Three Experts Explain Why We Need to be Concerned about Obstetric Fistula

WORDS ASSOCIATE PROFESSOR DR KHINE PWINT PHYU, ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN & ASSOCIATE PROFESSOR DR ANITHA PONNUPILLAI

The International Day to End Obstetric Fistula, observed annually on 23 May, serves as a reminder of the silent suffering endured by women around the world.

FEATURED EXPERT
ASSOCIATE PROFESSOR DR KHINE PWINT PHYU
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
OBSTETRIC FISTULA EXPLAINED IN 5 KEY POINTS

Click on the image for a larger, clearer version.

  1. Obstetric fistula is an excruciating childbirth injury resulting in an abnormal connection between a woman’s birth canal and bladder or rectum.
  2. The cause of obstetric fistulas lies in traumatic childbirth experiences. Prolonged and difficult labours subject women to prolonged pressure on the birth canal, resulting in inflammation, tissue damage, and death of cells.
  3. This can lead to the formation of fistulas, creating distressing symptoms such as urinary or faecal leakage, foul-smelling vaginal discharge, chronic vaginal infections, or painful sexual intercourse.
  4. Globally, 65% of obstetric fistula cases occur in girls under the age of 18, affecting impoverished and vulnerable girls and women.
  5. Despite its profound impact, obstetric fistula remains largely hidden in the shadows of societal taboos and healthcare disparities. However, empirically, because of the access most women in Malaysia have to good healthcare facilities, obstetric fistulas are exceedingly uncommon in our country.
FEATURED EXPERT
ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
3 FACTORS THAT INCREASE THE RISK OF OBSTETRIC FISTULA

Limited Access to Skilled Healthcare

Inadequate access to skilled birth attendants and emergency obstetric care can lead to prolonged labour without proper medical intervention. This is the leading cause of severe birth trauma and fistula formation.

Poor Socioeconomic Conditions

Due to poverty and lack of education, young women in underprivileged environments can be subjected to childhood marriages, teenage pregnancies, and associated complications that include fistula formation.

Social Stigma and Cultural Barriers

Some cultural beliefs and societal stigma surrounding childbirth-related injuries impede timely medical interventions. Misconceptions and shame prevent women from seeking the necessary healthcare, thus exacerbating the severity of obstetric fistulas.

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ANITHA PONNUPILLAI
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
INITIATIVES THAT MUST BE TAKEN TO REDUCE THE INCIDENCE OF OBSTETRIC FISTULAS

Promote Access to Quality Maternal Healthcare
  • Strengthen maternal healthcare services, especially in remote areas, is crucial.
  • Ensure healthcare for all, with emphasis on accessible care during pregnancy, labour, and after childbirth.
Health Education Initiatives
  • Public awareness campaigns and access to education are instrumental in dispelling myths and fostering early recognition of birth injuries.
  • Empower women with knowledge about childbirth complications.
  • Encourage proactive seeking of medical assistance and reduces the stigma surrounding fistulas.
Enhance Healthcare Infrastructure
  • Invest in healthcare infrastructure, including skilled birth attendants, surgical facilities, and postoperative rehabilitation services, play a crucial role.
  • Provide adequate resources and training for healthcare professionals to assist in ensuring timely diagnosis, treatment, and rehabilitation of obstetric fistula patients.
Conduct Population Studies and Research
  • Conduct comprehensive population studies on the prevalence and incidence of obstetric fistula to establish accurate regional data.
  • Use the data from these studies to dentify causative factors to shed light on the root causes and also to curtail and eliminate the factors responsible for obstetric fistulas.
WHAT ARE WE DOING IN MALAYSIA TO ADDRESS THE PROBLEM?

In Malaysia, extensive measures are taken to ensure that both urban and rural areas receive adequate care during pregnancy, labour, and childbirth.

Intensive training programs for midwives are conducted to ensure the delivery of babies with safe techniques and the timely diagnosis of serious postpartum complications, including obstetric fistulas.

Furthermore, urogynaecology departments have been established in both private and public sectors, staffed with trained urogynaecologists to effectively treat obstetric fistulas efficiently if at all they occur and provide comprehensive rehabilitation services.

Things You Should Know About Whiteheads & Blackheads – Beneath the Skin With Dr Benji

 

FEATURED EXPERT
DR BENJI TEOH TZE YUEN
Consultant Dermatologist
Central Dermatology Specialist Clinic

For most skin conditions, there is always a treatment. Hence, there is no need to suffer in silence because you have a skin condition that makes you feel self conscious about your appearance. I have encountered patients that are distressed about whiteheads, blackheads, and melasma. If you have any of these skin conditions, please join me as I share with you some useful information about these conditions and available treatments.
WHITEHEADS & BLACKHEADS

Acne is a common skin disease that affects about 85% of adolescents at some time of their lives. The most common type of acne is acne vulgaris, which makes up 99% of acne cases and affects about 95% of boys and 83% of girls by the time they are 16.1,2

Blackheads and whiteheads are common characteristics of acne vulgaris.1

They are the result of the pores or hair follicles of the skin being blocked by dead skin and sebum (the oil produced by the skin).1,2

The primary lesion of acne is called a comedo.3 The plural form of comedo is comedones.
Whiteheads form when the comedones are closed and follicles are completely blocked.

