A Lifetime of Good Health

Attention ladies: You probably take charge of your family's health, but when was the last time you took a step back to assess your own well-being? No, it isn't self-indulgent. It is a necessity for you and the family, and the good news is -- it's never too late to start. Reader's Digest brings you a complete primer as a Women's Day offering.

HYPOTHYROIDISM

Symptoms: Fatigue, sudden weight gain, irregular menstruation, a puffy and yellowish face, impaired memory, dry skin and hair, low pulse rate, constipation, intolerance to cold.

You can tell it is hypothyroidism with blood tests that measure hormone levels -- thyroxine (T4), thyroid stimulating hormone (TSH), triiodothyronine (T3) and thyroglobulin. However, if the TSH values are marginally out of whack (5-10 uIU/mL), chances are you don't need treatment except in the case of pregnancy or infertility. Remember, blood tests for anti-thyroid antibodies and certain imaging tests may be advised for more specific results.

What you should know: When the thyroid gland produces insufficient thyroid hormone it causes an imbalance. Autoimmunity is the most common cause of hypothyroidism. This occurs when your own immune system confuses thyroid gland cells and their enzymes for invaders and attacks them. Other causes include genetic predisposition, drugs used to treat psychological disorders, abnormal heart rhythms and epilepsy.

Those with a family history are at an increased risk. Pregnant women and newborn babies must be tested for an underactive thyroid as it can hamper the child's mental development. Timely treatment for the condition can prevent mental retardation. Women who have difficulty conceiving or irregular periods must get tested regularly. As should children with sluggish growth and women over 60 years of age.

Hypothyroidism, left untreated, can lead to depression, raise bad cholesterol, triglycerides and other lipids (fat molecules) associated with heart disease and blood pressure. It can also interfere with fertility.

The most widely accepted treatment for this condition is the thyroxine pill, which is sometimes prescribed for life. With the right dosage, there are virtually no side effects. However, don't stop the pill without your doctor's advice. Follow up with periodic TSH tests and lose the excess weight you may have gained.

Healthy tip: Contrary to popular belief, mild hypothyroidism isn't associated with weight gain. Severe hypothyroidism only adds about 2-4 kg. Go easy on soya beans as they may interfere with the treatment for thyroid. Cruciferous veggies contain goitre-producing substances that can impact thyroid, but are harmless for people who consume iodized salt. Hypothyroidism isn't a lifestyle disease and the Indian diet has no significant impact on it.

Rule out other possibilities: Arthritis, peri-menopause, menopause, kidney ailments.

POLYCYSTIC OVARY SYNDROME (PCOS)

Symptoms: Irregular menstrual cycles, delayed periods, sudden weight gain, increased facial and body hair growth, infertility, acne, thinning hair, obesity.

You can tell it is PCOS by testing blood levels of prolactin, TSH, the pituitary hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone), progesterone, testosterone and dehydroepiandrosterone sulfate (another male hormone), lipids and the patient's ability to process blood glucose (with a glucose tolerance test). Your doctor may also suggest a trans-vaginal ultrasound. It may reveal enlarged ovaries with multiple small follicles. Insulin levels are also checked for patients who are lean and show symptoms for the condition.

What you should know: PCOS is a common endocrine condition with reproductive and metabolic consequences; and characterized by an imbalance of LH and FSH hormones and increased secretion of insulin and male hormones, such as testosterone and androgen. This hormonal disarray can result in failed ovulation, infertility, obesity and an increased risk of diabetes and cardiovascular ailments. So women with PCOS should get screened at regular intervals for cardiovascular risks as well. PCOS is incurable, but its consequences can be managed with the following treatments: a) anti-oestrogen medication to induce ovulation; b) low-dose birth control pills to regularize menstrual cycles and androgen secretion; and c) insulin sensitizers to induce ovulation, and normalize insulin and glucose levels.

Healthy tip: Quitting smoking and weight loss, the healthy way, are extremely important. Regular exercise will increase insulin sensitivity and achieve weight loss. Studies claim that even 5 to 10 per cent loss of body weight can restore ovulatory cycles and secure your reproductive health.

