Women’s health: your start of the year review

Women and girls have unique health requirements, which require holistic care to enable them to remain healthy and live well. At the start of a New Year, I always recommend to my patients that they take a moment to review their health and make an appointment to see their doctor. Generally, health issues identified early have better health outcomes – so please don’t put it off!

Here is a summary of health issues women should take a moment to review:

1. Health screening for cardiovascular disease

Preventative care is a fundamental part of women’s health, in particular screening for cardiovascular disease. Latest research shows 1 in 3 women die from cardiovascular disease, such as heart attacks, heart failure and stroke. Women are often diagnosed at a later age with heart disease and they tend to have other co-morbidities, such as diabetes, at the time of diagnosis leading to higher risk of complications.

High blood pressure, or hypertension, is the single biggest risk factor for heart disease. It is often called the ‘silent killer’. Regularly screening for high blood pressure is, therefore, essential.

Other lifestyle risk factors that impact your heart health and can be modified are:

a) Nutrition: eating more plant-based foods, whole grains, fish, lean animal proteins and minimising processed meat and sweetened drinks.

b) Exercise: ideally 150 minutes of moderate-intensity exercise (i.e., an activity where you are slightly out of breath to maintain a conversation), or, 75 minutes of vigorous activity each week.

c) Weight: a ‘healthy’ weight is unique to each individual. BMI is a good way to give you an understanding of your weight – whether you are underweight, healthy weight, overweight or obese. However, BMI may not be an accurate reflection, especially in certain ethnic groups (Afro-Caribbeans, Asians). If you are concerned about your BMI (or are not sure what it is) please see your doctor.
Another useful way to assess weight is by measuring your waist size. A waist size larger than 35 inches for women and 40 inches for men raises risk of diabetes, heart disease and stroke.

d) Smoking: any smoking has a negative impact on your health, with smoking attributed as a risk factor for heart disease, stroke and cancers. Please talk to your doctor who can counsel you further about smoking and empower you to quit.

e) Alcohol: ideally limit your alcohol intake to no more than 14 units per week. This is on average 10 small glasses of low-strength wine, or, 6 pints of average-strength beer.

At Osler Health, we carefully review all aspects of your day-to-day life during your health screening. We ensure your health check is matched to your needs and truly reflects an accurate picture of your overall health. For more information on our approach to health screenings.

2. Cancer screening

Cancer screening is important as it helps to detect and treat cancer early. Cancers, in particular, lung, breast and colorectal cancers, are within the top 10 leading causes of death for women.

a) Lung cancer:  there is currently no investigation that is appropriate to screen for lung cancer. However, leading a healthy lifestyle, not smoking or stopping smoking can lower the risk of lung cancer.

b) Breast cancer: breast cancer screening is recommended for women aged 50 years and above. If you have other risk factors (such as family history, history of other cancers), your doctor will recommend starting breast screening at an earlier age. Breast screening is usually done with a mammogram. Some women may also require breast ultrasound. These tests are usually done every 2 years, but some women may require screening tests annually.

c) Cervical cancer: cervical cancer screening starts at an early age. The Singapore and UK guidelines recommend women start screening at the age of 25 years onwards, while, the US CDC recommends an earlier start for screening at 21 years. Cervical cancer screening is performed with a smear test and usually recommended once every 3 years.

For girls and younger women, a vaccine against HPV (human papilloma virus) can protect them against cervical cancer.

d) Colorectal cancer: screening is recommended for both men and women. Different countries have different guidelines of the most appropriate age for screening, but this usually tends to be when you are 50 years or above. This screening can be done by either using a stool test annually, or, other tests to look at your colon (e.g., colonoscopy). Your doctor will discuss with you the frequency if such tests are required.

3. Sexual health and Urinary Incontinence

Sexual health is a crucial part of women’s health and one that is not discussed enough. It is important to be aware of possible disorders that may affect your sexual health.

Sexually transmitted infections and diseases (STIs / STDs) require specific treatment and care. The impact of STIs / STDs is not limited to the individual – it can affect your partner and there can be many adverse effects with mother-to-child transmission.

Diagnosis and treatment of STDs can often be made in primary care. We can arrange testing for you and refer you to the most appropriate centre should you need these next steps. Some concerning features that you should be aware of for STDs are:

• New vaginal discharge or change in vaginal discharge, including smell
• Ulcers or warts around the genitalia or anus
• Rashes
• New symptoms affecting different organs of the body

It is common for women to have sexual health concerns, with nearly 50% – 98% of women experiencing symptoms like reduced interest in sex, difficulty with orgasm, painful sexual intercourse. As your family doctor, we ensure to address your concerns confidentially and help you to manage these issues holistically.