Blackheads form when the comedones are open and the surface is dark black in colour due to oxidation of the lipid and melanin contents of the comedones.2,3

Acne vulgaris on its own is not associated with any mortality, but it can cause scars to form.3 These scars can cause psychosocial challenges such as depression, anxiety, and more.3

Common causes of acne vulgaris. Click on the image for a larger, clearer version.

HOW IS ACNE VULGARIS TREATED?

Be wary of treatment or management given by non-medical doctors when it comes to treating acne—there is a risk that these procedures may worsen the acne or cause scarring. Always consult a general practitioner or dermatologist first, so that you will receive evidence-based treatments and advice in line with the Malaysian clinical practice guidelines.

The following are the recommended treatment options for acne
vulgaris.

First line treatment
The first line treatment is the first recommended treatment for a certain disease.

When it comes to acne vulgaris, the first line treatment is pharmacological treatment, usually in the form of topical creams, gels, lotions, solutions, and other forms that can be applied onto the affected area of the skin.4

Medical topical treatments. These contain active ingredients such as benzoyl peroxide, retinoids, antibiotics, and others.4 They may be used on their own or, for moderate cases, in combination with other creams.4

Systemic treatments
Medications such as oral antibiotics as well as combined oral contraceptives may be prescribed by the doctor depending on the severity of the acne and other factors.5

Supplementary treatments
Physical treatments. Corticosteroid injection into the affected area of the skin may be helpful, either to complement existing therapy or to improve the appearance of skin after treatment.6

Chemical peels—in particular salicylic acid and glycolic acid peels—may be beneficial. However, they need to be carried out with care under the supervision of an experienced dermatologist.6

Energy-based devices. Laser treatment on the affected skin area may be beneficial when applied alongside other treatments.6

RETINOIDS ARE USEFUL IN TREATING ACNE VULGARIS.

‘Retinoid’ is an umbrella term for a family of chemical compounds that share structural and functional similarities with vitamin A.

They normalize shedding of the skin (desquamation) by reducing the proliferation of a common type of skin cells called keratinocytes as well as promoting the differentiation of these cells.4,6

Topical retinoids also block several important inflammatory pathways that are activated in acne: toll-like receptor, leukocyte migration, and AP-1 pathways. Blocking these pathways can reduce the release of inflammatory cytokines and nitric oxide as well as inhibit cellular inflammation.7

ADAPALENE IS A RETINOID APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA) FOR USE IN TREATING MILD TO MODERATE ACNE.

Adapalene is a third-generation retinoid. Compared to earlier generation retinoids, it interacts with the retinoid receptors of the skin in a different manner, so it causes less irritation compared to earlier generation retinoids while remaining just as effective.8

How effective is adapalene?

A meta-analysis of 5 large studies with 900 patients for over 12 weeks demonstrated that gel containing 0.1% adapalene is as effective as gel containing 0.025% tretinoin, another retinoid commonly used to treat acne (Cunliffe et al, 1998). After 12 weeks, both agents were equally effective but adapalene had a faster onset of action and less irritation.8

Another study (Cunliffe et al, 1997) compared 0.1% adapalene and 0.025% tretinoin on 323 patients for 3 months. They found that adapalene caused more decrease in total and noninflammatory lesions than tretinoin. However, there was no significant difference in terms of inflammatory lesions.9

Also, there is a study (Korkut and Piskin, 2005) that demonstrated how adapalane is more effective in treating non-inflammatory lesions compared to inflammatory lesions. The use of adapalene gel may yield results in as early as two weeks, but overall, it will take some time to see significant results.10

General adverse reactions

These include dryness, redness, irritation, and burning or stinging. These symptoms usually peak at the 2nd- to 4th-week mark before subsiding.11

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Things You Should Know About Melasma – Beneath the Skin With Dr Benji

FEATURED EXPERT
DR BENJI TEOH TZE YUEN
Consultant Dermatologist
Central Dermatology Specialist Clinic

For most skin conditions, there is always a treatment. Hence, there is no need to suffer in silence because you have a skin condition that makes you feel self conscious about your appearance. I have encountered patients that are distressed about whiteheads, blackheads, and melasma. If you have any of these skin conditions, please join me as I share with you some useful information about these conditions and available treatments.

MELASMA

Melasma is a common skin condition that causes brown patches and spots, usually on the face, which are darker than your natural skin tone.12,13

Melasma is not associated with any mortality but has significant psychosocial morbidity.12,14 It is shown in a systemic review and metaanalysis that prevalence of depression was as high 48.5% in Asia!14

WHAT HAPPENS TO YOUR SKIN WHEN YOU HAVE MELASMA?

Melasma is linked to an increase in the production of melanin, a skin pigment that gives the skin a darker tone.15

This increased production of melanin is linked the presence of ultraviolet (UV) light.15

However, the exact mechanism of how increased melanin production can lead to the development of melasma is still being researched upon.15

Common causes of melasma. Click on the image for a larger, clearer version.