Rule out other possibilities: Cushing's syndrome (a hormone disorder caused by high levels of cortisol), hyperprolactinemia (abnormally high levels of prolactin, a hormone associated with lactation), late onset congenital adrenal hyperplasia (a hormonal disorder), and adrenal or ovarian tumours.

ENDOMETRIOSIS

Symptoms: Heavy and painful periods, chronic pelvic pain, painful sex, bowel disorders, infertility.

You can tell it is endometriosis with an ultrasound of the pelvic region, a laparoscopy, CT scan and MRI. Some doctors may recommend examining the levels of Ca-125 (a marker for endometriosis) in blood.

What you should know: Endometriosis is a gynaecological condition where a tissue resembling the endometrial tissue (that lines the uterus) grows outside the uterine cavity. The tissue may grow in the pelvic area, on the ovaries, bowel, rectum or bladder. One theory attributes the condition to a possible backward flow of menstrual tissue through
the fallopian tubes. Another theory points to an impaired immune system that fails to identify and destroy endometrial tissue outside the uterus. Other factors are excess oestrogen and a genetic predisposition. Endometriosis can lead to infertility, chronic pelvic pain and large cysts in the pelvis that may rupture. Chances of malignancy, though minimal, cannot be overlooked. The treatment options include pain medication, hormone therapy, laparoscopic surgery and, as a last resort, hysterectomy (only if essential and you are not planning children).

Healthy tip: Have a discussion with your partner and explore sex postures that are not painful. Plan an early pregnancy if you have a family history of endometriosis.

Rule out other possibilities: Fibroids, ovarian malignancies.

FIBROIDS

Symptoms: Long and heavy periods, higher urinary frequency caused by large fibroids pressing against the bladder, pregnancy complications, pain depending on the size and location of the fibroid.

You can tell they are fibroids with a trans-vaginal and pelvic ultrasound. Sometimes, a pelvic MRI is used to confirm the diagnosis.


What you should know: Studies show that fibroids are common but with few bothersome symptoms. Fibroids are non-cancerous tumours that develop from the muscle tissue of the uterus. Experts are divided over their opinion on the causes of fibroids. A probable cause for the condition could be increased oestrogen levels. Women with a family history and those who've never been pregnant are more at risk. If you are nearing menopause and have mild symptoms, then your doc may skip the treatment, as fibroids tend to shrink after menopause. Those with stronger symptoms may be prescribed oral contraceptives to control heavy periods and/or advised hormonal therapy to shrink the fibroids. Surgical treatment options include uterine fibroid embolization, myomectomy -- removal of fibroids keeping the uterus intact-and hysterectomy (in extreme situations). For those with multiple fibroids, and if nearing menopause, hysterectomy is often recommended.

Healthy tip: In case of heavy bleeding, eat iron-rich foods to keep anaemia at bay.

Rule out other possibilities: Ovarian tumour, inflammation of the fallopian tubes, uterine adenomyosis (where the uterine lining grows into the uterus wall), endometrial polyps and cysts.

VAGINITIS

Symptoms: Excessive vaginal discharge with itching and burning or a strong odour.

You can tell it is a vaginal infection by analyzing the discharge, through simply observing it or a vaginal swab culture. Fungal infections (candidiasis) cause a curdy, white discharge; bacterial vaginosis causes a milky discharge with an unpleasant odour; trichomoniasis causes a yellowish-greenish, frothy, smelly discharge.

What you should know Vaginitis is an inflammation of the vagina. Change in the normal balance of yeast and bacteria in the vagina can also cause it. This can happen post-intercourse, or if you are on antibiotics, or during a hormonal change. Poor personal hygiene may be another cause. Wearing tight, synthetic lowers can trap moisture and heat and lead to an overgrowth of the fungus candida. Diabetes is also a major cause of yeast infections. These are usually treated with vaginal tablets. Bacterial vaginosis may be sexually transmitted. Sometimes an IUD (intrauterine device, like Copper-T) can also trigger a bacterial infection, so get it examined frequently. Oral and/or vaginal antibiotics are prescribed for bacterial vaginosis. Trichomoniasis is sexually transmitted and is treated with oral meds. If your doctor finds that the infection is sexually transmitted, she may also check your partner for infection and treat him/her along with you.

