7 women's health conditions to be aware of

1. Menstrual irregularities

Menstrual irregularities refer to any changes or abnormalities in the menstrual cycle, including changes in cycle length, frequency, duration, or intensity.

The normal menstrual cycle is 24 to 38 days.

What are the classifications for menstrual irregularities?

The terminology for describing menstrual abnormalities has evolved over time. Previously, the terms menorrhagia, metrorrhagia, polymenorrhea, hypermenorrhea, oligomenorrhea, and dysfunctional uterine bleeding were used.

However, newer terms have been adopted to provide a more standardised and precise classification of menstrual irregularities.

1. Abnormalities in frequency

   Abnormalities in frequency is defined as:

   • Frequent: Bleeding period at intervals <24 days
   • Infrequent: Bleeding period at intervals >38 days
   • Absent: Primary amenorrhea (absence of menarche by age 15) or secondary amenorrhea (absence of spontaneous menstrual bleeding for 6 months in a patient who previously had menstrual bleeding)

2. Irregular bleeding

   Depending on the patient's age, irregular bleeding is defined as:

   • Cycle length variance >9 days for ages 18 to 25
   • Cycle length variance >7 days for ages 26 to 41
   • Cycle length variance >9 days for ages 42 to 45

3. Prolonged menstrual bleeding

   • Menstrual bleeding that consistently lasts longer than 8 days

What are the causes for menstrual irregularities?

Menstrual irregularities are common and can be caused by a variety of factors, including:

• During puberty, period may be irregular for the first 2 years
• The beginning of menopause (between the ages of 45 and 55)
• Hormonal imbalances
• Stress
• Excessive exercise
• Extreme weight gain or loss
• Underlying health conditions such as thyroid disorders, polycystic ovary syndrome (PCOS), endometriosis and uterine fibroids
• Certain medications

Sometimes, menstrual irregularities can signify a more serious underlying condition, such as cervical or uterine cancer.

What are the treatment options for menstrual irregularities?

The treatment options will depend on the underlying cause. They include:

1. Lifestyle changes such as reducing stress, maintaining a healthy weight, getting enough sleep, and exercising.
2. Birth control pills.
3. Progestin (synthetic form of progesterone) may be suggested to treat abnormal bleeding.
4. Intrauterine device (IUD), which is a T-shaped device can be inserted by your doctor through the vagina and cervix into the uterus.
5. Surgery may be recommended to remove abnormal uterine structures.

2. Endometriosis

Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (womb), called endometrium, grows outside the uterus, such as on the ovaries, fallopian tubes, or other organs in the pelvic cavity.

The exact cause of endometriosis is unclear, but it is believed to be related to retrograde menstruation, genetics, and immune system dysfunction.

What are the symptoms of endometriosis?

• Pelvic pain that worsens during your period.
• Painful periods (dysmenorrhea).
• Pain during or after sexual intercourse.
• Painful bowel movements or urination, especially during menstruation.
• Difficulty getting pregnant (infertility).
• Fatigue, bloating, constipation, diarrhoea, or nausea, especially during menstruation.

However, some women with endometriosis may not have any symptoms.

What are the risk factors for endometriosis?

• Family history: Women with a first-degree relative (mother, sister) with endometriosis have a higher risk of developing the condition.
• Uterine abnormalities: Some uterine abnormalities, such as a retroverted uterus, may increase the risk.
• Hormonal imbalances: Elevated oestrogen levels or an imbalance between oestrogen and progesterone may contribute to endometriosis.
• Genetic factors: Genetic predisposition plays a role, with endometriosis often occurring in families.

How is endometriosis diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Pelvic examination

   • Your doctor would manually palpate the pelvic area to check for any abnormalities or tender areas.

2. Imaging tests

   • Transvaginal ultrasound is often the initial imaging test done to evaluate the uterus and pelvic organs. It can help identify structural abnormalities, such as uterine enlargement or the presence of uterine masses.
   • Magnetic resonance imaging (MRI) may be recommended for a more detailed assessment of the uterus and surrounding tissues. It can provide clearer images of the extent and location of endometrial tissue.

3. Laparoscopy

   • Laparoscopy is a minimally invasive surgical procedure.
   • The doctor will insert a thin, lighted tube with a camera through a small incision in the abdomen to view the pelvic organs and take a tissue sample for biopsy.

4. Biopsy

   • A tissue sample taken during laparoscopy can be examined under a microscope to confirm the presence of endometrial tissue outside the uterus.