SUN PROTECTION

Increased production of melanin is linked to the presence of UV light and UV light is a component of sunlight. Therefore, it is essential to reduce your skin exposure to sunlight.

Use a broad-spectrum sunscreen when you spend time under the sun. One study found that SPF 60 sunscreen is found to offer greater improvements than SPF 30 ones.16

THE US FOOD AND DRUG ADMINISTRATION (FDA) HAS APPROVED THE USE OF A TOPICAL TREATMENT FOR DARK SPOTS ASSOCIATED WITH MODERATE TO SEVERE MELASMA.

Such a topical cream includes the active ingredients fluocinolone acetonide, hydroquinone, and tretinoin.17

The cream works to disrupt pigment production in the skin and lighten the existing dark spots on the skin.18

It is considered a prescription medicine, available only with a doctor’s prescription, so you should consult a doctor to discuss whether this cream would be suitable to treat your melasma.

What’s in the cream?

Hydroquinone is considered the primary and most effective topical agent for blocking the enzyme tyrosinase, which is a very important enzyme in the pathway of melanin production.18

On top of that, it also is known to play a role in the degradation of melanin-producing cells (melanocytes) and melanin-storing cell structures called melanosomes.18

Tretinoin, a retinoid, works by motivating epidermal and dermal turnover, which may cause rapid loss of cell pigment. In addition, it inhibits tyrosinase, facilitates the penetration of hydroquinone, and neutralizes the stratum corneum thinning effects of corticosteroids.18

Fluocinolone acetonide is a moderate potent topical steroid used to reduce the irritation caused by both hydroquinone and tretinoin.

General adverse reactions

Some people may develop allergic reaction to one or more of the active ingredients. Both tretinoin and hydroquinone have been known to be cause irritation in some people. Some people may experience adverse reactions related to the general use of retinoids, which include redness, peeling, burning, dryness, or itching.

OTHER COMMON OPTIONS

Available over-the-counter creams to manage melasma commonly contain ingredients such as vitamin C, azelaic acid, kojic acid, salicylic acid, cysteamine, niacinamide, ascorbic acid, tranexamic acid, glutathione, and soybean extract.18

These ingredients help to reduce pigmentation by disrupting the pigment production process in the skin.18

These products, however, are categorised as cosmeceuticals and they may not work as well or as fast as a medical-grade treatment. The effectiveness of their use is still being researched upon, and they may also cause irritation to the skin of some people.

Chemical peel and laser treatments may also be useful for superficial melasma.12

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Experts Explain Endometriosis and Encourage Women with This Condition to Reach Out for Help

WORDS LIM TECK CHOON

5 FACTS ABOUT ENDOMETRIOSIS

Click on the image for a larger, clearer version.

  1. It is a condition that sees tissue similar to that of the uterine lining growing outside the uterus, such as at the ovaries, fallopian tubes, and the tissue lining the pelvis.
  2. It can also be found in other areas of the body, but this is very rare.
  3. Endometriosis can cause debilitating pain, severe bloating, and fatigue, especially during one’s period.
  4. It can affect one’s ability to have children, as 30% to 50% of women with infertility also have endometriosis.
  5. Approximately 350,000 women in Malaysia may be silently suffering from this condition.
WOMEN SHOULD REACH OUT FOR MEDICAL ATTENTION IF THEY BELIEVE THAT THEY HAVE ENDOMETRIOSIS
FEATURED EXPERT
SURITA MORGAN
Founder and President
Endometriosis Association of Malaysia (MYEndosis)
Website

Surita Morgan tells us: “Malaysians are generally not aware of what endometriosis really is and why some women have this condition. One of the biggest reasons is because it is often considered as a taboo subject. People are simply uncomfortable speaking about menstrual health openly. But it doesn’t have to—rather, it shouldn’t—be that way.”

She adds: “We need to change the narrative around menstrual health and endometriosis. We need better research, better resources, and better recognition of this condition. By doing so, we can begin to pave the way for a future where endometriosis is not a burden anymore carried in silence, but a challenge met with understanding and solidarity.”

UNDERSTANDING ENDOMETRIOSIS
FEATURED EXPERT
DR LIZA LING PING
Consultant Obstetrician, Gynaecologist, and Fertility Specialist
TMC Fertility

Dr Liza Ling Ping shares that endometriosis reveals itself in stages.

The First Stage or Minimal Endometriosis

At this stage, there are scattered patches of endometriosis tissue, often without symptoms or with mild pelvic discomfort.

The Second Stage or Mild Endometriosis

The number of tissue patches increases, potentially affecting fertility and causing discomfort during menstruation and intercourse.

The Third Stage or Moderate Endometriosis

There is further spread of endometriosis tissue, along with scar tissue and adhesions that can lead to chronic pelvic pain and digestive issues.

The Fourth Stage or Severe Endometriosis

This stage is characterized by extensive endometriosis tissue patches, large cysts, and significant scarring. There is intense pain as well as potentially impacting bowel and urinary functions.

CAN ENDOMETRIOSIS BE TREATED?

Dr Liza reveals that there is a range of treatments available such as laparoscopic surgery to specialized fertility treatments, all aimed at managing symptoms and preventing escalation.

