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Early menopause as a result of your treatment
Fatigue means feeling tired and exhausted. Fatigue can be constant, or you may find that there are times when you feel less tired, and other times when it feels too difficult to do everyday tasks, and no amount of resting seems to make any difference. During treatment you might expect to feel tired as a side effect of surgery, radiation and/or chemotherapy. At that time fatigue may not be a surprise to you. However, what is surprising for many women is ongoing fatigue once their treatment has been completed. Not every woman experiences fatigue, but for those who do, it is important to remember that while fatigue can be distressing, it is a common problem.
Fatigue affects everyone differently and can have many different effects on your day-to-day life. Some of the more common symptoms that accompany fatigue are: Some of the more common symptoms of fatigue are:
Many women experience anxiety, stress and uncertainty following their diagnosis and, together with changes in sleeping and eating patterns, these can all contribute to fatigue. In addition, treatment often starts soon after you are diagnosed. So, while your body is trying to cope with treatment, your mind is trying to deal with the shock of the diagnosis. Travelling to and from the hospital or treatment centre and dealing with other treatment side-effects can also be tiring. Fatigue can also result from the treatment itself. If you are feeling fatigued while undergoing treatment, talk to the health professionals involved in your care. Often people think that they shouldn't "bother" the health professionals, or that they would not be interested. Fatigue is not a sign of weakness, laziness or failure to cope. Health professionals are involved in your overall care and need to know about your emotional and physical well-being.
Once treatment is completed, many women expect to return to their previous energy levels. While many women do, a significant number of women continue to feel fatigued. This usually improves after a short while, but it can continue for longer. Some women find it can take one or two years to fully recover. During this time there are a number of things you can do to help yourself cope with ongoing fatigue.
Support: After treatment, many women find that the support they received during treatment from friends and family dwindles or disappears. There is a general expectation that it is now time to "get on with things", and "put your experience behind you". Most women find this easier said than done, and continue to need practical and/or emotional support for some time. It is important to explain to partners, family and friends that you are not yet able to take on a full load, that this is normal, and you still need their help. Be specific, identify the tasks with which you are having difficulty and suggest ways that they can be useful. Often women say they feel "guilty", that they "should" be able to do all the things they were able to do before their illness. Remember that while you may not be undergoing treatment, your body and mind still have a lot of healing and adjusting to do. This all takes effort, and sometimes there is just not enough energy left over to do the everyday things. It may be necessary for you to relax housekeeping standards, accept offers of help with shopping, cooking, and other tasks, and delegate others to take on some of your more exhausting roles. It is important also to recognise how much you are achieving. Try focusing on what you can do, rather than what you find too hard. Think about your expectations; are they unrealistic right now? Knowing what you have been through, would you expect someone else in your place to be doing what you are expecting of yourself? Maybe you would be encouraging them to do what they can, while setting themselves achievable goals to work towards? Sometimes the messages we would give to others are the ones we need to give to ourselves. Sleep: You may find that your sleeping habits have changed. Some women say they are constantly running through the "what ifs" in their minds when they are trying to sleep. If this is happening to you, make sure that you don't let your bed become your "worry couch". If you are unable to sleep because of your thoughts, it is best to get up for a short while, do something to help calm yourself, then return to bed. Avoid stimulants (coffee, tea, alcohol, nicotine, sugars etc.) in the evening as these may make your anxiety levels higher. Menopausal factors may be stopping you getting 'a good nights sleep'. Hot flushes at night and increased urinary frequency can mean you find yourself waking in the night. Check these symptoms out with your health care team or local health clinic. Help with these troubling symptoms can also help you sleep better. Diet and exercise: You may find that your eating habits have changed, or you may no longer enjoy certain foods. Maintaining a well balanced diet can be hard at this time, but good nutrition can play an important part in your healing. In addition, you may be feeling too tired to exercise. Gentle exercise such as walking can help you overcome fatigue, even if you don't feel like it. As everybody has different needs, talk to your doctor or health professional if you need advice. Together you can come up with an appropriate and balanced diet and exercise plan that suits you. Dieticians are often available in major hospitals, to provide additional advice.
Some women find keeping an Energy Diary (a note of their energy levels) helps them to identify times when they have more energy than others. Recognising your "good" times allows you to plan your days. You may also note certain things that seem to drain your energy more than others, and work on ways of dealing with this. It may also be useful to you when you speak about your fatigue to doctors, family, friends and employers. On the next page is an example of an energy diary that you can print and photocopy.
Regardless of whether you already have children, or whether you wanted children, to be told that you will lose your fertility (your ability to have children) can be devastating. The idea of having children, or having more children to love and nurture, may have been a long-held dream. The loss of this dream can be felt as a deep grief. Even if having children was not in your plans, loss of fertility can be very distressing. Motherhood and fertility are strongly tied to our sense of ourselves as women. For some women, losing their fertility can be as difficult to accept as their cancer diagnosis. For others there may be a sense of regret, but also of acceptance. There is no right or wrong way to feel. Women facing infertility often say they feel that "life is not fair". As if being diagnosed with cancer is not bad enough, the loss of fertility, as well, can feel overwhelming. Women often feel angry and cheated. Symptoms of such grief may include a preoccupation with your own thoughts, teariness, emptiness and a desire to withdraw from others, especially friends and family members who have children. While such feelings may not go away completely, they usually lessen over time and become easier to recognize and handle (see Emotions section of this site). As with other emotional distress, it is important that you talk about your feelings. If you need support beyond your family, speak to members of your treatment team.
