Chemotherapy, while life-saving, brings with it a whole suite of side effects that can feel anything but healing. They feel, frankly, terrible. You might not have any side effects; you might have many. And lots of these side effects are weird (water tastes bad; your nails change colors), upsetting (hair loss; infertility), and so unpleasant (nausea, constipation, and fatigue). And they’re often totally normal.

Feeling prepared can help with feeling overwhelmed, at least. We talked to doctors, nurses, and people who’ve been there for our guide on what to expect, what’s manageable, and how to navigate it all.

Fatigue and Chemo Brain

“Fatigue can be surprising. And it’s one of the most common side effects of chemo,” says Nancy Ohanian Gerhard, an advanced practice nurse at the University of Southern California Norris Cancer Hospital. Fatigue due to chemo is different from regular fatigue, as it’s not simply alleviated by rest; it can feel thick and consuming. Because chemo also kills healthy cells, it can cause you to feel very tired and may make it difficult to sleep at the same time. A loss of fluids (due to vomiting and diarrhea caused by chemo) can also lead to depleted energy levels.

Fatigue can also be due to anemia, which is when chemo lowers red blood cell production. Red blood cells are responsible for carrying oxygen to your tissues. Thus, anemia leads to lower energy levels. About anemia, Gerhard says: “You might be pale, pale in skin and pale in gums. You may be short of breath, with a fast heart rate.” Experts see this often and are equipped to treat it using medications, iron or other supplements, or a red blood cell transfusion.

You may find that naps become one of your best friends during chemotherapy treatment, though they often won’t leave you feeling well rested.

“I'd sleep late in the morning, I'd get up, I'd get my kids off to camp. They'd be gone from the house, and I'd sleep for another four or five hours. Then I'd wake up, I'd have dinner,” says Colleen G.*, who was diagnosed with breast cancer when she was 42. “We'd do dinner and baths and then I'd go back to bed and sleep again. I just slept constantly.”

“Chemo brain” is a term used to describe brain fog and trouble with memory recall or concentration from chemo treatment. This fog can be frustrating because it can get in the way of your job or day-to-day activities and make things that used to be easy for you feel more strenuous. To help with memory retrieval, you can try taking notes to help plan out tasks or remember things you read. Stress can also make memory retrieval worse. To slow down during moments of stress, some of our favorite mindfulness and deep breathing techniques are here.

A Solution: Light Exercise

It might sound counter-intuitive, but the best remedy for chemo-related fatigue is actually physical activity. “In terms of managing fatigue, the only evidence-based intervention is exercise, basically physical activity as tolerated. You certainly want to balance physical activity with rest,” Gerhard says.

Jadey also has resources on staying active during treatment, which you can find here. We love walking somewhere beautiful, getting on the stationary bike for fifteen minutes slowly, doing some gentle yoga, or learning (trying to learn) a little dance choreography.

Finding that sweet spot between rest and activity can be difficult, so it’s always best to talk to your medical team for advice.

Low Blood Cell Counts and Weakened Immune System

The way chemo works against cancer is by destroying quickly dividing cells. The cells that help make blood and immune cells are also quickly dividing, and so this can lead to low counts of those cell types. This all means you’ll be more vulnerable to getting sick. It can also lead you to feel like you always have a cold.

“You [may] feel like you have the flu,” says Colleen Sutphen, an oncology nurse. “You [may] have a fever, chills. Sometimes there's no source of fever…so we might be giving you antibiotics, but it's not necessarily fighting infection. It might just be preventing one for you.”

Your doctor may also advise you to avoid large crowds, travel, or other settings where you may get sick easily. Some doctors also suggest getting the flu shot or other necessary vaccines before starting chemo, if you have time. Ask your doctor if your chemo treatment will require taking any immune precautions for yourself or any people who spend a lot of time with you.

Taste Changes, Appetite, and Oral Care

Chemotherapy can disrupt cell growth in the mouth, leading to unpleasant oral side effects such as taste changes, mouth sores, saliva changes, and dry mouth. By inhibiting new cell growth in the lining of the mouth, it becomes harder for your body to produce saliva, leading to an imbalance in the healthy bacteria in your mouth. This can cause mouth sores, tooth decay, and infections.

There are certain toothbrushes and oral care products you may want to use to prevent symptoms like dry mouth and mouth sores. (un)cancer offers a line of oral care products specifically for cancer patients. Gerhard recommends brushing your teeth with a soft toothbrush after meals and before going to bed. Your care team may advise against flossing to avoid potential bleeding, especially if your platelet counts are low. Gerhard also recommends mouth rinses like Biotene after every meal and at bedtime. As you navigate your new dental hygiene routine, Jadey has a guide on oral care during treatment here.

“If you don't have mouth sores yet, use an alcohol-free mouthwash, because the alcohol causes burning,” Gerhard says. In some cases, she recommends “magic mouthwash,” a solution that helps relieve discomfort that’s prescribed and made by your oncology team (you can’t buy it). “We do that 20 minutes before you start eating, because it numbs the area of the mouth temporarily so you can eat without pain. It can help with mouth sores, too,” she says.

