Women's health: The core issues

Women experience unique health problems from pregnancy and menopause to gynaecological conditions. Dr Niti Krishna Raizada lists out some of the red flags that should never be ignored

When it comes to women’s health, cancers, gynaecological health, systemic diseases, pregnancy-related and general health including mental health are all a cause for concern. The most common cancers affecting women are breast, cervical, endometrial and ovarian.

Breast cancer: Apart from the obvious lump in the breast, look out for
bloody discharge from the nipple; retraction of nipple, flaking skin around the nipple; erythema i.e., redness of the skin of the breast, bruising look like red or purple or bluish tint; armpit/underarm swelling because of lymph nodes being affected; skin texture change like thickening; dimpling of skin (like an orange peel); tenderness/painful breast or nipple area; size and shape changes of the breast.

What you need to do:

Age 20-30 years: Breast self-examination/awareness.

Age 31-40 years: Clinical examination by an oncologist every 6 months

Age 41-55 years: Annual Mammogram

Beyond 55 years: Mammogram once in two years

Cancer cervix: This cancer is common in women with promiscuous sexual activity with multiple partners and is caused by Human Papilloma Virus (HPV) which is sexually transmitted. We now have vaccines for this and it will protect both the woman from getting cervical cancer in a later date, and the men from penile cancers.

To diagnose this, the gold standard test is PAP smear and is performed once in 3 years in women between 20 and 30 years and once in 5 years in women between 30 and 65 years. Screening test includes testing for the HPV Endometrial Cancer which is the cancer of the inner lining of the uterus. It is more common in the peri-menopausal period and amongst those who are on a certain type of hormones (like taking estrogen without progesterone, or on tamoxifen treatment for breast cancer). While there is no prescribed preventive screening test, those who develop unusual discharge, spotting, or vaginal bleeding (that’s getting worse, occurring between periods, or happening after menopause) should visit a doctor for evaluation.

Ovarian cancer: While it can occur at any age, it is more likely as a woman gets older. Women who have never had children or had their first child after 35 years are at a higher risk. Family history, those who have had estrogen-only as HRT, are also at high risk. While there is no recommended cancer screening tests, a routine pelvic examination and a proper history and evaluation for ovarian cancer by scanning is necessary.

Gynaecological health: During the reproductive age group, women are also affected by non-cancerous issues, which include breast lump like fibrocystic disease, fibroadenomas, breast pain, etc., & ovarian lesions/cysts/polycystic ovarian disease, uterine fibroids and irregular or heavy vaginal bleeding. It is important not to neglect any symptom and seek medical evaluation.

When we speak of women’s health, it is often possible to overlook systemic diseases like heart disease, autoimmune diseases, diabetes and other hormonal issues for eg., thyroid. Perimenopausal and postmenopausal women have the same risk for heart disease as men of the same age. The protection offered by the estrogen hormone wanes away and the risk for coronary artery disease increases.

Pregnancy issues: During pregnancy, the pre-existing diseases which a woman has can worsen affecting the life of both the mother and the child she is carrying. Chiefly, asthma, diabetes, anaemia, are to be looked out for apart from pregnancy per se which includes ectopic pregnancy or foetal deformities. Your obstetrician will cover all the issues during routine antenatal examinations.

General & mental health: Osteoporosis during menopause is an important cause of morbidity. Bone density testing, supplements with activated Vitamin D3 and calcium to prevent the osteoporotic weak bones are important must-do steps to be taken by ageing women. Depression and anxiety are the other common challenges. It ranges from Premenstrual Syndrome (PMS) depression which is due to natural hormonal fluctuations and is sometimes greatly intensified and referred to as Premenstrual Dysmorphic Disorder (PMDD). Also, shortly after birth, many mothers acquire a form of depression called Perinatal Depression. Depression also occurs during the shift into menopause, called Perimenopause Depression. No matter how intense the symptoms, care providers can provide relief with a prescription or therapeutic treatments, and women should not suffer by themselves but seek medical help.

(The author is a medical oncologist.)