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

The full-size images may not display properly on certain desktop devices due to technical limitations.

If you experience this issue, to get the full-size image (warning: these images are huge), click on each thumbnail and then save the image or open it in a new tab.

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

A Quick Primer for Understanding Ovarian Cysts & Uterine Fibroids

WORDS LIM TECK CHOON

FEATURED EXPERTS
DR WONG YEN SHI
Consultant Obstetrician & Gynaecologist
Sunway Medical Centre Velocity
DR FARAH LEONG RAHMAN
Consultant Obstetrician & Gynaecologist and Fertility Specialist
Sunway Medical Centre Velocity
DR WONG YEN SHI ON UTERINE FIBROIDS
Click on image for a larger, clearer version.

AT A GLANCE
  • They are non-cancerous growths that form in the muscular layers of the uterus.
  • One can have a single fibroid or multiple fibroids.
  • Often found in women in their reproductive years—that is, the period of time when they are capable of conceiving.
  • We still don’t know what causes fibroids to develop in a woman. Dr Wong states that hormones and growth factors could be possible causes.
YOU MAY HAVE UTERINE FIBROID(S) IF YOU HAVE…
  • Irregular or painful period
  • Heavy bleeding during your period
  • Frequent urination or constipation
  • Abdominal distension or bloating
  • Back pain
  • Unexplained weight gain
  • Painful sexual intercourse

TREATMENT

  • Fibroids can be removed via surgery. Depending on the location and size of the fibroid(s) present in the uterus, this can be open surgery or laparoscopic surgery, the latter involving the use of a laparoscope to make fewer and smaller cuts in the body. Women that no longer want to have children can also opt to have their womb surgically removed.
  • Newer treatments such as uterine artery embolization (blocking the blood vessels that nourish the fibroid, thus causing it to shrink) and high intensity focused ultrasound (HIFU) surgery can be considered, but note that not every medical facility in Malaysia offer these treatments.
  • Medicines to relieve symptoms such as heavy menstrual bleeding and painful period
DR WONG YEN SHI & DR FARAH LEONG RAHMAN ON OVARIAN CYSTS
Click on the image above for a larger, clearer version.

AT A GLANCE
  • These are sacs that contain mostly fluid, sometimes with tissues or blood, which form within the ovaries or on its surface.
  • They are mostly benign, but can be cancerous on rare occasions–especially among women between 60 and 65.
  • Ultrasound and CA125 tumour marker test are used to tell whether an ovarian cyst is benign or cancerous.
  • Conditions such as pregnancy, pelvic infections, and endometriosis can increase the likelihood of developing ovarian cysts. A woman with a history of ovarian cysts is more likely to develop ovarian cysts in the future.
  • Yes, it’s possible to have both fibroids and ovarian cysts at the same time.
YOU MAY HAVE OVARIAN CYST(S) IF YOU HAVE…
  • Irregular or painful period
  • Frequent urination or constipation
  • Abdominal distension or bloating
  • Back pain
  • Unexplained weight change
  • Unexplained loss of appetite
  • Quick sense of fullness while eating
  • Painful sexual intercourse

TREATMENT

  • Smaller cysts usually don’t require treatment. Instead, the doctor will monitor the cyst for signs of growth and other changes. 
  • Larger cysts can be removed via open or laparoscopic surgery.
CAN UTERINE FIBROIDS & OVARIAN CYSTS AFFECT ONE’S CHANCES OF HAVING A BABY? DR FARAH EXPLAINS 
  • Most women with fibroids and cysts have no problems getting pregnant.
  • However, depending on the size and location, uterine fibroids may affect one’s fertility. For example, fibroids that form in the womb lining may block the fallopian tubes, keeping the egg from being fertilized by a sperm cell, or make the womb environment less conducive for a fertilized egg to attach to the womb for further development.
  • Fibroid developing during pregnancy may increase the risk of early delivery. “In some cases, it can cause severe pain when fibroids outgrow their blood supply. If the fibroid is large, it can cause the baby to be positioned wrongly, such as the baby’s head not turning down even at term,” explains Dr Farah.
  • Ovarian cysts forming during pregnancy is usually not a cause of concern, except when the cyst grows so big that it ruptures open.

