Health tips

Facts & figures on women's health

In the last 20 years, there has been a growing debate on the relation between health and gender. It has been acknowledged that there are differences and differentials in health for men and women that are not taken into account: some diseases only affect women, are more prevalent in women or show different symptoms in women than in men. However, research that focuses in particular on women is insufficient. There is still a lack of aggregated information that would help to address the needs of women.

There are certain diseases that are more prevalent or unique to women:

• Chronic diseases: women are more likely to experience chronic diseases such as osteoporosis (1 in 3 women and 1 in 8 men over the age of 50 suffer from osteoporosis). Old age and female gender are the risk factors in developing rheumatic arthritis.



• Mental health: there are considerable differences that exist between men and women with regards to the prevalence of certain mental health disorders and at specific life stages. Women are more likely to experience depression. It has become one of the most widespread diseases among women worldwide. The reason for higher rate of the disease among women is however still unknown, according to the European Institute of Women's Health.



• Breast and cervical cancer: there are differences regarding the prevalence of certain types of cancer among men and women. Some cancers are more prevalent among women than men such as breast cancer, while other types such as cervical cancer is unique to women. According to the European Commission, one of the most common screening programmes for women is for example the ?pap' smear (test for cervical cancer), which nearly a third of EU women had had in the previous twelve months. A manual breast exam, the most common test for breast cancer, was carried out for just over one in four women in 2002. Since 1996 the number of examinations undertaken by women in the EU has constantly decreased. While just 30.3% of women in 1997 had neither the pap smear nor the manual breast examination, in 2002 this figure had increased to 43.4%. Only for mammography (breast examination by x-ray) has the percentage increased slightly from 1996. It is estimated that 20,000 lives could be saved every year in Europe through the implementation of organised cervical cancer screening programmes.



• Endometriosis is a condition where cells normally lining the uterus are found in other parts of the body (mainly the pelvis). Each month the affected tissue builds up and bleeds in the same way as the lining of the uterus during a woman's menstruation. The bleeding has no way of leaving the body. This leads to inflammation, pain and the formation of scar tissue. The European Institute of Women's Health estimated that 14 million women across the EU are affected by this disease, and 2 million in the UK alone. Patients face a lack of awareness among doctors which leads to an inadequate treatment. In addition, there is no agreement on the causes of the disease, but they are linked to a number of circumstances such as retrograde menstruation, lymphatic or circulatory spread, genetic predisposition, immune dysfunction or environmental causes.

There are certain diseases that show different symptoms in women:

• Cardiovascular diseases are a leading cause of deaths among women. According to the European Institute of Women's Health, heart attack symptoms differ considerably between men and women. A signal for a heart attack in women can be for example a discomfort or pain in the centre of the chest, or in other parts of the upper body, including the stomach or the back. A lack of awareness often leads to life-threatening delays in diagnosis. Nevertheless, research and long-term studies on cardiovascular diseases still focus primarily on men rather than women.


Woman are more likely to be infected with certain diseases:
• Sexually transmitted infections: Women are at a higher risk of being infected with sexually transmitted diseases. A number of these diseases do not show specific symptoms which increases the risk of subsequent health threats. In addition, the number of women infected with HIV has increased constantly since 1985. The risk of HIV infection during unprotected intercourse is 2-4 times higher for women than for men. Nevertheless, women have been excluded from clinical trials and are diagnosed at a later stage than men.

Stages of Cancer

Staging Cancers of the Female Reproductive System

Type	Stage 0	Stage I	Stage II	Stage III	Stage IV
Endometrial cancer	-	Only in the upper part of the uterus (not the cervix)	Spread to the cervix	Spread to nearby tissues but still within the pelvic area	A: Spread to the bladder or rectum B: Spread to distant organs
Ovarian cancer	-	Only in one or both ovaries	Spread to the uterus, fallopian tubes, and/or nearby tissues within the pelvis	Spread outside the pelvis to the lymph nodes or other organs in the abdomen (such as the surface of the liver or intestine)	Spread outside the abdomen or to the inside of the liver
Cervical cancer	Only on the surface of the cervix	Only in the cervix	Spread to nearby tissues but still within the pelvic area	Spread throughout the pelvic area, sometimes blocking the ureters	A: Spread to the bladder or rectum B: Spread to distant organs
Vulvar cancer	Only on the surface of the vulva	Only in the vulva and/or the area between the opening of the rectum and vagina (perineum); ¾ inch (2 centimeters) or smaller	In the vulva and/or perineum, but larger than ¾ inch	In the vulva and/or perineum and spread to nearby tissues and/or lymph nodes	Spread beyond nearby tissues to the bladder, to the intestine, or to more distant lymph nodes
Vaginal cancer	Only in the lining of the vagina	Only in the vagina but deeper (in the wall)	Spread to nearby tissues but still within the pelvic area	Spread throughout the pelvic area and possibly to nearby organs and lymph nodes	A: Spread to the bladder or rectum B: Spread to distant organs
Fallopian tube cancer	Only in the lining of the fallopian tubes	Only in the fallopian tubes but deeper (in the wall)	Spread to nearby tissues but still within the pelvic area	Spread throughout the pelvic area and possibly to nearby organs and lymph nodes	Spread to distant organs

Breast Cancer

Breast disorders may be noncancerous (benign) or cancerous (malignant). Most are noncancerous and not life threatening. Often, they do not require treatment. In contrast, breast cancer can mean loss of a breast or of life. Thus, for many women, breast cancer is their worst fear. However, potential problems can be detected early when women regularly examine their breasts themselves and have mammograms.

