The Beginnings of a ‘Well Woman’.

Recently there has been a change in attitude towards women’s health and wellbeing, with a global recognition of the unique health problems faced by women throughout their lives (see March issue of Connector).

Dr Rihab Awad, consultant obstetrician/ gynecologist at the American Hospital Dubai cites three distinctive phases in the lifecycle of a ‘Well Woman’; the reproductive, midlife, and post-menopausal phases, each of which has a different healthcare priority. In this issue, we will be looking in more detail at the reproductive phase; following with the midlife and post-menopausal phases in subsequent issues.

In the reproductive phase, up to the age of 40, we concentrate on building healthy bodies, and ensuring we are free of genetic and inherited disease ready for childbirth. This stage of a woman’s life is very dynamic, with lots of major life-changing events taking place within it; these events include studying, leaving home, marriage, bringing up children, and developing a career. Each of these events has social and psychological implications for her health, making it even more important that she is proactive in keeping herself healthy and well.

Healthy choices for a better lifestyle
A woman can monitor her health, and manage it herself to a large extent, by looking at her lifestyle. The advice that is passed down from mother to daughter about exercise, diet, hair & complexion care, exposure to the sun, smoking, and health/sexual education should be taken into consideration when looking at modern lifestyles.

Exercise and physical activity are very important at this stage in a woman’s life to ensure the body is fit and able to reproduce; the recommendation is twenty minutes, three times a week, and height, weight and BMI (Body Mass Index) should be monitored on a regular basis.

Diet is obviously equally important at this time of growth and development for the same reasons. To keep the body healthy, calorie intake should be kept low, while vitamin and mineral intake should be high, with calcium and iron being particularly important, and phyto-oestrogens should also be part of every woman’s diet. Phyto-oestrogens are chemicals which are similar in structure to the female hormone oestrogen, and are found in soya bean products, whole grains, fruit, vegetables and flax seed. Some studies have shown that women whose diets are high in phyto-oestrogens have a lower chance of developing breast cancer.

Self examination- good health starts at home
Women who monitor their lifestyles, and are aware of their health issues, should also examine themselves regularly and educate themselves on the health problems associated with their age/situation. However, they still need regular check-ups from a doctor and in this stage of life there are several necessary health checks; the pre-nuptial check up before marriage, pre-conception health checks before trying for children, pre-natal tests and screening during pregnancy, followed by post-natal check ups after childbirth, with regular general check-ups also recommended throughout this period. The regular check-ups can help prevent breast cancer, cervical cancer, and colon cancer, as well as diabetes, osteoporosis and high cholesterol leading to atherosclerosis.

There are also times when a woman should consult her doctor outside of the regular check ups. These times will be obvious to a woman more quickly if she is monitoring herself, for example if she finds a lump in her breast, has any sign of genital or Urinary infection, has palpitations or recurring dizziness, or has any sign or symptom of diabetes, a doctor should be consulted immediately.

Screening- for better health
These are the range of tests and screenings that the American Hospital Dubai recommends for all age groups, with two extra tests being phase specific for women in the reproductive phase.

• Universal tests include monthly breast self examination, and regular height, weight and BMI monitoring as already noted, as well as regular eye tests.
• An annual pap smear is also included in the list of screenings recommended by the American Hospital Dubai. This is a smear of cells taken from the cervix to detect abnormal cervical cells, which can lead to cervical cancer. Cervical cancer is found at the neck of the womb, and is one of the three major cancers with high mortality rates for women; early detection of this cancer relies on regular pap smears.
• Other screenings include: CBC (Complete Blood Count) blood screening which can detect dehydration, blood loss or anemia, or blood abnormalities, infections, and allergies; Lipid profile, which is blood screening to check the body fat, represented in cholesterol and Triglycerides, which are indicators of heart disease; and Urinalysis which is urine screening to check overall kidney function, and detect urinary tract infections, diabetes, or any other kidney disease.
• The two recommended tests specific to the reproductive phase are the chlamydia test, and the bilateral breast ultrasound scan. Chlamydia is a sexually transmitted infection which causes gynecology and fertility problems. The majority of infected women will not carry any overt symptoms until problems arise, which can include ectopic pregnancy, infertility and pelvic inflammatory disease amongst others. It is estimated that one in ten young women carry this infection; those at the highest risk are sexually active women under the age of 35, and it is therefore strongly recommended that these women are screened.
• The bilateral breast ultrasound scan gives an internal picture of the breast, which is used to detect tumors, and also to differentiate between benign (non-cancerous) and malignant (cancerous) tumors. Mammograms are recommended for women over 40, but, for those in the reproductive phase, mammography is only recommended if there is relevant family history of breast cancer, or if there is any abnormality upon the scan and/or clinical examination.

The reproductive phase is one of the most important times of a woman’s life, as the name suggests it is the time that women reproduce, making their health not only an important priority for their own lives and futures, but also for the lives and futures that they create. It is therefore essential that ‘Well Women’ in the reproductive phase look after themselves and keep themselves healthy to allow them to look after others. This care and attention to their health should continue right through their lives, through midlife, menopause and beyond; in the next issue, Connector will explore the midlife phase and the health issues a woman needs to consider at this time.