Healthy tip: Practise safe sex - condom use helps prevent sexually transmitted vaginal infections.

Rule out other possibilities: Vaginal infection 
or cervicitis.

URINARY TRACT INFECTIONS (UTI)

Symptoms: Burning sensation while urinating, urine with a tinge of blood, having an increased urge to urinate but minimal output, cloudy urine, back pain and fever.

You can tell it's an UTI with a routine urine test and culture. A midstream sample, preferably the first one in the morning, is taken for analysis. The culture report helps determine the type of bacteria so suitable antibiotics can be prescribed.  

What you should know: UTIs occur when bacteria enter through 
the opening of the urethra and spread upwards into the urinary system. Left untreated, it can also lead to kidney infections. Young women who have just become sexually active, women nearing menopause, those with diabetes and compromised immunity are more susceptible. One of the main causes of UTIs is reduced fluid intake and lack of personal hygiene. Holding back urine for long is also a contributing factor.

Healthy tip: Drink at least eight glasses of water daily, wipe your vagina front to back, cleanse after intercourse and urinate every three to four hours.

Rule out other possibilities: Vaginal infection or irritation.           

ANAEMIA

Chronic fatigue, cognitive impairment, paleness, chipping nails and pale lower eyelids are common symptoms. A complete blood count (CBC) and serum ferritin tests are suggested.

More than 50 per cent of Indian women in 11 states and union territories are anaemic, according to the National Family Health Survey 2015-16. Anaemia develops when iron intake is lower than 10 mg per day (normal range: 11-13 g/dL) and due to chronic infections. With inadequate haemoglobin-carrying red blood cells, the heart needs to work harder to circulate the reduced oxygen in the blood-stream. Severe anaemia can then lead to arrhythmia, heart murmurs, an enlarged heart 
or even heart failure.

Take iron supplements, as prescribed. An iron-rich diet is key: include liver, chicken, fish and iron-fortified 
foods, such as breakfast 
cereals, green leafy vegetables, legumes (kidney beans, chickpeas) and broccoli. In fact, haem iron (from animal sources) is better absorbed than non-heam iron (from plant sources). Pair foods high in vitamin C with iron-rich foods to boost iron absorption. Caffeine and canin are iron-inhibitors, hence reduce the intake of tea, coffee and aerated drinks.

CALCIUM DEFICIENCY

Aching bones and muscles, general pain, cramps and frequent fractures are typical symptoms. A bone density test along with serum calcium, serum phosphorus, alkaline phosphatase and parathyroid hormone tests are suggested.

Calcium is essential for healthy teeth and bones, and to keep your heartbeat, nerves and muscles functioning well. To make up for inadequate calcium (less than 1000 mg/day), the body steals it from our bones. Result: weak bones and, eventually, osteoporosis. Bones increase in size and mass as we grow up, peaking around age 30. As we age, osteoclasts (bone cells) absorb bone tissue faster than osteoblasts can replenish them. In fact, post-menopausal women are at risk of losing up to 20 per cent of their bone density in the first five to seven years. The greater your peak bone mass, the longer you can delay bone loss.

Calcium and vitamin D (for absorption) supplements are prescribed. Post-menopausal women may be advised hormone therapy. A diet rich in calcium and vitamin D with calcium-fortified foods, eggs and fatty fish (bony ones) is ideal. Exercise is also key. Reduce caffeine as it can inhibit calcium absorption. 

-- with inputs by Saswati Sarkar 

Sources: Dr Ambrish Mithal, chairman and head, division of endocrinology and diabetes, Medanta -- The Medicity, Gurugram; Dr Indira Hinduja, honorary obstetrician and gynaecologist, department of obstetrics and gynaecology, P. D. Hinduja Hospital & Research Centre, Mumbai; Dr Puneet Bedi, consultant, obstetrics and gynaecology, Indraprastha Apollo Hospitals, New Delhi; Ritika Samaddar, regional head, department of clinical nutrition and dietetics, Max Healthcare, New Delhi; Dr Kiran Coelho, head, department of gynaecology, Lilavati Hospital, Mumbai.

Adapted From Prevention India  2010 LIVING MEDIA INDIA LIMITED