health dossier
Her Health Matters
health dossier >
Her Health Matters

From her teens to old age, a woman’s body goes through a host of changes, affecting her health and quality of life. THIS Quarterly looks at various conditions that females are susceptible to, from autoimmune diseases to reproductive problems.

According to a United Nations report, ‘The World’s Women 2015’, life expectancy for women and men is 72 and 68 years respectively.

Why does the fairer sex have an advantage when it comes to longevity? One strong factor, health experts say, is the health-protecting effects of the female hormone oestrogen: it increases the good cholesterol and reduces the bad cholesterol levels, thus reducing her risk of getting strokes and heart disease. In men, the presence of the male hormone testosterone does the opposite, raising bad cholesterol and lowering good cholesterol levels.

But when that oestrogen well runs dry, that’s when women often have to pay back for all the protection they have received. Yes, we’re talking about menopause and all its attendant discomfort. It’s more than just mood swings and hot flashes. Women experiencing ‘the change’ have to watch out for cysts and fibroids in their reproductive organs. You can read more about this condition later.

Besides menopause, this feature aims to educate you on other common medical issues that women - whatever their age and background - could face.

For example, did you know that the autoimmune disease lupus strikes females nine times more frequently than males? In that case, should she forsake her dream of giving birth?

And in discussions about women’s health, motherhood plays a large component. While being a parent can be a hugely gratifying experience, the frequent picking up of the child can lead to a painful condition called Mommy Thumb.

Whether you are male or female, young or old, we trust that you will learn something new from this overview of women’s health.

Associate Professor Leong Keng Hong (Rheumatologist)

GETTING PREGNANT WITH LUPUS

Autoimmune diseases like lupus happen when the body turns against itself — the immune system attacks healthy tissues. Although lupus affects women more than men, especially during their reproductive years, pregnancy is still possible.

In the past, doctors would be concerned when a woman with lupus wished to conceive as it could mean plenty of complications, such as increased risk of miscarriage, premature delivery, and congenital heart problems for the baby.

What is lupus?

It is the common name for systemic lupus erythematosus. In someone suffering from the disease, the immune system attacks and destroys healthy cells in various parts of the body, including the skin, joints and internal organs. According to the National Resource Center on Lupus, the disease is nine times more common in women than men. A study the centre conducted revealed that women are more prone because “men need to inherit a greater number of lupus susceptibility genes than women in order to develop lupus”. Among women, those of childbearing age (15–44 years) appear to be at greatest risk.

But does this mean that women with lupus should forget about giving birth?

For rheumatologist Associate Professor Leong Keng Hong, a woman suffering from lupus can bring a baby to term — with planning and preparation. “A woman can get pregnant safely as long as the lupus is quiet, she is not on drugs that will affect the baby, and she checks for other antibodies that can affect the pregnancy,” he assures. Indeed, lupus does not compromise a woman’s chances of conceiving, and less than 50% of pregnancies in women with lupus develop complications. Nevertheless, all lupus pregnancies are considered high-risk.

A woman can get pregnant safely as long as the lupus is quiet, she is not on drugs that will affect the baby, and she checks for other antibodies that can affect the pregnancy

While planning a pregnancy with a chronic condition sounds difficult, the results are encouraging. In a 2015 research published in Annals of Internal Medicine, 385 pregnant women with lupus were studied, of whom 81% gave birth to a full-term, normal-weight baby. Despite the reassuring findings, taking the cautious approach is recommended. The patient must extend her full cooperation to her doctor and get a complete health evaluation done before getting pregnant. She should also plan to be pregnant during a remission phase as that will reduce the risks of complications.

Once the pregnancy is confirmed, a woman with lupus has to take some extra steps to ensure a safe delivery. These steps could include:

  • Consult the doctor often Frequent doctor visits are crucial to recognise abnormalities and monitor the baby’s development via sonograms or ultrasounds.
  • Be aware of flare-ups Symptoms of a lupus flare can be similar to pregnancy symptoms. Check with your doctor to determine which one you are experiencing. Both present signs such as swelling in the joints and fluid accumulation, rashes on the face, and changes in the hair.
  • Avoid lupus fatigue Given the challenges posed by pregnancy, getting enough rest is extremely important. Women with lupus should watch their weight, follow a wellbalanced diet, and modify activities and routines to minimise pain and exhaustion.

Leong Keng Hong Arthritis and Medical Clinic
6 Napier Road
#04-18 Gleneagles Medical Centre
Singapore 258499
Tel: 6472 4337
www.www.leongkenghong.com

Dr Hong Soo Wan (Plastic Surgeon)

LIFTING DROOPING LIDS

“The beauty of a woman is seen in her eyes.” Audrey Hepburn’s famous quote serves as a possible explanation as to why eyelid surgery is one of the most sought-after cosmetic procedures among women in Singapore.