If discomfort persists, your care team may provide you with pain medication.

Eating can become a challenge during chemo, and you may not enjoy the same foods or drinks. Even something as basic as water may start to taste bad to you. Sutphen describes the taste changes as “metallic.” Lemon drop candies and mints can also help with masking the metallic taste.

A Solution: Finding Foods You Do Like

Sutphen says it’s important to find what kinds of foods you can best tolerate so that you’re still eating and nourishing your body during treatment, even if it’s not what you would typically eat. You may find that simple foods feel most appealing.

Foods that are cold, soft, and neutral are often easiest to eat when you have mouth sores. For example, Colleen G. says hot dog rolls, white bread, pasta, ice cream, and cream cheese were her go-tos. “Find what works for you, and for me, it was dairy,” says Tara Hoffmann, who was diagnosed with breast cancer when she was 43, “Toward the end, the only things I could really tolerate were McDonald's cheeseburgers and vanilla ice cream, and so I just ate that.”

You can also ask your care team to put you in touch with an oncology dietitian to help suggest foods that feel and taste good.

Nausea and GI Symptoms

Because chemo affects the rapidly dividing cells that line tissue throughout the GI tract–including both your mouth and intestines– it can cause a variety of unpleasant side effects like nausea, vomiting, diarrhea, and constipation. Nausea is the most common of these symptoms.

Sometimes just the stress and anxiety of upcoming chemotherapy or the hospital environment can also cause nausea. “Anticipatory nausea and vomiting is sometimes overlooked: where patients come to the hospital and just the sights, the smells, the sounds of the hospital will make them nauseous,” Gerhard says. If you experience anticipatory nausea, your doctor may prescribe anti-anxiety medication that can be helpful with counteracting this unpleasant form of nausea.

A Solution: Medicine (and Water)

With chemo-induced nausea and vomiting, it’s especially important to stay ahead of the game and start taking anti-nausea medications (called antiemetics), which your care team will likely provide, before or early in each treatment. This is because nausea and vomiting are hard to control once they start.

“Antiemetics are the best thing,” Gerhard says. Your doctor may recommend multiple types of antiemetics to counter nausea during and after treatment, and getting on these medications early can prevent distressing symptoms later on. Experts and people who’ve been there also recommend eating several smaller meals throughout the day, eating neutral-flavor foods, avoiding strong odors or fragrances, and staying hydrated throughout the day.

Also try to drink so so much water. “The day before chemo, I drank two to three liters of water, and during chemo, I just kept drinking,” Colleen G. says.

With constipation, your doctor can provide generic laxatives to help clear your system. For diarrhea, staying hydrated is important to make sure you’re replenishing lost fluids. Eating smaller meals may help, as well as specific foods that are low in fiber. There are also medicines your doctor can provide to help with diarrhea.

Hair Loss

This is often the scariest side effect from chemo treatment. It is important to know that not all chemo treatments lead to hair loss, and hair loss looks different for everyone. Read more on Jadey's guide to hair loss here.

“Our hair is something that a lot of us pride ourselves on. We spend a lot of money getting our hair done, it’s something that has essential parts in so many aspects of our life and the events of our life,” Sutphen says. “I think it’s a tangible thing that makes your diagnosis real. It’s the first time that a lot of patients see their diagnosis in the mirror.”

Hair loss begins about two to four weeks after chemo treatment begins (or after your first few rounds of chemo are complete). It can happen in clumps or gradually. You may also notice your hair thinning or your scalp feeling tender, itchy, or sensitive. Seeing these changes can be distressing, especially because it’s not just on your scalp – it’s eyelashes, eyebrows, and body hair, too. There's no right or wrong way to face hair loss: some people will decide to get a short cut or buzz; others wait to see what happens. Whatever feels right for you is going to be right.

A Solution: Cold Capping

Cold capping, a treatment involving wearing a tight-fitting helmet-like cap that emits very cold temperature, is an option for some people and can mitigate hair loss from chemo (though not 100%). Not everyone is a candidate for cold capping (if you have a blood cancer or a tumor on your head or neck, you can’t use it; or if you have type 3 or type 4 curls it might not be as effective). To learn more, Jadey’s guide to cold capping is here.

Hair loss can continue for a few weeks after you complete treatment, and your hair may not grow back the same as it was before. The color or texture of your hair may be different, and regrowth may be slow. It will grow back though. (And in the meantime, here are some of our favorite hair loss products and our guide to hair regrowth.)

Skin and Nail Changes

Chemo may cause skin changes like dry skin, hyperpigmentation, or rashes and changes to your nails like ridging or lifting (more here). Dermatologists and cancer experts say it’s best to show your skin some tender care during this time–by using gentle, fragrance-free products.