DR FARAH’S ADVICE

  • Go for regular gynaecology check-up to detect the growths of uterine fibroids and ovarian cysts as well as to ensure that the rest of the reproductive system is in good condition and working order.
  • When you’re about to embark on your pregnancy journey, seek advice from your doctor if you have a history of uterine fibroids and/or ovarian cysts.
  • We still don’t have any evidence-based method to prevent the formation of uterine cysts or ovarian fibroids. However, practicing good health and maintaining a well-balanced diet will be good for your overall well-being and improve your chances of a safe and successful pregnancy.

Diets & Exercise Tips to Regain Your Pre-Pregnancy Body Shape

WORDS DR VICKY KOH

FEATURED EXPERT
DR VICKY KOH
Medical Director
Clinic RX
WELL, READ THIS FIRST

Every woman’s body is unique. Therefore, the question of the ‘right option’ or ‘best option’ is something that each and every woman has to figure out on her own.

For example, mothers that breastfeed often experience rapid weight loss and may benefit from an increased intake of certain nutrients or supplements. Women that gave birth via caesarean section may need a longer time to recover. Existing health issues and lifestyle variables also need to be considered.

If you are interested to find out more about the topics discussed below, you should discuss the matter further with your doctor.

BREASTFEEDING CONSIDERATIONS

Postpartum weight loss averages about 4.5 to 5.5 kg in the first 6 weeks. Women often return to their pre-pregnancy weight within a year, though this time frame varies depending on how much weight was gained during their pregnancy.

Breastfeeding aids in weight loss since it consumes extra calories, resulting in a natural weight loss for many women.

Breastfeeding women should pay special attention to their diets at this time.

While experiencing weight loss after giving birth may seem like a good idea, doing so too quickly will actually hinder healing!

POST-PREGNANCY DIETARY RECOMMENDATIONS

Dietary recommendations should include a variety of fresh produce, whole grains, lean proteins, and healthy fats.

Breastfeeding mothers, in particular, should drink a lot of water (6-10 glasses daily). Try to stay away from sodas and other sugary drinks.

Meanwhile, for moms that had a C-section, they should focus on eating foods that are high in protein. Avoid junk foods and take vitamin supplements, especially if they are nursing.

Vitamin and mineral supplements are crucial for moms during and after pregnancy.

This is because nutrients such as calcium, iron, vitamin D, folic acid, zinc, and more are normally redirected from the mother’s bloodstream to the developing infant.

Furthermore, the delivery process as well as breastfeeding depletes the body of essential vitamins.

Hence, postnatal supplements such as calcium, vitamin D, B vitamins, docosahexaenoic acid (DHA), magnesium, selenium, iodine, and choline may be helpful in replenishing nutrients that were used up during pregnancy and after childbirth.

EXERCISE RECOMMENDATIONS

Regular exercise after childbirth will help strengthen and tone your muscles while increasing your energy levels and making you feel less weary.

It also aids in the loss of excess weight.

During the first 6 weeks, the uterus returns to its pre-pregnancy size, and some women may feel uterine cramping and discharge.

However, mothers are recommended to gradually resume their exercise habits, starting with less strenuous activities during the first few weeks after giving birth.

A few days after delivery, you can start doing gentle abdominal and pelvic floor exercises if they don’t cause you any pain.

Try to proceed at your own pace—you can gradually increase the duration and tempo of your workout of over time.

Swimming, cycling, yoga, pilates, mild weight training, and low-impact aerobics are all good alternatives after the first few weeks.

How Breast Ultrasound & Mammogram May Save Your Life

WORDS LIM TECK CHOON

FEATURED EXPERT
DR WINNIE NG NYEK PING
Consultant Clinical Oncologist
Subang Jaya Medical Centre
NO FAMILY HISTORY OF BREAST CANCER = NO PROBLEM? WELL, THINK AGAIN!