What are the treatment options for endometriosis?

Treatment for endometriosis depends on the severity of symptoms and the desire for future fertility. Options can include:

1. Pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs).
2. Hormonal therapy such as birth control pills or progesterone.
3. Surgery to remove the endometrial tissue.
4. In severe cases, surgery to remove the uterus (hysterectomy) may be necessary.

3. Fibroids

Fibroids, also known as uterine leiomyomas or myomas, are non-cancerous growths that develop in the uterus. They are made up of muscle and fibrous tissue and can vary in size from small, pea-sized growths to large, grapefruit-sized ones.

Fibroids are highly common. Approximately 80% of females will develop fibroids at some point, although not everyone will experience unpleasant symptoms.

The exact cause of fibroids is unknown, but they are believed to be related to hormonal imbalances (oestrogen and progesterone).

What are the risk factors for developing fibroids?

• Family history of fibroids
• Being overweight or obese
• Early menarche
• Genetics
• Smoking
• Consumption of alcohol
• High blood pressure (hypertension)

What are the symptoms of fibroids?

• Heavy or prolonged menstrual bleeding
• Pelvic pain or pressure
• Lower back pain
• Urinary incontinence or frequent urination
• Constipation
• Infertility

However, some women with fibroids may not have any symptoms.

How are fibroids diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Pelvic examination to look for mass.

2. Imaging tests

   • Pelvic ultrasound to confirm the presence of fibroids.
   • A hysteroscope, a thin, lighted tube, is inserted through the vagina and cervix to examine the inside of the uterus during a hysteroscopy. It allows for direct visualisation of the uterine cavity and can help identify fibroids and any associated abnormalities.
   • Magnetic Resonance Imaging (MRI) provides more precise information about the size, location, and number of fibroids. It can help differentiate fibroids from other uterine conditions and determine the most appropriate treatment options.

What are the treatment options for fibroids?

Treatment for fibroids depends on the severity of symptoms and the desire for future fertility. Options can include:

1. Medication such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce menstrual cramps.
2. Iron and vitamins.
3. Hormonal birth control.
4. Antifibrinolytic medication such as Tranexamic acid to slow menstrual bleeding.
5. Gonadotropin-releasing hormone analogues to temporarily stop producing progesterone and oestrogen, which can, in return, reduce heavy menstrual bleeding.
6. Surgery to remove the fibroids.
7. In severe cases, surgery to remove the uterus (hysterectomy) may be necessary.

4. Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects women of reproductive age. It is a condition with three main characteristics:

• Irregular menstrual periods
• Excess androgen hormones (male hormones)
• Polycystic ovaries

The exact cause of PCOS is unknown, but it is believed to be related to hormonal imbalances, genetic factors, and insulin resistance.

What are the symptoms of PCOS?

• Irregular menstrual periods or no period
• Acne
• Excess facial and body hair growth (hirsutism)
• Weight gain
• Patches of thickened, velvety, and darkened skin (acanthosis nigricans)
• Sleep apnea
• Difficulty getting pregnant

How is PCOS diagnosed?

The diagnosis of PCOS is typically suspected in women who present with irregular menstrual cycle and symptoms of hyperandrogenism such as acne, hirsutism, and female pattern hair loss. In addition to these symptoms, obesity can further raise suspicion for PCOS.

What are the treatment options for PCOS?

PCOS cannot be cured, but the symptoms are treatable.

• Lifestyle changes such as exercising regularly while maintaining a healthy diet.
• Medications to regulate menstrual periods and control excess hair growth.
• Fertility treatments for women planning to get pregnant.

5. Breast cancer and lumps

Breast cancer occurs when the cells in the breast grow rapidly and multiply uncontrollably. It commonly starts in the cells that line the milk ducts of the breast.

Approximately 1 in 7 women are diagnosed with breast cancer at some point. There is a good possibility of recovery if it is detected early.

What are the symptoms of breast cancer?

• A new lump or swelling in your breast or armpit
• Change in size, shape, or feel of your breast
• Skin changes such as puckering, dimpling or redness of the skin
• Changes in the position of the nipple
• Discharge from either of your nipples

How is breast cancer diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Mammography: Mammograms are X-ray images of the breast tissue. They can detect masses or microcalcifications that may indicate the presence of breast cancer. Mammograms are often the first step in breast cancer screening.
2. Ultrasound: Ultrasound uses sound waves to create images of the breast tissue. It can help determine if a breast lump is solid or filled with fluid (cystic). Ultrasound is often used in conjunction with mammography for further evaluation.
3. Magnetic Resonance Imaging (MRI): In some cases, an MRI may be recommended for further evaluation as it provides detailed images of the breast tissue and can help identify additional areas of concern.
4. Fine needle aspiration biopsy: Tissue sample is taken using a fine needle to be examined under a microscope to confirm the presence of breast cancer.