Early diagnosis and intervention can open the door to effective treatment options that not only alleviate symptoms, but also improve quality of life, and even protect fertility.

Hence, she advises women that are affected by this condition to seek formal help and professional medical attention.

How Combining Anti-Hormone Treatments & CDK4/6 Inhibitors Can Benefit Women with Certain Breast Cancers

WORDS DR KILEY LOH WEI-JEN

FEATURED EXPERT
DR KILEY LOH WEI-JIN
Consultant Medical & Breast Oncologist
Penang Adventist Hospital
30-40% OF MALAYSIAN WOMEN PRESENT WITH ADVANCED BREAST CANCER

These women either have a very high risk of relapse or are already experiencing cancer that has spread to other parts of the body.

Unfortunately, cancer that has spread outside the breast and surrounding lymph nodes is mostly incurable.

For these women, the focus is how we can help them live well and longer.

THERE ARE DIFFERENT TYPES OF BREAST CANCERS, EACH WITH VERY DISTINCTIVE TREATMENTS

The types of breast cancers are usually assessed by a laboratory test called immunohistochemistry for the presence of oestrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor 2 (HER-2) receptors.

Breast cancers that are positive for ER and PR and negative for HER2, also termed hormone receptor-positive HER2 negative breast cancers, are the most common type, making up about 70% of all breast cancers.

The female hormone oestrogen mainly drives these breast cancers and is usually treated with anti-hormone treatments in combination with a targeted treatment called CDK4/6 inhibitors.

LET’S LOOK AT THESE TREATMENTS IN MORE DETAIL

Anti-hormone treatments block breast cancer cell’s ability to use oestrogen within a woman’s body, while CDK4/6 inhibitors work by blocking the proteins CDK4 and CDK6 that help cancer cells to divide.

Both these treatments are usually given as tablets.

However, premenopausal women usually require additional anti-hormone treatments to render them menopausal, either through anti-hormone injections or surgery to remove the ovaries.

Research-based evidence

Studies have shown that a combination of anti-hormone and CDK4/6 inhibitors effectively controls advanced breast cancers and helps these women live longer.

Smaller studies suggest that men with hormone receptor-positive HER-2 advanced breast cancers benefit equally from these treatments.

Additional studies have also shown that they are more effective and tolerable than traditional chemotherapy. As patients may be on treatment for an extended period, sometimes over many years, side effects must be considered and managed well.

Recent studies have also now shown that anti-hormone treatments and some CDK4/6 inhibitors also work in people with high-risk, early-stage hormone receptor-positive HER-2 negative breast cancers, as well as reducing the risk of the cancer relapsing.

Potential side effects

Anti-hormone treatments can potentially give rise to low oestrogen symptoms, such as hot flashes, joint stiffness, dry skin and vaginal dryness, all of which tend to dissipate over time.

CDK4/6 inhibitors can commonly cause fatigue, low blood counts, and appetite changes, which are manageable with dose changes and tend to dissipate over time.

HOW ABOUT THE COST OF TREATMENT?

Despite the importance of anti-hormone treatments and CDK4/6 inhibitors for people with advanced or high-risk early-stage hormone receptor-positive HER-2 negative breast cancers, access remains a problem in Malaysia due to the cost of treatments.

Most people who are insured are able to access these treatments, but access through the public healthcare system is limited due to cost issues.

Nonetheless, financial support for these treatments can sometimes be available through some charitable organizations in Malaysia.

Expert Advice for Moms That Are Juggling Breastfeeding and Work

WORDS MAS AMIRAH MOHMAD AZHAR & DR HASLINA ABDUL HAMID

FEATURED EXPERTS

MAS AMIRAH MOHMAD AZHAR
Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR HASLINA ABDUL HAMID
Lecturer and Registered Dietitian Nutritionist
Centre for Community Health Studies (ReaCH)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Exclusive breastfeeding is recommended for infants from birth until at least 6 months of age.

This is defined as providing an infant with just breast milk—no other foods or liquids.

For the first six months of life, the World Health Organization (WHO) and other health organizations highly advise this practice, as it can contribute to many advantages for both mother and baby.

THE BENEFITS OF BREASTFEEDING

In addition to its balanced nutritional composition, breast milk contains important substances such as immunoglobulin A or Ig A, lactoferrin, cytokines, enzymes, growth factors and leucocytes. These substances provide the baby with protection against infections while also promoting intestinal adaptation and maturation.

Breast milk also contains numerous prebiotic substances such as human milk oligosaccharides (HMO), which support the growth of non-pathogenic probiotic microorganisms, primarily lactobacilli and bifidobacteria, while removing the potentially pathogenic bacteria. This high concentration of HMO is unique to humans, and studies have shown that breastfed infant has a more stable and constant population of oligosaccharides compared with infants fed with formula milk.

Furthermore, the composition of breast milk is unique, as the concentration of both energy and protein in expressed breast milk is highly variable throughout lactation stages, between mothers, and even from the same mother.

Breast milk feeding also has been linked to improved long-term neurocognitive development and cardiovascular health outcomes.

Additionally, numerous studies have demonstrated the effectiveness of breast milk in offering protection even to preterm infants in the Neonatal Intensive Care Unit (NICU).