“You want to really focus on gentle skin care, so things like not taking too hot of baths, but warm baths, lukewarm baths [or showers], using gentle soaps or soaps sparingly, just in the dirty areas,” says dermatologist Dr. Yesul Kim. You’ll want to moisturize frequently, with an alcohol-free moisturizer. “You want to go for more creams and ointments rather than things like lotions, because lotions have more alcohol content and they could sting a little bit more.”

“For the most part, the lightest makeup that you can use for every day would be great. Tinted moisturizers are wonderful, things with SPF,” Sutphen says, as some chemo treatments can increase sun sensitivity. Experts typically recommend using sunscreen that is at least SPF 30 to make sure our skin is protected during treatment.

Anxiety, Depression, General Fear, General Sadness, General Anger

Intense, serious feelings are so common, and so expected during cancer treatment.

A Few Solutions: A Helpful Therapist, and Some Pharmaceuticals

Don’t hesitate to ask your team to connect you to a therapist (more on finding a therapist here), and don’t hesitate to inquire about some pharmaceutical help. This is an extreme situation; and your reactions and fears and sadness are all normal (and very common). Marcella Kelson, a life coach with masters degrees in developmental psychology and social work, who primarily works with new mothers and women with cancer, says: “The first thing that I did when I got diagnosed was I went on a low dose antidepressant that also helps with anxiety.”

Sometimes it can feel like you’re being told to push through the pain, even though there are useful tools and medications out there to help.

“There’s an idea to just get through it, because you're supposed to get through hard things. I think that’s really short-sighted,” Kelson says, “It’s healthier being on a low-dose antidepressant and not feeling terrified all the time than it is to be in a situation where your nervous system is revved up all the time.” Once she finished treatment and was feeling better, she tapered off. [Editor’s note: of course, this is advice to talk to your medical team about.]

Neuropathy

You may notice a tingling sensation or numbness in your hands and feet from chemo. This is a result of neuropathy, a type of nerve damage caused by chemotherapy. It’s a very common side effect and can interfere with fine motor skills, like typing or buttoning up your shirt, and balance. Unfortunately, neuropathy can be very painful.

“Neuropathy was a whole lifestyle change. I went from being a national level triathlete to not being able to walk a mile without my feet flaring up,” says Alayna Riozzi-Bodine, who was diagnosed with Hodgkin lymphoma when she was 17 (our interview with Alayna here). Her neuropathy was so severe that her care team ultimately shifted her to a different treatment plan to avoid those symptoms. Always be transparent with your doctor about what you’re feeling so that they can best support your comfort and healing.

A Solution: A Little Exercise Again (and Some Icing)

Currently, there’s no concrete cure or way to prevent neuropathy, but experts agree that exercise definitely helps with the side effects. “There's different types of exercises that could be beneficial. So, for example, if patients are having a lot of neuropathy in their feet and walking is challenging, there's alternative exercises like yoga that are very helpful with balancing,” says Jessica Scott, director of the exercise oncology program at Memorial Sloan Kettering (read our interview with her here).

Some people also recommend wearing icy gloves and icy socks during chemo treatment to minimize neuropathy; these can also help minimize changes to nails.

Sexual and Reproductive Health

Chemo can cause many changes to your sexual and reproductive health, as well. Changes like low libido and vaginal dryness can be uncomfortable, and some doctors recommend gentle, fragrance-free lubricants or jellies to help.

The cells of the reproductive organs are also fast dividing, meaning that chemotherapy can target them, too. This may lead to temporary or permanent treatment-induced menopause and ensuing menopause-like symptoms, such as paused periods, hot flashes, and joint pain. Especially if you’re younger, these symptoms can be disorienting and distressing.

“I think that this is something that is often glossed over in the very, very long list of potential side effects of cancer treatments, and I think that what women can experience can vary,” says Dr. Suneeta Senapati, a reproductive endocrinology specialist at Penn Medicine. We have some suggestions from experts on how to navigate treatment-induced menopause as well as a product guide of some clever, helpful items that can alleviate menopause symptoms.

Depending on your age and treatment course, there may also be some fertility risks. No matter where you are in terms of thinking about a family–years away or actively trying–fertility preservation can feel overwhelming. Jadey has a guide about navigating fertility, family-building, and cancer here.

“You can decide whether or not you pursue fertility preservation,” says Tracy Weiss, who pursued fertility preservation at the time of her cervical cancer diagnosis as a 30-year-old newlywed and now the Executive Director of oncofertility support organization Chick Mission, “you get to decide what to do with your future because you’re going to have a future.”

What About Everything Else?

Unfortunately, there are many different side effects from chemo, including hearing or vision problems and weight changes. You may experience many of these, or you may not experience any. The effects of chemo treatment are cumulative, so side effects may shift, change, and often get worse as treatment continues. It's important to talk to your care team about side effects to make sure there's nothing concerning; they might have medication or strategies to help minimize any unpleasant side effects. Talking to them–and your loved ones–will also help you process what’s going on, and give cues to everyone who cares about you on where you could use some help.

*Some names have been shortened by request.