If a breast lump is found to be cancerous, depending on the stage and severity of the cancer, as well as the individual's health and preferences, treatment options may include:

1. Breast cancer surgery such as mastectomy, lumpectomy, axillary lymph node dissection
2. Chemotherapy
3. Radiotherapy
4. Hormonal therapy
5. Targeted therapy
6. Bisphosphonates

Women are advised to perform regular breast self-exams and go for regular mammograms because early detection is essential for breast cancer treatment. Many women who are diagnosed with breast cancer in its early stages can go on to live long, healthy lives.

6. Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine and is a common problem. When and how this occurs depends on the type of urine incontinence a person has.

There are several types of urinary incontinence:

• Stress incontinence: Occurs when pressure on the bladder, such as from coughing, sneezing, laughing, or exercise, causes urine to leak.
• Urge incontinence: Occurs when there is a sudden urge to urinate and an involuntary loss of urine before making it to the restroom.
• Mixed incontinence: Combination of stress and urge incontinence.
• Overflow incontinence: You are unable to fully empty your bladder, which causes frequent leaking

What the causes of urinary incontinence?

• Weak pelvic floor muscles
• Nerve damage
• Damage during childbirth
• Damage to the bladder or nearby area during surgery
• Neurological conditions such as Parkinson’s disease
• Certain medication

What are the treatment options for urinary incontinence?

Treatment for urinary incontinence include:

1. Lifestyle modifications include weight loss, scheduled voiding, and drinking small amounts of fluid at regular intervals throughout the day instead of drinking larger amounts all at once.
2. Pelvic floor exercises, such as Kegels, strengthen the muscles involved in controlling urine leakage.
3. Bladder training.
4. Topical vaginal oestrogen.

In some cases, surgery may be required. However, undergoing surgery for stress urinary incontinence is not recommended until you have completed having children, as pregnancy and childbirth can cause damage that could enable leakage to recur.

7. Osteoporosis

Osteoporosis is a disease characterised by a reduction in bone density and bone mass. This would decrease bone strength and lead to low-impact trauma fractures (broken bones). Most common osteoporotic fractures occur in the hip, vertebra (spine bone) and wrist.

Osteoporosis is more common in women, particularly if their menopause begins early.

What are the risk factors for developing osteoporosis?

• Age more than 50 years old
• Family history of osteoporosis
• Individuals who are small and thinly built
• A diet low in vitamin D, calcium, and protein
• Smoking
• Excessive alcohol consumption
• Certain medical conditions, such as rheumatoid arthritis, celiac disease, and hyperthyroidism.

How to reduce the risk of developing osteoporosis?

Prevention and treatment of osteoporosis focus on building and maintaining strong bones.

1. Incorporating a diet rich in calcium and vitamin D.
2. Regular weight-bearing exercises, such as walking or strength training.
3. Avoiding smoking and excessive alcohol consumption.
4. Medications:
   • Bisphosphonates to preserve bone loss and reduce the risk of fractures.
   • Selective oestrogen receptor modulators (SERMs) to preserve bone density and minimise the risk of fractures.
   • Parathyroid hormone (PTH) to regulate the amount of calcium in bone.
   • Denosumab (monoclonal antibody) to help reduce bone loss.
   • Vitamin D and Calcium supplements.

Why is women’s health screening important?

Women's health screening is vital because it allows for the early detection of health conditions, leading to more effective treatment and better outcomes.

Regular screening tests can help identify potential health issues, allowing for early intervention and management, and help women make informed decisions about their health and lifestyle.

Some common screening tests for women include mammograms for breast cancer, Pap test for cervical cancer, and bone density scans for osteoporosis. Read this article to learn about the types of health screening tests available for women.

Make an appointment at Pantai Hospitals

At Pantai Hospitals, we offer a wide range of health screening programs catered to each individual, depending on their health status and needs. The team of healthcare professionals are here to assist and recommend or tailor a screening package to suit your age, gender, family, and medical history.

For appointments, please contact the Health Screening Centre at your nearest Pantai Hospital.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.