Living and practising medicine around the IT corridor in Chennai, I get to see many young women, who come to me seeking help for their gynaecological problems. These are women whose educational qualifications would be, at the very least, a basic bachelor’s degree. Many of them hold responsible positions and have a promising career ahead. And yet the one thing that strikes me as completely discordant is their complete lack of education and awareness about their general health, and more specifically their reproductive health.
I emphasize on reproductive health not simply because I am a gynaecologist, but because a majority of these women primarily fall into one of two categories: they are either soon going to be sexually active, or already are.
PCOS: Most common, and most often ignored
The commonest problems affecting this age group is irregular periods. A woman rarely seeks help if her periods are irregular unless it is disruptive to her normal daily life. An important underlying cause of this problem in the 18-30 age group is PCOS (Polycystic Ovarian Syndrome). This disorder constitutes almost 20% of all problems seen by a gynaecologist.
While the exact pathology of this problem is unknown, it does exhibit a genetic susceptibility, therefore a familial tendency is seen. It is characterized by irregular periods, weight gain, excessive hair on the body, loss of hair on the head, fertility problems and skin problems such as acne. Long term consequences of this condition include the risks of developing type II diabetes and endometrial hyperplasia (excessive thickening of the uterine lining, also a precursor to uterine cancer).
Recent studies in India have shown that the incidence of this condition is six times more prevalent among the urban population than the rural population. Sedentary lifestyles, access to high calorie food and domestic help for all household work have been attributed as the causes for increased prevalence of PCOS among higher socio-economic urban population in India.
On questioning, many of the women I see admit to eating out more than 4-5 times a week. Very few are aware of the need for exercise on a regular basis. For overweight women with PCOS, weight loss alone often regulates the menstrual cycle. Even a loss of 5-10% of their body weight can be helpful in making menstrual periods more regular. Weight loss can also improve insulin levels and help in resolution of symptoms of excess hair and acne.
Sexual health and contraception
Another fact that I often notice is the complete lack of insight regarding the need for contraception. But contraception and related issues can be prioritised or thought about only if facts about conception are known. Many women are unaware that a single act of intercourse can be enough to get pregnant.
While one may assume that secondary school does impart sexual education, yet basic knowledge around the birds and the bees continues to be lacking. This may partly be due to the social taboo on discussions around sex, and the resulting hesitation and shyness to ask. Many young women don’t even feel comfortable asking their mothers, and the little information they have is purely through friends or the web.
Even today, it is alarming to note the ignorance and callousness around the concept of planning a family and having a child only when ready. Many urban educated women don’t use contraception even when there is a sea of products available.
There exist so many myths about using hormonal pills for contraception, the most common, perhaps, is that they may lead to ‘problems’ later on in life, and that ‘it may not happen when you want it to’. Contraceptive modalities have been around for at least for three to four decades and are only getting better with regard to safety profile. A couple should be able to plan a family when they are financially and physically fit to do so, but so many educated, urban women just drift into parenthood in an inevitable turn of events.
Having said that, one must also add a note on emergency contraception. At the other end of the spectrum, I also see women who take emergency contraceptives time and again, without any prescription. True to its name, emergency contraceptive is meant for an emergency – a one-off unprotected act of sexual intercourse. Unfortunately, this over-the-counter pill is quite brazenly abused and women take it rampantly without any medical supervision.
Then there are women who use termination of pregnancy as contraception! This is clearly alarming, as each such episode is a big risk to the woman’s long-term health. Despite a legal ban on medical abortion pills, women are still able to easily procure these and use them time and again, oblivious of the potential complications of using these drugs.
Cancer of the uterine cervix and breast cancer are the two of the most common cancers seen in women. Data suggests that breast cancer is related to several lifestyle factors such as late marriage, delayed motherhood as well as increasing incidence of obesity. Sedentary lifestyle adds to the risk.
Cancer of the cervix has reduced significantly in developed countries; however, in India due to lack of mandatory population-based screening programmes, detection of cervical cancer often happens at an advanced stage.
HPV is the most common viral infection of the reproductive tract and is an important cause of cervical cancer. It is generally acquired by young women after the onset of sexual activity. The majority of HPV infections do not cause symptoms or disease and resolve spontaneously within two years. However, persistence of HPV is one of the most important causes for cancer of the cervix. Hence the role of vaccination of young women (15-25 years) in preventing HPV-associated cancer of cervix cannot be overstated.
For those beyond this age, cervical screening through a Pap smear is advised. The number of Indian women, even in the cities, who have never had a smear or had it just once is actually quite alarming.
Don’t skip that doc visit!
To sum up, a routine health check including a consultation with the gynaecologist must be undertaken regularly, at least every three years starting at the age of 25 till the woman hits menopause. This check should include a breast examination as well as a cervical smear. Thereafter, it can be individualized depending on her medical history and conditions.
The power of the Internet cannot be underestimated. Most people these days consult ‘Dr Google’ and then self-diagnose even before coming to a professional. While resources are available online, without informed guidance many are likely to feel lost and completely confused as contradictory information is not uncommon on the web from different sites. It is far better to seek professional help first and then ask for online information that your doctor recommends, after you have at least a probable diagnosis.
Some of the more trusted websites include Nhp.gov.in (also contains links for various health-related apps); womenshealth.gov; rcog.org.uk; acog.org. As a guideline, the advice is to look at authentic websites, such as those which are government-based (.gov) or linked with organizations (.org). One could also look at condition-based websites, such as pcosindia.org, thyroid.org etc.
Finally, there has to be a change in the practice and the mindset that a woman needs to visit a gynaecologist only when she has problems. Overall well-being of women is a concept that Indian women must embrace. To that end, a routine comprehensive health check and a frank discussion with your gynaecologist to address your reproductive health needs must take place regularly.