Yesterday was International Women ’s Day,an occasion rooted in the centuries-old struggle of women to participate in society on an equal footing with men.Let ’s take this time to look at a vital aspect of women ’s lives – the issue of healthfrom birth to the end of life.By PAUL YEO
WHEN a child is born into this world, its destiny is often determined by the presence, or more appropriately, absence, of a tiny strand of protein called the Y chromosome. There is truth in this, though fallacy is often not too far away.
To be born a woman is to be subjected to the vagaries of life imposed by those with the Y chromosome. This is evident in many parts of the world, though things are changing, albeit at a snail’s pace.
But what is even more evident are the biological differences that are stamped from birth. The various stages of a woman’s life (let’s call her Eve) are marked with milestones that exert significant influence in the way she lives and the effects on her health. Puberty, menstruation, pregnancy, childbirth, menopause – these are phenomena alien to possessors of the Y-chromosome.
Eve’s life will be significantly affected by the changes imposed by these biological developments. This is one of the many reasons why medicine in recent years has increasingly focused on the speciality of women’s health, and all it implies.
Let’s take a brief look at these stages. It has been conveniently packaged into seven parts to echo Shakespeare's “Seven Ages of Man” and for the sake of simplicity, but we have to remember that health is a continuum and cannot be regarded in isolation.
Birth to teens
The first bloom of life heralds a period of rapid growth and discovery for Eve. She’s going through the developments that all children go through, until she reaches the age of eight. That’s when she finds that boys and girls are different, in many different ways.
According to consultant obstetrician and gynaecologist Dr Nor Ashikin Mokhtar, puberty refers to the period during which an individual becomes capable of sexual reproduction. It is heralded with breast changes and the development of secondary sexual characteristics. “These days, the age of puberty has become younger, with some girls experiencing it from ages eight to 10, compared to 11 or 12 in the older days. This may be due to reasons such as lifestyle, food, the environment.
“The effects of puberty are remarkable. There are dramatic changes in physical appearance that occur during a short span. One enters puberty looking like a child, and within a few years or so, has the physical appearance of a young adult.”
Dr Nor Ashikin comments that this can be a rather anxious time. “There may be unequal development of the breasts, which is quite normal. In addition, the onset of menses can cause panic in some girls. Primary dysmenorrhoea (period pain) can also be very distressing. You have to remember that the neck of the uterus is only about the size of a pinhole, so if the body is trying to squeeze out menses through this opening, pain may be inevitable.
“Besides painful periods, the young girl may also be experiencing irregular periods. Sometimes it’s too little, other times it’s too much, too early, too late. This is quite normal as the ovaries are still ‘new’ at it. However, do consult a doctor to exclude any problems.
“All these changes and developments require the support and understanding of parents. It is crucial.
“Other changes that occur include those related to the skin like pimples and body odour. These are the rituals of puberty. Such developments should be followed closely by parents and appropriate support extended to the daughter,” she advises.
Most of all, reproductive health changes will come to the fore. As a result, issues of sexuality need to be looked at. “Sex education is important in this stage of life. It’s a misconception that sex education encourages promiscuity. A study in the US has shown that half to two-thirds of teenagers who start experimenting with sex did not have sex education. This gives rise to many dangers, especially sexually transmitted infections and unwanted pregnancies,” she observes.
Peer pressure, the influence of popular media and pop icons may also give rise to a unique problem – eating disorders. This could persist throughout their lives, and can even be deadly in certain circumstances.
20s to 30
According to Dr Nor Ashikin, this is the time when a woman is at her reproductive peak. “If a woman has plans to start a family, this is the right time. She is at her most fertile, and does not generally have any underlying disease that is associated with older women, like diabetes, high blood pressure, endometriosis. The quality of eggs is at its best. With increasing age, eggs do deteriorate, and this is a factor to consider.”
