds less and so you have to pass urine more often. This is because the treatment causes fibrosis in the wall of the bladder, so it is less stretchy.

Also rarely, the bowel can be affected. This usually shows up as persistent diarrhoea. Sometimes this happens all the time. Sometimes it comes and goes. Your doctor can give you medicines to slow down the bowel and help control diarrhoea. There are guidelines for doctors on how to treat people who have gastrointestinal symptoms after radiotherapy.

Do see your radiotherapy specialist again if you develop either of these problems in the months after your treatment. There are likely to be ways they can help. And it is important that specialists know about side effects.