Symptoms

Common symptoms include breast pain, lumps, and a discharge from the nipple. Breast symptoms do not necessarily mean that a woman has breast cancer or another serious disorder. However, if a woman has any of the following symptoms, she should see her doctor:

• a lump that feels distinctly different from other breast tissue or that does not go away



• swelling that does not go away



• puckering or dimpling in the skin of the breast



• scaly skin around the nipple



• changes in the shape of the breast



• changes in the nipple, such as turning inward



• discharge from the nipple, especially if it is bloody

Breast Pain: Many women experience breast pain (mastalgia). Breast pain may be related to hormonal changes. For example, it may occur during or just before a menstrual period (as part of the premenstrual syndrome) or early in pregnancy. Women who take oral contraceptives or who take hormone therapy after menopause commonly have this kind of pain. The pain is due to growth of breast tissue. Such pain is usually diffuse, making the breasts tender to touch. Pain related to the menstrual period may come and go for months or years.Other causes of breast pain include breast cysts, infections, and abscesses.

In these cases, breast pain is usually felt in a particular place. Fibrocystic breast disease can also cause breast pain. Breast pain is occasionally due to breast cancer, but breast cancer does not usually cause pain. Breast pain that persists for more than 1 month should be evaluated.Mild breast pain usually disappears eventually, even without treatment. Pain that occurs during menstrual periods can usually be relieved by taking pain killers. These drugs inhibit the activity of estrogen and progesterone, which affect the breast. Because long-term use of these drugs causes side effects, the drugs are usually given for only a short time. If a specific disorder is identified as the cause, the disorder is treated. For example, if a cyst is the cause, draining the fluid from the cyst usually relieves the pain.

Breast Lumps: Lumps in the breasts are relatively common and are usually not cancerous. But because they may be cancerous, they should be evaluated by a doctor without delay. Lumps may be fluid-filled sacs (cysts) or solid masses, which are usually fibroadenomas.Other solid breast lumps include hardened glandular tissue (sclerosing adenosis) and scar tissue that has replaced injured fatty tissue (fat necrosis). Neither is cancerous. However, these lumps can be diagnosed only by biopsy. They require no treatment.

Nipple Discharge: One or both nipples sometimes discharge a fluid. A nipple discharge occurs normally during milk production (lactation) after childbirth or as a result of mechanical stimulation of the nipple by fondling, suckling, or irritation from clothing. During the last weeks of pregnancy, the breasts may produce a milky discharge (colostrum). A normal nipple discharge is a thin, cloudy, whitish or almost clear fluid that is not sticky. However, during pregnancy or breastfeeding, a slightly bloody discharge sometimes occurs normally

Several disorders can cause an abnormal discharge. Abnormal discharges vary in appearance depending on the cause. A bloody discharge may be caused by a noncancerous breast tumor (such as a tumor in a milk duct, called an intraductal papilloma) or, less commonly, by breast cancer. Among women who have an abnormal discharge, breast cancer is the cause in fewer than 10%. A greenish discharge is usually due to a fibroadenoma, a noncancerous solid lump. A discharge that contains pus and smells foul may result from a breast infection. A large amount of milky discharge in women who are not breastfeeding may result from galactorrhea. Tumors of the pituitary gland or brain, encephalitis (a brain infection), and head injuries can also cause a nipple discharge. Taking certain drugs, such as antidepressants and certain antihypertensives, can cause a nipple discharge. Taking oral contraceptives may cause a watery discharge.A discharge from one breast is likely to be caused by a problem with that breast, such as a noncancerous or cancerous breast tumor. A discharge from both breasts is more likely to be caused by a problem outside the breast, such as a pituitary tumor, or by drugs.

If a nipple discharge persists for more than one menstrual cycle or seems unusual to the woman, she should see a doctor. Postmenopausal women who have a nipple discharge should see a doctor promptly. Doctors examine the breast, looking for abnormalities. Mammography and blood tests to measure hormone levels may be performed. Computed tomography (CT) or magnetic resonance imaging (MRI) of the head may be performed. The woman is asked for a complete list of drugs she is taking. Sometimes a specific cause cannot be identified.

If a disorder is the cause, the disorder is treated. If a noncancerous tumor is causing a discharge from one breast, the duct that the discharge is coming from may be removed.

Labor & Delivery

In the last 20 years, there has been a growing debate on the relation between health and gender. It has been acknowledged that there are differences and differentials in health for men and women that are not taken into account: some diseases only affect women, are more prevalent in women or show different symptoms in women than in men. However, research that focuses in particular on women is insufficient. There is still a lack of aggregated information that would help to address the needs of women.

Pelvic floor (pelvic support) disorders involve a dropping down (prolapse) of the bladder, rectum, or uterus caused by weakness of or injury to the ligaments, connective tissue, and muscles of the pelvis. Pelvic floor disorders occur only in women and become more common with age. About 1 of 11 women needs surgery for a pelvic floor disorder during her lifetime.The pelvic floor is a network of muscles, ligaments, and tissues that act like a hammock to support the organs of the pelvis: the uterus, bladder, and rectum.

If the muscles become weak or the ligaments or tissues are stretched or damaged, the pelvic organs may drop down and protrude into the wall of the vagina. If the disorder is severe, tissues may protrude all the way through the vagina and outside the body.

Pelvic floor disorders usually result from a combination of factors. Being pregnant and having a vaginal delivery may weaken or stretch some of the supporting structures in the pelvis. Pelvic floor disorders are more common among women who have had several vaginal deliveries, and the risk may increase with each delivery. The delivery itself may damage nerves, leading to muscle weakness. Delivery by cesarean section may reduce the risk of developing a pelvic floor disorder.