THE JUGGLE BETWEEN BABY AND BRIEFCASE

For many working mothers, balancing work and breastfeeding can be challenging.

If you’re one of these mothers, you can choose to breastfeed exclusively or partially once you go back to work.

If you choose to exclusively breastfeed, you should express your milk while you’re on your work breaks. You can use this expressed milk to build up a supply for the feeding of your infant by a caregiver while you’re at work or for moments when you face a shortage of breast milk.

TIPS & ADVICE

The following may be useful for working mothers that still wish to breastfeed as well as to support needs of their infants.

Don’t stress yourself out!

While it’s always ideal to aim to complete your breastfeeding journey until 2 years, you and your health matters too.

Studies have shown that the benefits of breast milk on babies are dose-dependent, so the more and the longer you give, the better the beneficial effects are.

With that said, it also means that some breast milk is better than none.

Every drop matter, so while you are trying your best to pump your milk within your capacity, do not be discouraged by the amount. You might get to express more in some days and just a little in other days, and it’s totally fine.

Seek help whenever necessary.

Being a new mother is overwhelming with both love and new responsibilities, so it is very important for you to prioritise your mental and physical well-being.

Also, go for consistent health check-ups and give yourself ample time to rest.

Know your employment policies.

Nowadays, many companies provide reasonable breaks for breastfeeding employees to express breast milk. Certain companies even provide special rooms or areas for pumping the breastmilk, which comes with a refrigerator to store breast milk as well as a wash area. These venues are kept out of sight and away from public or coworker intrusion.

You can request for such an area at your workplace if such a space is not available.

The location to express your breast milk, the number of breaks available for you, and the length of each break likely differ from company to company. You should get a better understanding on your employer’s company’s policy when it comes to expressing breast milk at the workplace. This way, you can incorporate breast milk expression into your work schedule without negatively affecting your work performance or your ability to get enough rest.

You have the right to ask for permission, explain about your timetable routines to express milk, and enquire about any accommodations to improve your ability express milk more conveniently, so don’t hesitate to talk to your supervisor or human resource department.

You can do this early, such as before your delivery date, so that you can transition from your maternity leave to back to work more seamlessly.

Manage your expectations.

Know how much you need to pump, how many sessions you need to spare your time for, and how much breast milk your baby needs.

How much does your baby need? While it is quite difficult to estimate how much a baby receives from direct breastfeeding, Recommended Nutrient Intake for Malaysia 2017 states that:

  • Babies need around 500 to 600 kcal/day during their first year of life.
  • This amount increases to around 900 to 980 kcal/day at the age of 1 to 3 years.

The number of breastfeeding sessions is reduced as the baby ages, but the amount of milk needed by the baby is increased, from 6 to 8 sessions and 60 to 150 ml.

So, the number of pumping sessions and amount of milk needed to be expressed could be tailored to that.

The amount of milk consumed by your baby is usually reduced once you start them on complementary feeding, but they can still be breastfed on demand, with direct breastfeeding done at home.

Estimated daily milk requirements of babies from 0 to 6 months old. Click image for a larger, clearer version.


The recommended nutrient intake for infants from 0 to 3 years old. Click on the image for a larger, clearer version.

Invest in a good breast pump and breast milk storage.

There are many innovations and developments in the design of breast pumps and related accessories.

Hence, before purchasing a breast pump, take time to research by reading reviews or talking to your healthcare about the necessary equipment to meet your breastfeeding needs. You can also opt for trial or rental period to determine whether a breast pump is suitable for you.

Don’t just choose based on design and brand—you must also choose based on your needs also your budget. Local brands are usually more economical while still having comparable good quality to imported brands.

If you have a busy schedule, there are certain brands that offer quiet, wearable, or hands-free option which could accommodate your routine.

You will also need specialised storage bags made specifically to hold breast milk for safe transportation and storage.

  • Look for BPA-free bags that are strong enough to be kept in the freezer or refrigerator.
  • Consider bags with double zipper seal, the ability to stand alone for simple pouring, and a write-on section to record the time and date you expressed the milk.

Also, after each use of the breast pump, you should clean every area that came into contact with your breast milk or breast tissue. It is not always possible to use soap and water, particularly at work when you might not have access to a sink or have limited time. Cleansing wipes prevail for these instances!

Breastfeeding sanitizer spray is another useful consideration for quick or last-minute cleaning.

To make breast pump cleaning easier when you are on the go, make sure the supplies you buy fit compactly inside your pump bag.

Maintain proper hydration.

Have a bottle of water ready every time you pump your breast milk as well as every time you breastfeed your baby.

Water is essential, but it’s especially critical for working breastfeeding moms to stay focused and energised throughout the day.

Studies have shown that consuming more fluids than normal does not result in an increase in milk production. However, drinking too little water can lead to dehydration, which can harm your health and the quality of your breast milk.

Therefore, to ensure that your body is functioning at its best, it is crucial to consume enough fluids as to stay hydrated, which can range from 1.5 to 2.5 litres per day.

Some mothers rely on coffee to stay awake— which makes sense when your baby decided to play at 3 am! —so consuming low to moderate amounts (around 2 to 3 cups per day, or less than 300 mg of caffeine) is still considered acceptable.

