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Embracing the Totality of Women’s Health

  • 20 Mar 2023
  • 4 mins

Women navigate various stages of life and experience many health changes throughout their lives; menstrual cycles, pregnancy, childbirth, menopause are a few of the associated concerns for starters. Obstetrician and gynecologist Dr. Timothy Lim discusses women’s health in general and how women experience health issues differently and with commonalities.

A Change of Mindset

Women's health covers more than reproductive health but it has been viewed through this particular prism and as a subset of healthcare. Indeed, certain health concerns might only impact women. However, women make up almost half of the world's population and in Singapore, comprise 47.7% of the population.1

It is time, perhaps, to turn the spotlight on women’s health and have a conversation on developing a holistic approach encompassing the workplace, family, and community.

The Stage of Adolescence

Adolescence is a time of transition from childhood to adulthood where social, cultural, and biological changes are seen along with the related impact on one’s health which could lead to lifelong consequences.

According to Dr. Lim, the top three pressing health concerns for adolescent females are menstruation issues, dysmenorrhea, and human papillomavirus (HPV) vaccination for preventing cervical cancer.

The first menstruation takes place between the ages of 13 and 16. Some may start before the age of 13 but if menstruation does not occur by the age of 16, it is advisable to seek medical help.

While the expected menstrual cycle covers 28 days, this is just a guide. The cycle lengths could vary, depending on the individual. A girl's body may not follow an exact schedule and it is common to have irregular periods. The number of days a girl has her period also varies. At times, menstruation may occur for two days or this may last for a week. This is because the level of hormones in the body can differ from one cycle to the next, affecting the amount and length of time of bleeding.

Besides physiological discomfort, sudden acne breakout, mood swings, or dysmenorrhea or menstrual pain may be experienced. This pain can be anything from dull achy cramps to intense pain that feels unmanageable, to great discomfort.

While one could rely on so-called age-old remedies to manage menstruation issues, Dr. Lim advises that the adolescent should see a gynecologist when her menses are irregular or heavy, causing symptoms such as dizziness, fainting spells, or severe menstrual cramps. However, he cautions against making this a "must-do" as the thought of seeing a gynecologist can be somewhat awkward for the teenager.

“Before the first visit, the parent would have to convince a child of the need to seek medical help and not force the issue. Once she has decided, is ready to be heard, and opens up about her issues, it becomes the first step to establishing rapport and trust with her doctor," Dr. Lim says.

HPV Vaccination

Another concern for teenage females today is getting HPV vaccination to prevent cervical cancer. From birth to 12 years of age, there are already several compulsory vaccinations a child has to take. In 2019, HPV vaccination was added to the National Childhood Immunisation Schedule as part of the school health vaccination program to protect against cervical cancer.2

Getting an HPV infection has seen an uptrend and those in their late teens and early 20s are susceptible when they begin dating. The majority of infections are clinically asymptomatic and will go away. However, if the infection remains in the body, it can result in cancer.

"All children of eligible age are encouraged to go for HPV vaccination," Dr. Lim advises. Cervarix is the HPV vaccine used for the school-based HPV vaccination program and it protects against HPV types associated with about 70% of cervical cancer cases.

“Gardasil 9 or G9 is another vaccine, a second generation one which is gender-neutral and can prevent up to 90% of cervical cancers as well as genital warts and other types of cancers,” he adds.

It benefits a female adolescent to be aware of associated health issues as she enters adolescence. Much as it is awkward to raise the topic, it is equally important to encourage female adolescents to talk about such issues and raise questions with parents, guardians, or trusted adults to learn more about the changes that they are going through.

With a better understanding of these changes, they will be empowered to take charge of their health – now and in the future.

Common Health Issues Women Experience

A mixture of urban living, busyness, and a hyper-connected social backdrop in Singapore might lead to little distinction among work, play, and rest.

Having a blended life of fulfilling professional and personal ambitions which may involve raising a family, spending time with friends, and helping to run a household could see many women putting attending to their physical health in the backseat.

“Many women do not look after their health enough but it is through no fault of theirs because most have to juggle between work and family and just do not have the time," Dr. Lim observes.

With such a situation, diagnosing health conditions can become delayed.

According to Dr. Lim, the common health risks women here face involve menstrual disorders, uterine fibroids, endometriosis, ovarian cysts, and vaginal discharge.

With menstruation, what adult women experience can be similar to that of adolescent females with issues of concern related to premenstrual syndrome, irregular periods, menstrual cramps, and flow. However, the symptom types and intensity vary among individuals.

Menstrual pain is often regarded as “normal” when it could be due to endometriosis.

“Endometriosis is a painful disorder in which tissue that normally lines the uterine cavity grows outside the uterus. It most commonly involves the ovaries, fallopian tubes, and tissue lining the pelvis. It is often characterized by chronic pelvic pain that can impact women's daily activities," Dr. Lim explains.

The symptoms of endometriosis include severe menstrual cramps, abdominal cramps, backache, heavy menses, painful sex, painful bowel movement or urination (especially during menses), and even difficulty getting pregnant. A point to note is that the severity of endometriosis does not determine the pain intensity and the stage of the condition. For certain women, the symptoms may not present.3

“Provisional diagnosis of this condition is often based on symptom history and ultrasound findings but the definitive diagnosis is made through surgery,” he adds. Treating endometriosis usually includes surgery or medication to manage the symptoms.

