Treatment-related loss of fertility and menopause (NBCC & NCCI 2003) requires sensitive discussion. The risk of early-onset menopause continues after chemotherapy and radiotherapy and not only immediately following treatment.

Women considering pregnancy after fertility-sparing treatment should have pre-pregnancy counselling and a formal cervical length assessment, which may require management before attempting pregnancy.

Ongoing assessment and management of (including hormonal therapy) for treatment-related menopause is required. Symptoms associated with treatment-induced menopause include night sweats, hot flushes, reduced libido and those related to reduced bone density. Symptoms, particularly vasomotor, may be more severe compared with women who go through natural menopause.

Radiation-induced vaginal toxicity (such as vaginal shortening and dyspareunia) can have a significant impact on sexual quality of life in these patients.

The lead clinician should provide the woman and carer with information about managing menopausal symptoms and other long-term side effects post chemoradiotherapy, including the use of hormonal therapy.

Referral to a social worker, menopause expert, fertility specialist, psychosexual counsellor, psychologist or psychiatrist may be appropriate, especially for younger women.