This kind of surgery is - going by anecdotal evidence - highly desired by women between 40 and 60 years old who are seeking to look refreshed in order to remain competitive in the Singapore workplace.

Backing such statistics is plastic surgeon Dr Hong Soo Wan, whose private practice sees similar figures. “The ratio of female to male patients undergoing eyelid surgery in my clinic is roughly 70% to 30%,” he estimates. “For upper eyelid surgery, most of the women are those in the older age group, from 40 to 60.” Dr Hong says that these women frequently consult him about “ageing upper eyelids, which make them appear tired; excess skin drooping over the eyelashes; and loss of double fold show”.

According to Dr Hong, another reason for the popularity of the procedure - applicable to both sexes - is that about 50% of Asians do not have natural double-fold eyelids, which create the perception of a bigger and more attractive eye.

Dr Hong performs blepharoplasty - the medical term for eyelid surgery - using two principal techniques: the stitch method and the open cutting method.

The ratio of female to male patients undergoing eyelid surgery in my clinic is roughly 70% to 30%.

The stitch method, which uses three stitches to hold up the fold, is more suitable for young people who have thin upper eyelids without excess skin. This offers the advantage of faster recovery and an imperceptible scar.

With the open method, an incision is made along the intended fold, cutting away some skin, muscle and fat and securing the skin to the levator muscle to create a double fold. This approach is better for older patients with excessive dropping skin or fat. A laserassisted technique is used in the open method to reduce bleeding and swelling, and shorten the recovery time to about a week.

For patients with eye bags, the most common method for lower eyelid surgery is the transconjunctival procedure - making a small incision inside the lower eyelid to remove excess bulging fat, and revitalise the eyes. This method is extremely useful for patients who have no or minimal excess skin. However, in some older patients, if there is excess skin, it may be trimmed at the same time via a subciliary approach.

Beyond cosmetic enhancement, eyelid surgery is sometimes used to improve vision. This is common among older people, whose sagging upper eyelids obstruct their vision.

Hong Plastic Surgery
38 Irrawaddy Road
#10-38 Mount Elizabeth Novena Specialist Centre
Singapore 329563
Tel: 6339 6210

820 Thomson Road
#06-68 Mount Alvernia Medical Centre D
Singapore 574623
Tel: 6352 9512
www.hongplasticsurgery.com.sg

Dr Tan Soo Heong (Hand Surgeon)

MOMMY THUMB: HURTS MORE THAN MOMS

This condition appears to afflict new mothers most, but anyone who constantly manoeuvres his hands and wrists improperly when lifting or gripping is at risk of developing the problem.

Do you experience painful clicking or popping every time you lift your tot or wring your wet clothes? That could be a possible sign of De Quervain’s Tenosynovitis. Widely seen in females aged between 30 and 50, Mommy Thumb, as the condition is more commonly known, is most prevalent among new mothers, especially those with heavy babies - their pain is due to them constantly lifting their baby with their thumb extended, their wrist bent and their fingers wrapped around the child’s back, straining the tendons below the thumb. Water retention during pregnancy and breastfeeding after delivery may precipitate the condition or make it worse.

While lifting babies and wringing clothes are rather womencentric chores, men are not exempt from getting Mommy Thumb. Other activities that can cause it include gardening, carpentry, typing on a keyboard, holding a tablet during prolonged usage, cooking and knitting. The condition is also seen in tennis players and musicians. Patients will experience severe, sharp and shooting pain when moving the thumb, and when twisting the wrist. A painful, tender swelling can develop at the base of the thumb or the side of the wrist.

Other activities that can cause it include gardening, carpentry, typing on a keyboard, holding a tablet during prolonged usage, cooking and knitting. The condition is also seen in tennis players and musicians.

When treatment is delayed, the pain can travel up the forearm, or down to the thumb and limit its movement. Notably, pregnant women, or those suffering from diabetes and rheumatoid arthritis, stand a higher chance of getting it.

“Hand injury is common because we use our hands for everything,” says hand surgeon Dr Tan Soo Heong. Picking up and holding a baby can seem like the most normal thing to do for mothers, but overstrain of the thumb and wrist from continuous, repetitive movements can lead to problems later on. Bending over to hold and carry your child causes the tendons located in the wrists and thumbs to be extremely strained. These tendons run from the forearm to the thumb and would normally glide easily through a tunnel located at the base of the thumb. But strained injury of the tendons leads to inflammation that can cause the tunnel to narrow, giving rise to swelling, friction and pain.

When it comes to treatment, Dr Tan highlights that relieving the pain and swelling in the thumb and wrist, and restoring their normal functions, will be the primary goals. Hand movements will have to be limited to avoid further trauma and to allow the tendons sufficient time to rest and repair. This can be done by wearing a brace to immobilise the area. Medications to reduce inflammation and pain can be given. Steroids injections are helpful, especially when the pain is severe. In long-standing or severe cases, surgery will be necessary.

