Women living longer but still troubled by health problems
SINGAPORE (JP): Modern women have an increased life expectancy and may expect to spend 30 years or more in a postmenopausal, estrogen deficient, state.
Dr. Ian Hammond, a gynaecologic oncologist at the King Edward Memorial Hospital for Women in Western Australia, said in a seminar on obstetrics and gynecology at the Westin Stamford hotel here recently, that many women will experience some minor or major problems regarding their health.
The seminar was annually organized by Mouth Elizabeth Hospital, one of the hospitals managed by the Parkway Healthcare Group.
"Women are living longer because of improved nutritional health as well as social status. Yet, during the aging process some problems may appear," said Dr. Hammond.
The menopause occurs at about 50 years of age. This has been constant since the writings of Hippocrates.
"But, many women enter the menopausal period earlier -- at between 35-40 years old," the doctor said.
Some premenopausal women require treatment for a variety of diseases including pelvic endometriosis, pelvic sepsis, gynecological cancers and breast cancer and treatment may lead to a premature menopausal state, either due to ovarian ablation by surgery, radiation or the effects of chemotheraphy.
"Unhealthy lifestyles, too much work and stressful conditions may also cause premature menopause among some women," he said.
The menopausal state is due to an estrogen deficiency. Many women regard this state as a natural process and one that should be endured or at most remedied with natural therapy. Many women find it difficult to accept the symptoms of estrogen deficiency (ED) and demand help to alleviate their distress.
Dr. Hammond said the syndrome was characterized by the following medical problems:
* Vasomotor instability (hot flushes, sweats)
* Urogenital atrophy (dry vagina, dyspareunia, urinary incontinence and infections)
* Central nervous system dysfunction (mood disorders, depression, memory loss and sleep disorders)
He said there was an increased risk of developing both heart disease and osteoporosis (with fractures of the hip, wrist and spine)
The doctor said giving these women estrogen therapy, usually in combination with progestogen (for women with an intact uterus), could treat this deficiency syndrome and the ensuing medical problems.
However, there are well documented risks and side effects of hormone replacement therapy (HRT) such as endometrical cancer, breast cancer and gall stones, with side effects such as bleeding, weight gain, headaches and breast tenderness.
Despite the problems with HRT, there are benefits:
* the relief of vasomotor and urogenital symptoms
* reduced risk of cardiovascular disease
* reduced rick of osteoporosis and thus fracture risk and overall reduced early mortality for women undergoing HRT.
Other problems faced by women include urinary incontinence.
According to Dr. Roy Ng Kwok Weng, consultant obstetrician and gynecologist at Mount Elizabeth Medical Center, urinary incontinence is the involuntary leakage of urine which is a social and hygienic problem.
Women suffering from urinary incontinence can be cured or the condition can be improved upon if the relevant causes are identified and corrected, explained Dr. Weng.
The causes of transient urinary incontinence include acute or febrile illness, infection (cystitis, urethris), urogenital syndrome in postmenopausal women, depression and confusional states, excessive urine production due to diabetes isipidus and diabetes mellitus or excessive fluid intake, especially coffee, tea, cola drinks, alcohol, water or excessive sugar and salt intake.
"Imagine you are at work and you find your chair is wet. This happens to women suffering from urinary incontinence," Dr. Weng added.
A recurrent urinary tract infection (UTI) in postmenopausal women may be due to urogenital syndrome. If the later has been treated or excluded, recurrent UTI has to be investigated by an intravenous urogram (IVU) and cystourethroscopy with bladder biopsies to exclude both upper and lower urinary tract pathology.
The culprit is estrogen deficiency during the menopause, whether natural surgically, or radiotherapy-induced. And, the treatment is either hormone replacement therapy (HRT) or estrogen replacement therapy (ERT).
Established urinary incontinence consists of four main types: stress incontinence, detrusor instability, overflow incontinence and true incontinence.
Genuine stress incontinence (GSI) is the involuntary loss of urine occurring when, in the absence of a detrusor contraction, the intraversical pressure exceeds the maximum urethral pressure.
In women who suffer from mild or occasional GSI, especially during strenuous physical activities, such as aerobics, during late pregnancy, after delivery or whose families are incomplete should be offered conservative treatment for at least three months.
The latter consists of pelvic floor exercises, biofeedback, vaginal cones, electrical stimulation or mechanical devices.
Family physicians, pediatricians, gynecologist and other specialists may come across children and women who suffer from long-term continuous (true) urinary incontinence.
Doctors, nurses have a significant role to play to increase the awareness, diagnosis and arrangement of this debilitating and socially embarrassing stigma. (raw)