Early menopause and infertility This information is an extract from the booklet, Understanding pelvic radiotherapy in women – possible late effects. You may find the full booklet helpful. We can send you a copy free – see page 5.

Early menopause Pelvic radiotherapy will cause an early menopause because it stops the production of sex hormones by the ovaries. An early menopause can be avoided if the ovaries are moved out of the treatment area before the radiotherapy starts. Hormone levels generally start to lower over about three months from the start of treatment. Your periods will gradually stop and the symptoms of the menopause may then occur. Your doctor or specialist nurse can talk to you about the likely effects of radiotherapy in your particular case. An early menopause due to radiotherapy can cause more severe menopausal symptoms than a natural menopause. The symptoms will pass but they may take a couple of years. These can include: • hot flushes and sweats • vaginal dryness

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Early menopause and infertility

• passing urine more often • lower interest in sex • tiredness and difficulty sleeping • dry skin • aches and pains • mood swings, poor concentration, lower confidence and changes in memory. All of the above effects may affect your sex life in some way.

Dealing with menopausal symptoms You can discuss with your specialist at the hospital whether you can have hormone replacement therapy (HRT). HRT can help control menopausal symptoms. If you’ve had breast cancer or some gynaecological cancers you may need to avoid taking HRT which contains oestrogen. However, you can talk to your doctor about other medicines which can help to control menopausal symptoms, such as low-dose progesterone treatment. Some post-menopausal women also have hot flushes after radiotherapy. Some women find complementary therapies such as evening primrose oil, acupuncture or herbal remedies helpful. Having low sex hormone levels at a young age can increase the risk of weakening of the bones (osteoporosis) as women get older. Radiotherapy can also directly affect the bones in some women. HRT and other medicines can help the bones to stay stronger. We can send you detailed information about complementary therapies and coping with menopausal symptoms.

Contraception Having an early menopause will mean that you will no longer produce any eggs, and will not be able to become pregnant. However, it usually takes about three months for egg production to stop completely after radiotherapy finishes. It’s not advisable to get pregnant during this time so it’s important to use effective contraception until egg production has completely stopped.

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Early menopause and infertility

If you don’t get menopausal symptoms, a blood test to check your sex hormone levels can show whether the menopause has happened.

Infertility After pelvic radiotherapy you won’t be able to have children due to the effect of radiotherapy on your womb and your ovaries. This can feel devastating. Infertility is very hard to come to terms with, especially if you were planning to have children in the future or to have more children to complete your family. The sense of loss can be very painful and distressing. Sometimes it can feel as though you have actually lost a part of yourself. You may feel less feminine. Our leaflet Cancer and fertility for women discusses the options for having a baby (such as adoption or surrogacy) if treatment for cancer has affected your fertility.

Emotional effects People vary in their reactions to infertility. Some women may come to terms with it more quickly and feel that dealing with the cancer is more important. Others may find that they accept the news calmly when they start treatment, and find that the impact doesn’t hit them until the treatment is over and they are sorting out their lives again. There is no right or wrong way to react. Your partner will need special consideration in any discussions about fertility and future plans. You may both need to speak to a professional counsellor or therapist specialising in fertility problems. They can help you to come to terms with your situation. Your doctor may be able to refer you to a fertility specialist. Our cancer support specialists can discuss problems you may have and they can also help you to find a counsellor who can give you help and advice. Our booklet, The emotional effects of cancer, has more information about the feelings you may have and how to deal with them.

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Early menopause and infertility

Pelvic pain Pain in the pelvic area after radiotherapy can be caused by a number of different things. It’s important to see your doctor quickly if you are in pain.

Infection Bladder infections (cystitis) can cause pain and a burning sensation, and are more common after radiotherapy. The pain is usually worse when the bladder is full and may be at its worst when you are passing urine or just afterwards. You may pass urine more often and your urine may be cloudy or smelly or have small amounts of blood. You may also feel ill, have a high temperature or feel sick (nauseated). Your urine will need to be tested to find out which type of infection you have so that the correct antibiotic can be prescribed.

Bowel changes Spasm of the muscles lining the bowel can cause pain and is made worse when you open your bowels. The pain in this situation is cramp-like and may come in waves. Constipation or an anal stricture can also cause pain. Sometimes pain may be due to a split in the skin of the anus (fissure) and this causes a very sharp and intense pain when you open your bowels. To find out whether there are any changes in the bowel, you may be asked to have an examination of the bowel with a flexible sigmoidoscope. This test is usually done by a gastroenterologist.

Fine cracks in the pelvic bones Very rarely pelvic radiotherapy can cause tiny cracks in the pelvic bones some time afterwards. The tiny cracks are called pelvic insufficiency fractures and the pain can be quite severe. Bone pain can often be controlled with painkillers. Drugs called bisphosphonates can be used to help strengthen the bones and a diet rich in calcium can help to heal insufficiency fractures.

Cancer coming back Pain can also occur if the cancer has come back and this is what many people who get pain worry about most. Your doctor can discuss with you the chance of your cancer coming back.

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Early menopause and infertility

If the pain is caused by cancer, it may: • be there constantly and not go away when you rest • get worse when you exercise or move around • also be there at night and keep you awake. The pain may not be bad and may go away if you take mild painkillers. However, if you have this type of pain, your doctor should examine you and arrange for you to have x-rays, a CT or MRI scan, or a combination of these to find the cause.

More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on 0808 808 00 00, Monday–Friday, 9am–8pm www.macmillan.org.uk We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. © Macmillan Cancer Support 2010. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ

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