Obviously, if the woman is not prepared for children, and she is sexually active, she has to take precautions. This is not only to avoid unwanted pregnancies, but also to protect against sexually transmitted illnesses (STIs). Condoms (used correctly) will offer the best protection from STIs. It is worth using these as well as another contraceptive, such as the pill. This is known as the “Double Dutch” method, and it allows two-fold protection – from both pregnancy and infection.
“The pill also has other beneficial effects. It can protect against ovarian cysts, ovarian and uterine cancers and endometriosis,” says Dr Nor Ashikin. “If a woman is thinking about postponing conception, it may be a good idea to take the pill because of all these beneficial effects.”
Other barrier methods include diaphragms and cervical caps, all usually used with a spermicide cream or gel, and the female condom. These fit over the entrance to the womb, preventing the sperm from reaching and fertilising the egg.
This is also the time when beauty concerns are the most prominent. It’s that age when the dating and mating game is played most frequently. However you look at it, health and beauty are inseparable. The healthier you are, the better you look.
30s to 40
Most of the concerns about health for Eve in this stage of her life are similar to those in her 20s, except that depending on how she has taken care of her body, illnesses such as diabetes and hypertension become more of a concern.
In addition, her reproductive clock is starting to wind down. Dr Nor Ashikin says: “The risk of endometriosis becomes greater, especially for the woman who has postponed pregnancy.
“Endometriosis is a condition where the woman develops patches of the womb lining (endometrium) growing outside the womb. Usually this is still within the abdomen, but it has been reported to occur all over the body. Why this happens is not clear although there are many theories. At the time of her period, there is pain and bleeding from these areas of endometriosis, which can result in the abdominal cavity becoming a sticky mess of adhesions.
“The condition can be treated with drugs, hormones and surgery but for some women their fertility is reduced and, worse still, they may end up having to have a hysterectomy or other major gynaecological surgery.”
For the woman who is prepared for childbirth, planning is important. Once you are pregnant, life will seem an endless stream of new experiences, prompting questions on pregnancy itself, the developing baby, your own health and the effects of the change in relationship for the other family members.
And all might not be as rosy as you want if you’re prepared for a baby. Miscarriage is surprisingly common, with many being lost before the woman even is aware she is pregnant. Recurrent miscarriage is particularly distressing. Establishing a cause is important, although for many, there is no simple answer. Where a cause is found, such as a loose cervix or underdeveloped placenta, there is potential for treatment that can reduce the risk for future pregnancies.
“At this stage, it would be appropriate to talk about pap smears. It checks for changes in the cells of the cervix, the lower part of the uterus (womb) that opens into the vagina. The test can tell if you have an infection, abnormal (unhealthy) cells, or cancer of the cervix. Any woman who is sexually active should get an annual pap smear carried out. The chances for cancer of the cervix increase when a woman starts having sex before age 18, has many sexual partners or has genital warts,” says Dr Nor Ashikin.
40s to 50
According to Dr Nor Ashikin, the possibility of illnesses such as hypertension and diabetes increases. In addition, for the woman who hasn’t started a family and wants to start one now, the risks increase, both for the woman and the baby. Chances of abnormalities in the baby increases, and such concerns should be addressed.
“For some women,” says Dr Nor Ashikin, “they may start experiencing peri-menopausal symptoms. These can occur five to 10 years before actual menopause, and can be distressing.
“This is most apparent in this age group. It is a collection of symptoms that include: mood swings, both depression and agitation, irritability, bloating, headaches, breast tenderness, skin and hair changes.
“At this time, career women are possibly at the peak of their working life,” comments Dr Nor Ashikin. “Such symptoms can be handled with the appropriate treatment, which is important to enable the woman to achieve her goals in her career.
“She should also be thinking seriously about annual check-ups. Besides the usual physical examination and blood tests, mamograms should be included.”
50s to 60
“These are the menopausal years,” says Dr Nor Ashikin. “It’s the end of the reproductive period. A woman can see the situation in either one of two ways – a life half empty, or half full.
“In the modern era, the menopausal years become even more significant because women are generally living longer lives. The average age of life has progressively increased.