Early menopause as a result of your treatment As a result of surgery, chemotherapy or radiation treatments you may find you no longer have menstrual periods and are suddenly thrown into menopause. As menopause is usually associated with growing older and is normally a gradual transition, the sudden onset of menopause can be both physically and emotionally difficult to handle. It may take you a while to adjust, not only to changing levels of hormones in your body, but to the fact that your symptoms belong to women of an older age group and signify the end of childbearing. The most common emotion surrounding early menopause is a sense of loss. For most women this becomes less painful in time, but it is important that you seek emotional support from friends, family members, a member of your treatment team or your local women's health clinic, if you are experiencing ongoing emotional or physical distress. Many hospitals also run menopause clinics. Ask your treatment team to refer you to your nearest clinic if your symptoms are not improving. The symptoms most commonly associated with menopause are: hot flushes, night sweats, vaginal dryness, mood swings, fuzzy thinking and forgetfulness, and problems with sleep. The following tips may help you deal with these troubling symptoms. Hot flushes: (a hot flush is a sudden feeling of heat in the body that may last for several minutes. You may also find you sweat, go red in the face, and your heart may race). To help with this symptom try to avoid going out in the heat of the day, turn down heating in the home, wear cool, loose fitting clothes (preferably cotton) and avoid spicy foods. Night sweats: (a night time version of hot flushes where you may find yourself waking up drenched in sweat). To help with this symptom try to keep your bedroom as cool as possible. If you find a doona too hot in winter, use blankets (preferably cotton), so you can throw off a layer or two when you feel too hot. Vaginal dryness: Water based lubricants may be helpful. Talk to a member of your treatment team for advice.
Fuzzy thinking and forgetfulness: Fuzzy thinking and difficulty in concentrating during menopause bothers many women. The sudden change from being able to remember many things to forgetting many things can be very disturbing. Often women are afraid that it is the start of an ongoing decline and become afraid they are "going senile". The more anxious you become about this loss the more you are likely to be troubled by it. You can probably remember many times when you forgot where you put something and the more agitated you became the less effective you were in finding it. Perhaps you looked in the same drawer for something over and over, becoming more and more distressed, only to have someone find it right where you had already looked. When we get agitated our recall of things is poor, so one way you can help yourself is to do everything you can to remain calm when you experience forgetfulness. It will not help if you tell yourself that you are "silly, stupid or going crazy". Give yourself permission to forget some things while your body and brain is working flat out helping you cope with your diagnosis, treatment, and the ongoing challenges cancer presents. A 'to do' list is also useful. Jot down appointments and other things you need to remember. In this way you don't need to remember them. (Though you do need to remember where you left your list!) Mood swings: It is not uncommon for women going through menopause to experience sudden changes in their mood. If you are dealing with menopause, in addition to a cancer diagnosis, understandably your moods may swing from high anxiety to low depression. It is common for women to also experience times of anger. See the Emotions section of this site for help with your feelings, and if your symptoms are troubling you seek support from your health team. Sleep difficulties: Night sweats are likely to disturb your sleep, however other worries may also be contributing to a difficulty in getting to sleep, or in staying asleep. It may help to avoid caffeine, alcohol, and heavy meals in the afternoon and evening. Also, go to bed at the same time each night, and make sure your bedroom is dark, quiet, and comfortable. If you find yourself lying in bed unable to sleep it is often better to get up and do something to take your mind off your concerns, and then return to bed when you are feeling more relaxed. A daily routine of gentle exercise and relaxation will also help.
Hair loss is a common side effect of chemotherapy, but not all drugs cause hair loss. Ask your doctor if you are likely to lose your hair with the drug or drugs you are taking. When hair loss does occur, the hair may become thinner or fall out entirely. Many women are aware that they may lose the hair on their head, but are surprised to find that they also lose their hair in other areas including the head, face, arms and legs, underarms, and pubic area. The hair usually grows back after the treatments are over. Some people even start to get their hair back while they are still having treatments. As the hair grows back you may find it is a different colour or texture. It may even grow back curlier or thicker than before. Hair loss does not always happen right away. It can start after a few treatments, or a few weeks after a treatment. Women often find that their head becomes sensitive before losing hair. If you do lose your hair, it may fall out gradually or in clumps and any hair that is still growing may become dull and dry. Even before you lose your hair it is important to take especial care of your scalp and hair. The following tips have been found helpful to others who have gone through this
Some women choose to wear a wig or turbans and scarves. Others leave their head uncovered. You may prefer to cover your head in public and leave it uncovered at home. Do whatever makes you feel most comfortable. Losing hair from your head, face, or body can be hard to accept. Some women find it very hard to deal with, as it is so visible. Feeling angry or depressed is understandable. At the same time remember that it is a temporary side effect.
Talking about your feelings will help. It is also a good idea to talk with other women going through the same experience. Find out where a Look Good Feel Better course is going on in your neighbourhood (ask at your treatment center). They provide helpful tips and the opportunity to talk with other women who understand what you may be experiencing. Lymphoedema occurs when the lymphatic system is not functioning normally and lymph fluid is unable to drain away resulting in swelling. Women diagnosed with gynaecological cancer that have undergone surgery and in particular the removal of lymph nodes, and/or radiotherapy, are more at risk of developing lymphoedema. Lymphoedema can cause discomfort, pain, increase risk of infections and even effect mobility if left untreated. If you are concerned about any swelling it is important that you contact the clinical nurse consultant, or if unavailable speak to another member of your treatment team at any of the specialist gynaecological units, to ask for advice and an appropriate referral to a lymphoedema specialist located in your local area. The earlier treatment commences the more successful the outcome.
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