In addition, Dr Tan also recommends steps that one could take at home to relieve mild symptoms. These include:

  • Limit activities in the affected hand and wrist; avoid activities that cause pain
  • Use a splint to immobilise the wrist and thumb
  • Modify the way you carry your baby or when breastfeeding
  • Apply a hot or cold compress on the affected area a few times a day

In early and mild conditions, symptoms often improve in a few weeks with self care. Consult a doctor if the pain persists or if you experience severe pain. Patients may also start incorporating some gentle stretches once the symptoms ease, preferably under the guidance of a hand therapist.

Hand, Wrist & Upper Limb Surgery
3 Mount Elizabeth
#07-01 Mount Elizabeth Medical Centre
Singapore 228510
Tel: 6737 0177
www.hand.com.sg

Dr Ann Tan (Obstetrician & Gynaecologist)

MOODS, MENSES, LUMPS & BUMPS

Mood swings across a spectrum of emotions is just one sign of women entering menopause. Biological changes may be expected, too. While women going through ‘the change’ could be facing a rough ride, symptoms can be managed by medical intervention.

“During menopause, oestrogen levels decline. With that, many women experience hot flushes, fatigue, irritability and, occasionally, difficulty in concentrating,” says gynaecologist and obstetrician Dr Ann Tan. “There is often a sense of loss of one’s youth and virility, which affects them negatively, too.”

But it’s not just dipping oestrogen levels that are responsible for menopausal women’s mercurial temperament. According to Dr Tan, the simultaneous lack of progesterone may also adversely impact their mood. “They tend to get more anxious or depressed. Sleep may also become more difficult or patchy,” she describes.

As challenging as menopause sounds, Dr Tan assures that there are ways for women to stay balanced during such a phase:

  • Taking things in one’s stride
  • Using natural herbal remedies to alleviate symptoms
  • Increasing physical activity, which generate endorphins, the ‘feel good’ hormone
  • Reducing stress and avoiding stimulants like caffeine and alcohol
  • Using Hormone Replacement Therapy to manage if the symptoms are negatively impacting her

Due to the oestrogen-progesterone imbalance, the time leading up to menopause is also when some women go through irregular and possibly abnormal heavy menses. There have been cases when the menstrual flow cannot be contained without a double dose of sanitary napkins or frequent napkin change - and these episodes can last longer than seven days.

Beyond being inconvenient, heavy bleeding can lead to fatigue and other health concerns, such as anaemia.

During menopause, oestrogen levels decline. With that, many women experience hot flushes, fatigue, irritability and, occasionally, difficulty in concentrating.

Apart from mood swings and heavy bleeding, menopausal women need to watch out for growths in their reproductive organs, such as cysts and fibroids.

Ovarian cysts are fluid-filled sacs that can develop in an ovary. Most cysts grow unnoticed. After menopause, though, there is an increase in the risk of ovarian cancer. Most cysts are diagnosed using the safe and painless ultrasound imaging. If cancer is suspected, further tests such as pelvic CT scan are often required. Surgery may be necessary when the cyst shows suspicious features, especially when the cyst is a new finding in a menopausal woman.

Uterine fibroids, on the other hand, are small and nonmalignant tumours that grow on a woman’s uterine wall. They often develop in women who are at childbearing age, but may be undetected until after menopause. “As hormone levels drop, new fibroids become rare and existing ones tend to reduce in size,” says Dr Tan. Although benign, they can cause pain and other discomfort in perimenopausal women, such as heavy bleeding, frequent spotting and menstrual-like cramping. Treatment options for fibroids are dependent on the severity of symptoms. Pain relievers are recommended for minor pains. Should the fibroids continue to grow, surgical procedures (myomectomy, hysterectomy, or uterine artery embolisation) may be needed.

Women Fertility & Fetal Centre
3 Mount Elizabeth
#11-12 Mount Elizabeth Medical Centre
Singapore 228510
Tel: 6734 8188
www.anntan.com.sg

Dr Leo Seo Wei (Ophthalmologist)

NO MORE TEARS

Episodes of excess tearing following periods of dryness, discharge, pain, redness, heavy eyelids or blurred vision - if you have been experiencing these symptoms, chances are you may have dry eyes, a condition women are more prone to.

A mixture of water, oils, mucus and proteins originating from special glands around the eye, tears provide moisture and lubrication to optimise vision and keep the eyes comfortable. Having dry eyes suggests that the tear system has gone awry; vision may be affected because tears on the surface of the eye play an important role in focusing light.

“Dry eyes can occur when basal tear production decreases, tear evaporation increases, or tear composition is imbalanced,” says ophthalmologist Dr Leo Seo Wei. But why are women more prone to it than men?

