Hibiscus Private Hospital is pleased to offer information on important women’s health issues. The overviews presented here are intended to inform and remind you, and to encourage you to take your health seriously by seeing your doctor at regular intervals.
A Health Overview for Women
Dr. D. Glass
Life is all about choices and to a large extent our health has to do with the lifestyle choices we make. There is no denying that illnesses and accidents can happen “out of the blue”. We live on a dangerous and hostile planet, and bad things happen even to the best of people. But there is so much we can do to preserve our health and well-being. Interventions can occur at two levels: Firstly in the area of health screening – picking up illnesses at an early stage when they are still curable; and secondly – choosing a lifestyle that promotes health and well-being.
There are many controversies about how frequently one should be screened for different conditions. Most of these are driven by cost and availability of resources. You may be able to afford more frequent checks and this would be a wise investment in your health. But even less frequent visits to your doctor or health centre are worthwhile. Screening tests are designed to pick up common dangerous conditions such as cancer of the cervix, breast, bowel and skin as well as other life-threatening illness such as diabetes, high blood pressure, heart disease and thyroid disease.
The most valuable screening tool for women is the “Pap” smear. This simple test is able to establish the presence of abnormal cells many years before the onset of cancer of the cervix. Apart from abnormal cells it can reveal viral, fungal and bacterial infections of the cervix and vagina as well as chronic inflammation. The test is relatively cheap and simple to perform. It should be virtually painless – if your health worker hurts you in doing this test, find someone who is gentler next time! It can be performed by any general practitioner or specifically trained nurse, but is often done as part of a gynaecological examination. The first Pap smear should be performed after the onset of sexual activity. It should thereafter be performed on a yearly basis. If a woman is in a mutually faithful relationship and Pap results are consistently normal she may repeat the smear up to 3 yearly.
A mammogram is an X-ray that seeks to pick up early changes suggestive of breast cancer. It is often combined with an ultrasound examination to complement the investigation. Because it is just a screening test it is possible to miss an early cancer that does not manifest usual features. The first mammogram should be performed at the age of 40, and then again at 45. After 50 years it should be performed either yearly or every 18 months. If there is a strong family history of breast cancer the first mammogram should be at 35 years. Other risk factors for breast cancer are obesity, high intake of animal fats, smoking, alcohol excess, non-breast feeding and prolonged use of combined oestrogen/progesterone hormones. The mammogram need not be painful. Insist on compassionate examination.
Breast Self Examination
Regular monthly self examination of your breasts can help to find early cancers and other benign lumps. Many women are too frightened they might find a lump, or don’t want to be alarmist. But the more often you examine your breasts, the better you will know what is normal for you. The best time to do this is about 1 week after your period, when the breasts are least likely to be lumpy from hormonal stimulation. More information
Bowel cancer is the third most common cancer affecting women. However there are many other benign but troublesome bowel conditions such as irritable bowel syndrome, spastic colon, piles, chronic constipation and diverticulosis. If you notice changes in your bowel habits or find blood or mucus in your stools you need to see your doctor. In many countries where the incidence of bowel cancer is high, a routine colonoscopy is done at age 50, and then repeated every 10 years thereafter. In some places occult blood tests are performed on stool specimens to look for minute amounts of human blood, arising from polyps or growths. However their value has not been established. Discuss this with your doctor.
In South Africa people with fair skin are particularly prone to skin cancers. Of the three types, the most dangerous is Malignant Melanoma. If you notice changes in a mole – enlarging, changing colour or bleeding – please go see your health practitioner.
In today’s climate where almost one quarter of the population is infected with HIV, it makes sense to be tested on a regular basis. This is particularly true if you are not in a mutually faithful relationship, or if you suspect your partner has other partners. Many people are frightened to be tested because they fear the consequences of knowing they are infected. Obviously this has consequences for your future and for relationships. However there is so much that can be done to ensure a long and useful life, even though infected, that you would be foolish to ignore the possibility of proper management of the condition. The best scenario is for partners to go together for voluntary counselling and testing. Your health practitioner or clinic can help you here.
The incidence of diabetes is rising as lifestyles change. It is certainly related to sedentary habits and increase in body weight. Unfortunately the incidence is also increasing in sedentary young people who are overweight, watch a lot of TV and who eat fast-foods. Normally one would start with 3 yearly blood sugar tests from the age of 45. However if you are overweight, or suffer from excessive thirst, increased urination, and unexplained weight loss you may need to be tested. If there is a strong family history you may also need to start testing earlier.
Another condition that is related to lifestyle is hypertension. High blood pressure occurs in up to 25% of certain population groups. Inactivity, excessive weight and a diet deficient in fruits and vegetables, and rich in animal fats and salt increases the risk. It is good to have your blood pressure checked every 2 years. Even your local pharmacy may do this for you. But if elevated it needs to be checked by your health practitioner who can initiate effective management.
The thyroid gland hormones affect the wellbeing of every cell in the body. It is not unusual for the thyroid gland to malfunction especially around puberty and again near menopause. If you notice enlargement of the front of the lower neck, or suffer from lethargy, irritability, have dry skin and unexplained weight gain; or sweat easily, and have unexplained weight loss; you may need to have your blood thyroid hormone levels tested.
If you have a strong family history of cardio-vascular diseases such as heart attacks and strokes, you may need to have your cholesterol levels checked. This becomes especially important at the time of menopause. Lifestyle can certainly improve your levels through sufficient exercise and proper diet.
We have already alluded to this in the previous section. It is painful to see how so many people abuse their bodies through poor choices, and are then surprised when they reap the consequences. These include diseases caused by smoking, excessive alcohol, over-indulgence, lack of exercise, insufficient rest and recreation, and persistent emotional stress.
Space does not allow us to delve into the simple interventions, but the evidence is there that changes in lifestyle can significantly improve your quality of life as well as your longevity.