Balanced meals are always key!

Recommended Nutrient Intake for Malaysia 2017 recommends that lactating mothers should consume about 2,400 kcal/day in the first 6 months of lactation, which is approximately 500 kcal more than normal adult women (1,800 to 1,900 kcal for a moderately active individual).

For mothers that want to lose some of their pregnancy weight, make sure to have adequate calories and protein according to your needs. Schedule an appointment with a dietitian if you need help to plan your meal.

Make sure to include plenty of fruits and vegetables in your meals as they are a great supply of important vitamins and minerals. Carbohydrates, especially from whole grains, is a great source of energy and fibre that can support the ability to feel full for longer.

Healthy snacking is encouraged in between meals. Go for fruit smoothies, toast, crackers, yogurt, and nuts.

TO SUM THINGS UP

Exclusive breastfeeding is one of the essential components of early childhood nutrition, but every breastfeeding mother’s circumstances are different. Therefore, it’s critical to identify a schedule and strategy that are most effective for you and your baby.

Furthermore, practice self-compassion while you manage this delicate balancing act, and don’t be afraid to seek for help and advice from your loved ones, coworkers, family members, and friends.

What Kind of Sleeping Position Is Best for a Pregnant Mom and Safest for Her Baby? Let’s Find Out!

WORDS LIM TECK CHOON

When it comes to pregnancy, the mom will have to generate enough energy for her well-being and for the growth and development of her baby. This includes eating for two (or more if she is carrying more than one baby!) as well as getting enough sleep to meet the physical demands of pregnancy.

Of course, the mom may have to adopt a different sleeping position during the pregnancy. This brings us to the question of which sleeping position is best when it comes to keeping the baby safe while allowing mom to get the most out of her sleep.

THE ACCEPTED CONVENTIONAL WISDOM OUT THERE

It is generally assumed that sleeping on the left side is better for a pregnant woman, as it’s more comfortable and helps to maintain proper blood flow between the mom and the baby she is carrying. This better blood flow also decreases the chances of swelling around the mom’s ankles and in her legs.

Sleeping on the right side is said to put pressure on the mom’s liver, so many advise a pregnant woman to sleep on her right side only for short naps.

How true are all these assumptions, though?

THE UK NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) REVIEWED AVAILABLE EVIDENCE

They stated that the purpose of their review was to determine whether there is any link between the mom’s sleeping position and the incidence of either stillbirth or the baby being born smaller in size than typical normal, healthy babies of the same age (small for gestational age or SGA).

In their findings, published in 2021, they stated that:

There is high quality evidence linking supine going-to-sleep position—that is, the mom sleeps lying on her back—and stillbirth.

NICE noted that the overall incidence of stillbirth is generally low (1 in every 244 births in the UK based on 2018 statistics), but they feel that there is enough evidence for doctors to advise pregnant moms to avoid sleeping in this position.

HOW ABOUT SLEEPING ON THE LEFT SIDE THAT IS GENERALLY SAID TO BE GOOD FOR MOM & BABY? ANY EVIDENCE FOR THAT?

Well, NICE noted that the evidence for this, as well as for sleeping on the right side, ranged from low quality to very low quality. They concluded, therefore, that more research would be needed to look into this matter.

One thing is for sure, though—they noted that sleeping on mom’s back is definitely something to be avoided!

THE TAKE HOME MESSAGE

Pregnancy may also give rise to other sleeping issues, such as problems falling asleep, and special care is often needed for pregnant women that also have obstructive sleep apneoa (OSA) and other health conditions that could affect her sleep or her breathing while she is asleep.

Hence, it’s always sensible for a couple expecting a baby to discuss mom’s sleep matters further with their obstetrician and gynaecologist. They should do this as early as possible—don’t wait for the sleeping issues to arise first!

Reference: National Guideline Alliance (UK). (2021). Maternal sleep position during pregnancy: Antenatal care. National Institute for Health and Care Excellence (NICE). https://www.ncbi.nlm.nih.gov/books/NBK573947/

Asia Pacific Women’s Cancer Coalition Releases Important Data on Women’s Cancers

WORDS LIM TECK CHOON

The Asia-Pacific Women’s Cancer Coalition recently launched a report called Impact and Opportunity: The Case for Investing in Women’s Cancers in Asia Pacific.

WHAT’S IN THE REPORT?

Published by the Economist Impact and supported by the pharmaceutical company Roche, this report presents a detailed examination of the burden of women’s cancer, specifically breast and cervical cancer, in 6 countries in the Asia Pacific region: India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam.

The report includes detailed snapshots of the breast and cervical cancer burden, incidence, and mortality in each of the 6 countries mentioned above. Readers will access the following information:

  • Current cancer care capacity status
  • Existing policies and planning
  • Prevention and screening measures
  • Diagnosis and resource capacity
  • Quality of treatment and access
  • Levels of awareness and education about breast and cervical cancer

The report furthermore identifies the gaps and opportunities for relevant stakeholders to improve the provision of assistance to women dying from these cancers every year in Asia Pacific.