“Even if one has no known family history of cancer, external factors such as environmental exposures, prolonged exposure to female hormones and lifestyle features may contribute to an increased relative risk of breast cancer,” says Dr Winnie Ng, a consultant clinical oncologist.

“Aside from genetics, there are numerous underlying possible causes of breast cancer,” says Dr Ng
  • Alcohol intake
  • Smoking
  • Prolonged exposure to female reproductive hormones such as oestrogen, such as in women that reach menstruation at early age, women that have never been pregnant, women on oral contraceptive pills, women that experience menopause late, and woman that have their first full-term pregnancy at a later age
  • Postmenopausal women on hormone replacement therapy
  • Obesity

Therefore, even if you have no family history of breast cancer, Dr Ng recommends that still going for breast cancer screening.

“The easiest method of screening is by self-examination of the breast,” she adds.

How to perform a breast self-examination. Click on this image to view a larger version.
AS WE STILL DON’T HAVE A CURE FOR BREAST CANCER, SCREENING REMAINS THE MOST PRACTICAL SOLUTION TO DETECT BREAST CANCER EARLY

Dr Ng recommends that:

  • Women below 40 should undergo a breast ultrasound.
  • Women above 40 are advised to go for a mammogram.

You should consult your doctor about your risk factors and how often you should go for breast cancer screening.

“A breast cancer diagnosis is not a death sentence. Self-tests and regular screenings can save lives,” says Dr Winnie Ng.

Keep the Hope of Pregnancy Alive in Spite of Breast Cancer

WORDS LIM TECK CHOON

FEATURED EXPERT
DR CHRISTINA LAI NYE BING
Consultant Clinical Oncologist
Sunway Medical Centre
WHY IS BREAST CANCER SO PREVALENT AMONG YOUNGER WOMEN THESE DAYS?

Aside from unhealthy diet and exposure to cancer-causing chemicals or carcinogens in the environment, Dr Christina Lai Nye Bing shares that one possible factor is that women are choosing to marry and have children at a later age.

This somewhat paradoxical concept can be explained by the link between breast cancer and the female sex hormone oestrogen.

“Breast cancer is a hormone-related cancer, and high levels of oestrogen in the body increases the risk of breast cancer as it encourages cancer cells to grow by promoting cell division and reproduction,” Dr Christina explains. “Women in the previous generation who get married and have children earlier have a lower risk of breast cancer, as the oestrogen in their body decreases when they are pregnant and choose to breastfeed.”

FEATURED EXPERT
DR HOO MEI LIN
Consultant Gynaecologist and Fertility Specialist
Sunway Medical Centre
IS PREGNANCY IMPOSSIBLE AFTER CHEMOTHERAPY?

Given that chemotherapy plays a big part in the treatment regime of many women with breast cancer, this raises the concern of whether the dream of having a family in the future an impossible one for them.

The unfortunate truth is that chemotherapy affects a woman’s fertility, with a 40% to 80% chance of early menopause.

The ovaries stop producing eggs upon menopause, so with that, the dream dies… or does it?

While Dr Hoo Mei Lin admits that the damage to the ovaries due to chemotherapy is irreversible, there is still a glimmer of hope.

“Patients can plan ahead, as conservation methods such as embryo freezing, egg freezing, and ovarian tissue freezing are available to enable patients to fulfil their wish of having children,” she shares.

Egg and ovarian freezing are suitable options for women that do not have a partner prior to having to undergo chemotherapy.

KEEP THE DREAM ALIVE

Dr Hoo advises breast cancer patients to have an open mind about their future and even consider having children.

After all, breast cancer patients under the age of 45 have an 80% survival rate after treatment!

“With the rapid advances in medical technology today, there is hope for breast cancer patients and survivors to plan their future. Technologies like egg and embryo freezing gives them the opportunity to have children in the future,” she says.

When it comes to cancer diagnosis, the focus is often about treating it, making fertility an afterthought. However, with the advancement in medical technology, surviving a cancer diagnosis is becoming increasingly successful hence, it is important to speak to your doctor as there are ways to help preserve fertility.