Another common menstrual disorder is abnormal uterine bleeding; in extreme cases, it is characterized by heavy and prolonged menstrual bleeding. At times, it may be so severe that it disrupts daily activities. The presence of uterine fibroids could cause heavy bleeding and can be diagnosed with an ultrasound scan.

Another common health issue for women relates to vaginal discharge.4  Vaginal discharge is a regular occurrence but if there is a change in the discharge amount, color, or smell, or if the discharge is stained with blood outside of menstruation, it would be time to seek medical advice as there could be an underlying health problem.

Reaching Menopause

The menopause journey for women varies from person to person but menopause is a health milestone for all women, uѕuаllу reached аrоund thе аgе оf 50. It describes thе сhаngеѕ a woman experiences shortly prior to or аftеr menstruation ending for her, signaling fertility’s cessation. Menopause can take place because of being ill or trеаted for a condition, оr surgery.5

"Onе оf the more соmmоn fеаrѕ that wоmеn hаvе аbоut menopause іѕ ѕіmрlу nоt knowing whаt to еxресt. Mоѕt реорlе would hаvе hеаrd аbоut thеіr frіеndѕ' menopause еxреrіеnсеѕ, whісh may at tіmеѕ sound frіghtеnіng. But іf you tаkе thе tіmе to learn аbоut thіѕ life-changing еxреrіеnсе, you may bе able tо avoid ѕоmе of the wоrrіеѕ аѕѕосіаtеd wіth іt," Dr. Lim says.

Should women be concerned if menopause occurs at a younger age, say before 50?

“Women may experience menopause symptoms from as early as age 40 but most women are menopausal by age 50, 51,” he says. “Common symptoms include hot flushes, insomnia, vaginal dryness, dry skin or mood changes. At times, the symptoms may affect the quality of life and medication may be needed to improve the symptoms. Furthermore, if bleeding occurs after menopause, it is considered abnormal and medical advice should be sought.”

Menopause, incontinence, and uterine prolapse are associated with older women's health conditions. And menopause could cause incontinence and urogynecological disorders including prolapse.

“In menopause, the estrogen hormone levels begin dropping and this causes the pelvic muscles to weaken. This may cause the prolapse of the uterus or vagina and loss of bladder control due to the weakening of the urinary sphincter muscles," Dr. Lim explains.

Besides incontinence, the risks of certain medical conditions increase with menopause and age.

“The long-term consequences of menopause include increased risk of osteoporosis, cardiovascular disease memory decline, dementia, and sexual problems,” he says.

“At thіѕ ѕtаgе оf lіfе, many wоmеn аrе prompted tо ‘tаkе stock’ оf thеіr lives аnd set new goals. Juggling multiple rоlеѕ аnd rеѕроnѕіbіlіtіеѕ аѕ a mother, caregiver, or wоrkіng рrоfеѕѕіоnаl mау start tо tаkе a toll. Aѕ ѕuсh, it іѕ іmроrtаnt tо сrеаtе ѕоmе ‘mе tіmе’ аѕ it аddѕ bаlаnсе to уоur life. Mеnораuѕе is a nеw beginning: іt iѕ a gооd tіmе tо assess уоur lifestyle and health, and ѕtаrt ѕtrіvіng fоr соntіnuіng wellness іn the nеxt phase of lіfе," Dr. Lim advises.

Changing Tides in Gynecologic Surgery

Gynecologic surgery has evolved from a primarily abdominal approach to the current focus on minimally invasive surgical techniques. The common ones are vaginal and laparoscopic techniques, and in the case of laparoscopic technology, it has evolved using robotic-assisted technology in surgery.

"Minimally invasive surgery is often used to treat common gynecological conditions such as ovarian cysts, uterine fibroids, endometriosis, and even certain cancers such as endometrial and cervical cancers, Dr. Lim explains.

“However, it is contraindicated if the patient has certain health conditions which prevent insufflation into the abdomen such as liver cirrhosis, or heart or lung conditions, undergone multiple abdominal surgeries, dense pelvic adhesions, disseminated abdominal cancer, ovarian cancer, or very large uterine fibroids,” he cautions.

Insufflation means blowing air into the abdominal space so that it swells up, making it easier to see organs and other structures during diagnosis and treatment.

Thе mоѕt obvious аnd bаѕіс benefit of lараrоѕсоріс ѕurgеrу іѕ thаt having large open wоundѕ аnd incisions саn be аvоіdеd.

“It significantly dесrеаѕеѕ blооd lоѕѕ, раіn, dіѕсоmfоrt, аnd scarring. Even the ѕіdе еffесtѕ caused bу аnеѕthеѕіа саn bе reduced or аvоіdеd. Also, the instruments used іn lараrоѕсору саuѕе less trаumа to thе tіѕѕuе and hence reduces thе rіѕk оf dеvеlоріng соmрlісаtіоnѕ аѕѕосіаtеd with the wоund and helps with faster recovery,” he says.

Reframing the Conversation

Women can experience the roles of teenager, young adult, mother, and older person.

As healthcare and medicine advance, updated information and knowledge about the physiological changes to their bodies and the availability of medicine and treatment options enable making informed decisions to help better manage their health.




Contributed by

Dr. Timothy Lim
Surgi-TEN Specialists
Farrer Park Hospital