Women's Health Series - Common Health Issues

Women’s health encompasses a wide range of physical and mental health issues that are unique to the female body. Throughout her life cycle, a woman may face various health challenges that arise due to biological factors, hormonal fluctuations, lifestyle choices, and societal factors. In this series, we will begin by addressing major health issues including reproductive health, breast health, bone health, and other conditions that are more prevalent among women. 

Here, we aim to explore some of the general key aspects of women’s health and discuss prevalent diseases and conditions that affect women worldwide.

 

Pictorial of a woman’s reproductive system.

 

Reproductive Health

The reproductive health of women involves the proper functioning of the reproductive system, including the fallopian tubes, ovaries, vagina, cervix and uterus. Each of the reproductive organs and their functions is briefly described below:

 

Fallopian Tubes: There are two fallopian tubes, one connected to each ovary. These tubes serve as pathways for the eggs to travel from the ovaries to the uterus. Fertilization of the egg by sperm typically occurs in the fallopian tubes.

Ovaries: The ovaries are a pair of small, almond-shaped glands located on either side of the uterus. Their main functions are to produce eggs (ova) and female hormones, including estrogen and progesterone. Disruption to ovarian function may lead to hormonal imbalances, irregular menstrual cycles, fertility challenges, and an increased risk of various gynecological conditions such as ovarian cysts or premature menopause. Each month, where one of the ovaries releases an egg during the menstrual cycle in a process called ovulation.

Vagina: The vagina is a muscular canal that connects the cervix to the external genitalia. It serves as a passageway for menstrual blood to exit the body and is the site of sexual intercourse. The vagina is also where sperm can enter the female reproductive system.

Uterus (Womb): The uterus is a muscular organ where a fertilized egg implants and develops into a fetus during pregnancy. If fertilization doesn’t occur, the lining of the uterus is shed during menstruation. It also plays a role in supporting the placenta and developing fetus during pregnancy.

Cervix: The cervix is the narrow, lower part of the uterus that connects to the vagina. It acts as a barrier between the uterus and the outside world, helping to keep the uterus protected. During childbirth, the cervix dilates up to 10 cm in size to allow the passage of the baby.

 

Some common reproductive health issues include menstrual disorders, polycystic ovary syndrome (PCOS), endometriosis and uterine fibroids. These conditions can cause pain, irregular menstrual cycles, and difficulties in conceiving, influencing both physical and a woman’s emotional well-being. 

As a general overview, PCOS is a condition; a syndrome, or a group of symptoms that affects ovaries and ovulation caused by androgen (including oestrogen and progesterone) imbalance. 

A pelvic exam can be part of a woman’s preventive care to check her sexual and overall reproductive health, by making it into a regular routine. The suggested frequency may vary depending on an individual experiencing symptoms like pain in the lower abdomen or pelvic area or those with one or more risk factors that could develop into gynaecological cancers, further briefed in the following section.

 

Gynaecological Cancers

In addition to breast cancer, gynaecological cancers also pose a significant threat and can be life-threatening if not detected early. Gynaecological cancer is a condition where abnormal cells in any parts of a woman’s reproductive organs start to multiply out of control  affecting the tissue and reproductive organs. There are 5 types of main gynaecologic cancer, named after each of the reproductive organs (cervical, ovarian, uterine, vaginal, and vulvar) they originates from, namely: 

• Cervical Cancer
• Ovarian Cancer
• Uterine Cancer (originates in the uterus)
• Vaginal Cancer
• Vulvar Cancer

 

Some sources also include a sixth type of cancer – which is called Fallopian Tube Cancer. which is the most rare type of cancer attacking the female reproductive system. Fallopian tube cancer is difficult to detect in its early stage and often already spreads before it is diagnosed.

Regular screenings, HPV vaccinations, and awareness of potential symptoms are vital in improving survival rates to all types of gynaecological cancer. 

 

Sexually Transmitted Infections (STIs)

STIs can take in various forms and they are caused by different pathogens and bacteria. Some common forms of STIs are:

 

HPV – Human Papillomavirus

HPV infection; thought to be the most common STI, has been identified as the most important risk factor for cervical cancer. This is an extremely common DNA virus infecting humans that almost everyone will contract HPV at some point in their life. Most of the time the infection will clear out on its own within 1-2 years, even without treatment and without causing any health complications.

There are over 150 different strains of HPV and only a handful have been associated with cancer. Although HPV usually causes no symptoms, some types of HPV can be triggered to develop into certain forms of cancer.