THE MALAYSIAN SNAPSHOT

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THE REPORT IS ONLINE—READ IT HERE!
Click here for the full report at the Asia-Pacific Women’s Cancer Coalition website. The link leads to a PDF file.

Everything You Need to Know About Managing Disruptive Menopause Symptoms

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR NAZIMAH IDRIS
Medical Director
IMU Healthcare

I’m still young. Should I be concerned about menopause at this point in time?
“We should speak to women long before they reach menopause, so that, when it happens, they are more prepared and less anxious about it,” says Professor Dr Nazimah Idris.

She adds: “Many women I see wish they had known earlier what they could have done to prepare themselves. As every woman will go through this experience, you should enter this life phase empowered with knowledge.”

What’s menopause, exactly?
According to Prof Dr Nazimah, menopause is when a woman’s ovaries stop producing eggs and she stops menstruating.

Medically, menopause is confirmed when a woman has not experienced menstruation after one year.

Generally, this takes place when a woman is between 45 and 55 years old.

About 5% of women worldwide, however, experience early menopause between the ages of 40 and 45.

It’s also possible to experience menopause after undergoing a hysterectomy, chemotherapy, and other medical procedures that can damage the ovaries and affect menstruation.

Common symptoms of menopause. Click on the image for a larger, clearer version.

Why do some women experience symptoms of menopause even when they are still menstruating?

Prof Dr Nazimah explains that this is likely because the woman is experiencing perimenopausal stage (often called perimenopause for short), which can occur even before a woman enters menopause.

This stage usually lasts 4 to 5 years.

“During this time, it is normal to have irregular menstruation that may include heavier bleeding as well as infrequent or skipped cycles,” she elaborates.

Perimenopause can occur due to changes in a woman’s endocrine system. These changes can cause a reduction in the levels of oestrogen, the female sex hormone.

Because of this reduction in levels, a woman may experience symptoms of menopause such as hot flashes, fluctuating emotional states, difficulty sleeping and vaginal dryness.

She may also experience forgetfulness, low energy levels and reduced libido which, combined with vaginal dryness, can lead to less interest in sex and intimacy.

Once the woman enters menopause, the symptoms can become more severe and last up to another 5 years.

That sounds uncomfortable. Can anything be done about it?

Prof Dr Nazimah admits that a woman going through perimenopause and later menopause may experience around 10 years of symptoms. “This is a long time to be coping with symptoms if they are disrupting your daily life.”

Hormone therapy can help to manage severe and disruptive symptoms.

Tell me more about hormone therapy. Does it work, and how does it work?

“Hormone therapy can be very helpful in relieving hot flashes and improving sleep quality, vaginal dryness and urinary incontinence, among others,” she says.

There are different types of hormone therapy: tablets, topical creams, vaginal ring, and more. Medications may also be prescribed when necessary, such as to reduce the risk of osteoporosis due to low levels of oestrogen in the body.

The doctor will recommend the most suitable option based on a woman’s needs, family history, and other factors.

This sounds intriguing. Is hormone therapy an option for every woman experiencing symptoms of menopause?

Well, for one thing, Prof Dr Nazimah points out that hormone therapy is generally well-tolerated.

Hence, it is an option available to most women even when they have chronic diseases such as type 2 diabetes and high blood pressure.

However, hormone therapy may not be suitable for women that have certain diseases and conditions such as breast cancer, liver disease, thromboembolism, and heart disease.

If you have a health condition and are interested in hormone therapy, Prof Dr Nazimah recommends consulting a doctor for more information.

FEATURED EXPERT
SIN YEN SUAN
Certified Chinese Medicine Practitioner
IMU Healthcare

How about natural remedies for menopause symptoms? Do they work?

According to Sin Yen Suan, a certified Chinese medical practitioner, natural remedies such as evening primrose and black cohosh are traditionally turned to for perimenopause and menopause.

However, research on the efficacy on these remedies has yet to uncover any conclusive evidence on their efficacy in relieving the symptoms of perimenopause and menopause.

“However, Chinese medicine may be able to help,” Yen Suan offers.

She explains that the effectiveness of Chinese medicine can be seen by about 3 cycles of treatment, although the whole treatment process for menopause symptoms may last 1 to 2 years.

How exactly can Chinese medicine help?

Yen Suan further elaborates that Chinese medicine treat health problems by addressing imbalances in the body through individualized therapies, based on each person’s health status, needs, and other factoers.

“Many women come to me for help with symptoms such as persistent or heavy vaginal bleeding especially, heavy sweating, hot flashes, and disturbed sleep,” she says. “To help, we use several different treatments such as herbal medications to balance their qi or acupuncture to stimulate blood flow at the meridian points. These methods help to ease their emotional state, so they are able to feel better and sleep better at night.”

Chinese medicine can complement a person’s current Western medicine regime. If you are considering Chinese medicine to complement your current medical treatments, she recommends keeping both your doctor and Chinese medicine practitioner updated on your current forms of treatment.