Urinary incontinence, the unintentional passage of urine, is a common problem that impacts quality of life for women of all ages. It may be due to different causes, with risk factors being age, general body habitus, pregnancy and childbirth, overall health, use of some medicines and previous surgical procedures.

Your doctor will evaluate your symptoms and recommend appropriate investigations and management. A referral to a specialist who manages women’s urinary symptoms, a Uro-gynaecologist, may be needed and we can arrange this for you.

4. Contraception, Pregnancy and Breastfeeding

Pregnancy and birth bring about significant changes to a woman’s life. Contraception allows you to manage your reproductive health. There are several different forms of contraception available – hormonal vs non-hormonal, daily medications vs long-standing medications or devices, reversible vs irreversible methods. An in-depth discussion with your family doctor will enable you to choose the most appropriate contraception for you.

When and if you decide to have a baby, please have a look at our Having a baby in Singapore guide. Most of the antenatal care in Singapore is provided by Obstetricians. We can support you through this period.

As your family doctor, we also look after your postnatal care. This often means a 6-week postnatal review. However, many women will require more immediate postnatal care, e.g., episiotomy wound care, breastfeeding concerns, management of their ongoing conditions such as high blood pressure or diabetes, which may have existed prior to pregnancy or diagnosed during pregnancy.

Breastfeeding can be a difficult but rewarding journey. It has important health benefits for you and your child. Please read our Breastfeeding 101 article as a guide to breastfeeding and get in touch with us for more information or seeking help with any breastfeeding concerns for you or your baby.

5. Menstrual cycle and Menopause

Menses usually start around the age of 12 years, but it may be earlier or later in some girls. Many adolescent girls or women of reproductive age often experience some common menstrual problems, such as:

• painful menses: crampy pain with periods, which may be in the lower abdomen and even your lower back. It affects 50 – 90% of girls and women.
• pre-menstrual syndrome (PMS): occurs as your body’s hormone levels change before your menses, affecting up to 12% of women. Common symptoms include bloatedness, breast tenderness, mood changes, skin or hair changes and loss of interest in sex.
• changes in menstrual pattern and menstrual irregularities: sudden heavy menstrual bleeding, bleeding between menses, or stopping of menstrual bleeding.

These menstrual symptoms can be a cause of concern. Your doctor will evaluate your symptoms and help you treat the underlying cause.

On the other spectrum of menses is menopause, which is a permanent cessation of menses. Most women notice their menses become less frequent until they completely stop. It is a natural physiological process that usually occurs between 45 years – 55 years of age. Most women experience menopausal symptoms, such as hot flushes, night sweats, vaginal dryness and discomfort during sex, mood changes, problems with sleep, memory and concentration.  You may experience these symptoms months or years before your menses stop and some can persist even after your last menses.

There are many lifestyle modifications that may help with menopausal symptoms. Please read our Demystifying Menopause article to understand this further. We also have some useful Menopause Factsheets. If you are experiencing bothersome menopausal symptoms, please come and speak to us. We can help in managing these and evaluate whether you will benefit from medical therapy.

6. Mental health

Feelings of stress, worry, sadness and anger are a part of our normal emotional well-being. However, when these feelings overwhelm and interfere with our day-to-day functioning, they are considered as more serious conditions, such as anxiety, depression and other mental health diagnoses.

Women are more likely to be affected by depression, anxiety, psychological distress, sexual violence and domestic abuse.  This has been amplified during the pandemic with social isolation, health uncertainty and economic challenges faced by many individuals. With COVID-19, stress has increased worldwide from 35% to 40%.

Mental health plays a significant role in leading our best health. Research shows the state of our emotional health can positively or negatively affect our cardiovascular health and be a risk factor for heart disease.

If you are or your loved one has been experiencing intense feelings of sadness, worry, loss of hope, feeling tearful or considered self-harm, please come and speak to us. At Osler Health International, we understand how difficult this first step can be and we will support you to manage your mental health.   Read more on Mental Health pages and reach out if you need support.

And finally…

As a family doctors, the team at Osler Health can guide you through whatever women’s health needs you require. We have a kind and experienced team including male and female doctors. Please prioritise your health and book in for an annual health check up now.

Dr Trisha is a British trained family doctor who is based at Osler Health Star Vista clinic. For appointments call: T: 63392727

References

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