 

HPV Vaccination

HPV Vaccination has been found to be safe and highly effective in preventing cancer-causing infections and pre-cancers. HPV vaccines target most common types of HPV that cause cervical cancer, primarily HPV types 16 and 18. It is important to note that HPV vaccines are most effective when administered before a person becomes sexually active.

 

Pelvic Inflammatory Disease (PID)

Certain STIs, caused by bacterial infections such as chlamydia, gonorrhea and syphilis, can ascend from the lower reproductive tract into the upper reproductive organs, including the uterus, fallopian tubes, and ovaries. This can lead to PID, an infection and inflammation of these organs if left untreated. Some people do  not experience symptoms while those who develop symptoms have reportedly experience:

• Severe pain in the pelvic or lower abdominal area. Some experience dull pressure or a more intense cramping-type pain.
• pain during penetrative vaginal sex or when urinating
• irregular, heavy, or painful vaginal bleeding
• unusual vaginal discharge – that is especially heavy and has an unpleasant odour.
• Gastrointestinal symptoms – nausea, lack of appetite, vomiting and diarrhoea.

           

 

Herpes

Genital herpes is one of the more common forms of STI that resulted from herpes   simplex virus (HSV). It is highly contagious and can take two forms:

• blister in the mouth or face (oral herpes or HSV type 1)
• appearing in the genital area (genital herpes or HSV type 2)

 

Pregnant mothers with genital herpes could potentially pass this infection to their unborn children during childbirth (perinatal transmission), which may cause various health complications to the newborn including meningitis, seizures and eye-infection that may result in blindness.

STI affects women differently, causing serious complications if left untreated for an extended period of time. Treatment for bacterial STIs typically involves antibiotics prescribed by a healthcare professional. Timely treatment not only helps to cure the infection but also reduces the risk of complications and prevents further spread of the infection. Practising safe sex, including consistent and correct condom use, is an effective way to reduce the risk of bacterial STIs.

 

Breast Health

Although not directly involved in reproduction, the breasts play a role in nurturing offspring. During pregnancy, hormonal changes cause the breasts to enlarge and produce milk for breastfeeding. Breast health is essential for women, and involves regular self-examinations and screenings which play significant roles for the early detection of breast-related issues, particularly breast cancer. Early detection through regular screenings can lead to better treatment outcomes and significantly improves the chances of successful treatment. If any concerning changes are noticed during self-examinations or if there’s a family history of breast cancer, it’s essential to consult a healthcare professional promptly for further evaluation and appropriate care. We will delve further into breast health and diseases in the next series.

Regular screenings include:

• Mammograms screening
• Self-examinations (Breast Self Examination -BSE), 
• Breast awareness
• Clinical Breast Examinations

 

Cardiovascular Diseases (CVD)

Heart disease amongst women is a serious health concern, often overlooked due to the historical association with men. Women however, are equally susceptible to heart problems, and it’s crucial to recognize and address the unique aspects of cardiovascular health in women. Symptoms of heart attacks in women can be different from those experienced by men, leading to delayed diagnosis and treatment.

While the most common symptom of CVD in both men and women is the same – chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes; it is not always severe or the most noticeable symptoms in women. Women are more likely to experience pain or discomfort that is unrelated to chest pain than men, such as:

• Back, or between shoulder blades
• Neck or throat
• Shortness of breath
• Pain in one or both arms
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue
• Heartburn (indigestion)

 

Risk factors such as high blood pressure, high cholesterol, diabetes, and smoking can contribute to heart disease in women. 

 

Osteoporosis

Osteoporosis is a bone disease characterised by decreased bone density, making bones more susceptible to fractures. Women, especially after menopause, are at a higher risk of developing osteoporosis due to hormonal changes that affect bone health. 

 

 

Our bones are structured by living, growing tissues where they are constantly breaking down and replacing themselves at a balanced, and coordinated rate throughout our lives. A consistent estrogen level plays an important role in maintaining the balance between the breaking-down-bone (osteoclasts) cells and the creating-new-bone (osteoblast) cells.  

As a woman ages, the production level of estrogen declines, affecting the coordination between osteoclasts and osteoblast. Osteoclasts become more active without estrogen, and the body breaks down more bone than it creates. At the menopausal stage, A woman will gradually start to lose bone mass, as the rate whereby the bone rebuild itself couldn’t catch up with the rate of bone breaking down.