“Thus, women are spending a substantial part of their lives in menopause. They have to take better care to avoid being ill for longer periods just because they are on living longer. It's about quality of life, and grabbing as much as you can.
“Whichever way you look at it, illnesses such as heart disease, diabetes, hypertension and stroke become real concerns. In fact, after menopause, a woman is equally at risk of heart disease as a man. The major cause of death after menopause is heart attack, and deaths in general due to heart attacks is 10 times more prevalent than cancer.
“It is therefore important that the woman maintains a healthy lifestyle and keeps her weight down. Menopausal women tend to gain an average of 4.5kg during this time. This increases the risk of diabetes, high cholesterol and certain cancers like of the breast and uterus.
Despite the fears inherent in hormone replacement therapy (HRT), such as increased risk of breast cancer, Dr Nor Ashikin stresses that individualised HRT treatment for menopausal symptoms is practical and should be considered.
60s to 70
This is the time of the silent epidemic – osteoporosis. According to Dr Nor Ashikin, if the woman has high calcium reserves “laid down” during her younger years, she’s less likely to be affected. “But it’s never too late. Carry out annual bone density scans. If a bone density scan shows brittle bones, there are medications to increase bone mass. Hormone replacement therapy helps. Calcium supplements help. It’s not too late.”
Chronic diseases such as diabetes, stroke, hypertension and heart disease are more prevalent. In addition, cataracts, tooth loss, all these become realities and affect the general well-being of the woman. “Everything’s failing,” comments Dr Nor Ashikin. “Alzheimer's disease becomes more prevalent and there’s increased incidence of colon cancer.”
The biological milestones that will affect Eve are but only one facet of her life. She will be expected to bear children. She will be expected to be a good mother. She will be expected to be a career woman (if she’s lucky). She will have to battle the prejudices of a world dominated by Y-chromosomes. She will face different battles, from the time she’s born, to the time she is laid down to rest. The fight to maintain life-long good health is certainly one of them.
Having my babies was the most exhilarating experience but I suddenly feel my two pregnancies (my children are aged two and four) have taken their toll on my body, and I have started feeling the effects a lot more over the last year. I have a bad back, get tired more easily and my blood pressure is higher than what it should be. All this is scary but I see it as a warning from within that my body's no longer that of a spring chicken and that it's time to start being more concerned about how I look after my health.
Up to very recently, I took no supplements at all, but now I religiously take my multivitamins and calcium tablets daily. I am also a lot more aware that regular checkups are necessary to prevent more problems: for the first time ever, I've done a full medical complete with blood tests, X-rays, pap smear and a full breast examination. I can't kid myself any longer that diseases like cancer and won't happen to people my age ? because it can, and that's a scary thought.
And there are other niggling reminders of my age ? little wrinkles on my forehead, and around my eyes, as well as increasingly dry skin. This means I have to be extra diligent with skincare too. Gosh, I really miss those carefree 20s.
Mila Kumar, 35, writer
I remember my mother moaning that I had lost my 'baby smell' – I was about 11 and my scalp and skin had started getting oily. It was the time I started getting pimples too. That was when I realised that I was leaving my childhood behind. My breasts started to grow and the process was sometimes painful. I found the changes to my body interesting and quite exciting. I was lucky that I could talk to my mother about them and she bought me books to read. My school also had people from a sanitary pad company coming to give us girls a talk on menstruation. My classmates and I were in Standard Five and we giggled a lot.
I got my menses quite late – 13 – compared to my friends and that really bugged me. When it finally arrived, it was like, 'At last, I am a woman.' Now that it's part of my life, it can be a real pain as I suffer from cramps.
My mum always says it seems like I shot up and grew into a young lady overnight. But she complains I don't act lady-like enough. It's hard sometimes because I feel I'm not in complete control of limbs; they are kinda gangly and I am trying not to hunch. Looking at my old photos from a few years ago, I sometimes can't believe how much I have changed in such a short space of time!
Tan Wei Li, 15