One reason is the hormonal changes a woman undergoes. Dr Leo explains, “Hormonal changes during pregnancy and after menopause have been linked with dry eye.” Another reason is because “women have an increased risk for autoimmune disorders”, such as Sjögren’s syndrome, lupus, scleroderma, and rheumatoid arthritis, all of which are “associated with dry eye”.

Dry eyes can occur when basal tear production decreases, tear evaporation increases, or tear composition is imbalanced.

If you experience any of the symptoms listed above, consult an eye specialist to establish the cause. These treatment approaches include:

  • Changing medications The eye specialist may discuss with the prescribing physician about switching medications - including antihistamines, decongestants, antidepressants, and medications for anxiety, Parkinson’s disease and high blood pressure - to those that are not associated with dry eyes.
  • Over-the-counter topical medications These include artificial tears, gels and ointments to treat mild symptoms.
  • Environmental and lifestyle changes These include decreasing screen time and taking periodic eye breaks. Sunglasses with side shields can be used to reduce symptoms in windy or dry conditions.
  • Smoking cessation/limit exposure to second-hand smoke
  • Omega-3 fatty acids Take supplements or add oily fish (salmon, sardine, tuna, trout, anchovy) and flaxseed to your diet.
  • Prescription dry eye medications Anti-inflammatory medication such as cyclosporine and corticosteroid eye drops may be necessary. In rare cases where all other medications have not produced satisfactory results, serum eye drops may be required. These are special eye drops made using components of the patient’s own blood. Something more invasive may sometimes be required.

Dr Leo describes, “Punctal plugs made of silicone or collagen may be partially or completely inserted to cap the tear ducts at the inner corners of the eye to prevent tear drainage. In severe cases, surgical closure of the drainage ducts by thermal punctal cautery may be recommended to close the tear ducts permanently.”

Dr Leo Adult & Paediatric Eye Specialist
3 Mount Elizabeth
#10-04 Mount Elizabeth Medical Centre
Singapore 228510
Tel: 6737 8366
www.drleoeyespecialist.com

Dr Dennis Koh (Colorectal Surgeon)

STOMACH PROBLEMS

Did you know that the No. 2 cancer among women here - colorectal cancer - shares similar symptoms with irritable bowel syndrome, another problem that females seem more susceptible to?

The top type of cancer among women is - no surprise - those that occur in the breast. The No. 2 cancer among the fairer sex is, surprisingly, not one that occurs in a woman’s reproductive organs; rather, it is colorectal cancer. This is according to the Health Promotion Board’s Singapore Cancer Registry Annual Registry Report 2015, says colorectal surgeon Dr Dennis Koh.

A growth can occur in the inner lining of the large intestine (colon and rectum). It usually starts as a benign polyp before transforming into a cancerous tumour. Colonic polyps do not usually present symptoms, so it is unwise to wait till symptoms appear before getting screened.

There are three main group of people who should be assessed:

  • Those who are 50 years and older, even if they are asymptomatic
  • Those with a family history of colorectal cancer
  • Those with persistent symptoms of colorectal cancer

People who fall into the first group should request for a colonoscopy. “If the results are normal, the procedure only needs to be repeated in the next five to 10 years,” advises Dr Koh. People who fall into the second group should have their first colonoscopy done when they turn 40 or 10 years younger than the age when the first-degree relative was diagnosed with the cancer, whichever is earlier.

What about the third group? Dr Koh offers some common symptoms of colorectal cancer:

  • Per-rectal bleeding
  • Change in bowel habit
  • Change in stool calibre
  • Unexplained weight loss
  • Unexplained anaemia
  • Abdominal pain
  • Abdominal bloatedness
  • Persistent tiredness

Coincidentally, these symptoms mimic those of another condition that women are prone to: irritable bowel syndrome (IBS). A woman suffering from this malady typically has a group of these intestinal symptoms showing up at the same time.

Women are generally diagnosed during their childbearing years. They also get more symptoms than men with IBS. These symptoms vary according to menstrual cycles. For example, before and during a menstrual cycle, women with IBS may experience more abdominal pain and diarrhoea; following ovulation, they may feel more bloated and constipated.

While there is no definite cure for IBS, tweaks to a woman’s diet and lifestyle may relieve symptoms without medications. These include:

  • Getting regular exercise
  • Cutting back on stimulants like caffeinated beverages
  • Eating smaller meals
  • Managing and minimising stress
  • Taking probiotics to help relieve gas and bloating
  • Avoiding deep-fried or spicy foods

“It is important to get the colon screened to ensure that your symptoms are purely due to IBS and not something more sinister,” urges Dr Koh.

Colorectal Practice
3 Mount Elizabeth
#12-14 Mount Elizabeth Medical Centre
Singapore 228510
Tel: 6262 1226
www.colorectalpractice.com

Top