PROF DR NAZIMAH’S TO-DO CHECKLIST FOR WOMEN EXPERIENCING MENOPAUSE
  • Menopause is not the end of life as you know it. Embrace new experiences, learn new things, take up a new hobby, make new friendships and rekindle old ones—the list goes on and on.
  • Speak to your doctor about health screenings such as Pap smear, mammograms, and colonoscopy, which are useful in detecting early stages of cancer and other health issues.
  • Also consider tests such as blood tests for anaemia and diabetes as well as bone density scans for osteoporosis.
  • Women over 51 should increase their calcium intake to 1,200 mg a day and consume vitamin D3 to keep their bones healthy and reduce their risk of osteoporosis.
  • Do regular Kegel or pelvic floor exercises, weight bearing exercises, and strength training to keep your body in good working condition.
  • Quit unhealthy habits such as smoking.

Here’s How Post-Menopausal Women Can Manage Their Vaginal Dryness

WORDS DR HOE YUT HUNG

FEATURED EXPERT
DR HOE YUT HUNG
Founder and Medical Director
MyClinic

As we get older, our bodies start to go through normal and expected changes.

It can be upsetting to find yourself unable to keep up with activities and lifestyles that were once simple and effortless, but we must learn to accept that aging is a natural part of life.

Changes in our physical capabilities become more noticeable as we age, and vaginal function, like many other areas of the body, can be affected by age.

AS WOMEN AGE, ESPECIALLY DURING MENOPAUSE, THE VAGINA AND SURROUNDING AREA MAY EXPERIENCE CHANGES THAT IMPACT THEIR ABILITY TO EXPERIENCE PLEASURE

Vaginal dryness is a common menopausal symptom that many Malaysian women experience. Furthermore, 56.1% and 39.9% of postmenopausal women had sexual problems and vaginal dryness, respectively.

However, according to one study, only 38% of the respondents with vaginal dryness sought treatment.

These statistics show that, despite its prevalence, many Malaysian women do not seek treatment for it. This could be due to a lack of awareness about the condition and available treatment options, as well as the societal stigma associated with it.

WHAT CAUSES VAGINAL DRYNESS?
Decrease in oestrogen levels
  • One of the most common causes.
  • Oestrogen plays an important role in maintaining the health of the vaginal lining, ensuring that it remains thick, elastic, and well-lubricated.
  • Its levels tend to drop in older women.
Certain medications Examples: antihistamines, antidepressants, and birth control pills.
Certain medical conditions Examples: diabetes, Sjögren’s syndrome, and lupus.
Lifestyle habits Examples: smoking and inadequate water intake.
SYMPTOMS OF VAGINAL DRYNESS
  • Vaginal itching
  • Burning, pain, or discomfort in the vaginal area
  • Vaginal bleeding after intercourse
  • Vaginal bleeding or spotting between periods
  • Frequent urinary tract infections
THE SOLUTIONS TO VAGINAL DRYNESS

While experiencing vaginal dryness can be frightening, it does not mean the end of the world.

Over-the-counter lubricants or moisturisers
  • These can help to relieve symptoms and make intercourse more comfortable.
  • They can help provide temporary relief from the symptoms of vaginal dryness, but they may not be effective for all women and may need to be used frequently.

Natural remedies

  • Examples include coconut oil and aloe vera gel, which can also be used to moisturise the vagina and relieve discomfort.
  • These natural remedies can also help improve of overall skin texture, reduce of inflammation, and relieve itching or burning sensations.
Hormone therapy
  • This can help to replace oestrogen and improve vaginal lubrication.
  • Can be prescribed in a variety of ways, including vaginal rings, tablets, and creams.
  • However, hormonal therapy is not the best choice for everyone, so it is important to talk to a doctor or speak to a specialist before you begin.
Ultra Femme 360 
  • This is a non-surgical radiofrequency treatment for both internal and external vaginal rejuvenation.
  • It can help improve muscle strength and laxity in the vagina, giving you a tighter, firmer vagina.
  • There is no downtime or scarring.
WHEN SHOULD YOU SEE A DOCTOR?

Although vaginal dryness can be treated at home or with non-invasive treatments, you should seek medical attention if you have symptoms such as:

  • Bleeding or unusual vaginal discharge
  • Discomfort from the vaginal dryness interfering with your daily activities
  • Bleeding between periods or after sexual intercourse.

It is important to note that vaginal dryness can be a sign of an underlying medical condition, such as vaginal infections or sexually transmitted infections.

If the vaginal dryness is severe or long-term, it is best to consult with a specialist, such as a gynaecologist. They can help determine the cause of vaginal dryness and recommend the best treatment option for you.

References:

  1. Abdullah, B., Moize, B., Ismail, B. A., Zamri, M., & Mohd Nasir, N. F. (2017). Prevalence of menopausal symptoms, its effect to quality of life among Malaysian women and their treatment seeking behaviour. The medical journal of Malaysia, 72(2), 94–99. https://www.e-mjm.org/2017/v72n2/menopausal-symptoms.pdf
  2. Nik Hazlina, N. H., Norhayati, M. N., Shaiful Bahari, I., & Nik Muhammad Arif, N. A. (2022). Prevalence of psychosomatic and genitourinary syndrome among menopausal women: A systematic review and meta-analysis. Frontiers in medicine, 9, 848202. https://doi.org/10.3389/fmed.2022.848202