Though no cure has been found for Osteoporosis, a proper treatment plan can help slow the rate of the body’s breaking bones down. Adequate calcium intake, vitamin D, and weight-bearing exercises are essential in preventing osteoporosis which stimulate the bones and encourage them to remodel and strengthen. Activities like walking, jogging, dancing, or resistance training can bolster bone density, reducing the risk of fractures. 

 

Mental Health

Mental health is a crucial aspect of overall well-being. It tends to overlap with hormonal transition, changes and fluctuations in women’s life. For example, during the menstrual cycle, pregnancy, and menopause a woman may be susceptible to conditions such as depression, anxiety, and eating disorders as they experience premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), which can lead to mood swings, irritability, and depressive symptoms. 

Pregnancy is another period of intense hormonal changes, which can affect mood and well-being. Some women may also experience Postpartum depression (PPD), a mental health complication that arises following childbirth until 1 year after delivery. PPD is not a 100% hormone-based; a study has linked that PPD could be contributed to by few aspects including physiological, psychological, as well as sociocultural factors.

 

 

Similarly, menopause, marked by the cessation of menstruation, is associated with hormonal shifts that may contribute to mood disturbances and an increased risk of depression in some women. Menopausal symptoms for some women may include:

• Anger and irritability
• Anxiety
• Loss of self-esteem and confidence
• Poor concentration – brain fog 
• Poor sleep quality

 

Fluctuating hormones in women also interact with genetics and stress exposure history, affecting brain structure and function, which can contribute to anxiety and depression. The majority of women who develop significant mood issues during perimenopause have had them in the past. It’s relatively rare for someone with no history of depression or anxiety to suddenly develop a severe case of it during menopause

 

Autoimmune Diseases

Autoimmune diseases, in which the body’s immune system attacks its healthy tissues, are more prevalent in women. This disease can attack any part of the body, weakening its functions and can cause complications that could potentially be life threatening. 

Experts say that female immune systems are generally stronger in response to most illnesses than male, and naturally have stronger inflammatory responses when triggered. 

Note: Inflammatory Response is the body’s defence mechanism – activated by the immune system, to fight against irritants, pathogens, viruses, toxin chemicals or other offending agents attacking the body. Scouts – like Cytokines, sent to regulate the inflammation, will send a coordination report to the immune system telling it how to deal with the invading threats and repair tissue, consequentially promotes healing of the damaged cells or removes threat.

In Autoimmune diseases however, the scouts coordination gets whacked; and too many inflammatory signals being sent leading to excess inflammation, become chronic and eventually lead to significant tissue, organ, and joint damage.

Conditions like rheumatoid arthritis, lupus, and multiple sclerosis are some of the well-known types of autoimmune diseases that are most common in women. They can lead to chronic pain, fatigue, and reduced quality of life. Though autoimmune diseases are not gender-related, researchers are still trying to figure out as to why the diseases seem to be more prevalent in women. Some of the key theories and hypotheses that researchers proposed to understand this phenomenon includes:

 

Sex Chromosomes: Some autoimmune genes are located on the X chromosome. Since women have two X chromosomes and men have one X and one Y chromosome, this may contribute to differences in autoimmune disease susceptibility.

Hormonal Factors: Hormones, particularly estrogen, have been implicated in the development and progression of autoimmune diseases. Estrogen is known to have immunomodulatory effects, and fluctuations in estrogen levels during a woman’s menstrual cycle, pregnancy, and menopause may influence the immune system.

Immunological Differences: Women tend to have stronger immune responses, which may contribute to a higher susceptibility to autoimmune diseases. This is also related to the first two key theories above.

Genetic Factors: Some autoimmune diseases have a genetic predisposition, and certain genetic markers associated with autoimmune diseases may be more common in women. Genetic factors likely interact with other environmental and hormonal factors.

Environmental Factors: Environmental factors, such as infections, exposure to certain chemicals, and stress, can trigger or exacerbate autoimmune diseases. Women may have different environmental exposures or responses that contribute to the gender difference.

 

Conclusion

In summary, women’s health is a complex and multifaceted aspect of medical care, influenced by biological, psychological, and societal factors. Regular health screenings, healthy lifestyle choices, and awareness of potential risks are crucial in maintaining optimal health throughout a woman’s life. By promoting awareness, encouraging preventive measures, and fostering a comprehensive understanding of these multifaceted issues, we can foster a healthier, more empowered female population.