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


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.


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.


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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


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.


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.

  • 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


Founder and Medical Director

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.


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.

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.
  • Vaginal itching
  • Burning, pain, or discomfort in the vaginal area
  • Vaginal bleeding after intercourse
  • Vaginal bleeding or spotting between periods
  • Frequent urinary tract infections

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.

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.


  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.
  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.

A Quick Primer for Understanding Ovarian Cysts & Uterine Fibroids


Consultant Obstetrician & Gynaecologist
Sunway Medical Centre Velocity
Consultant Obstetrician & Gynaecologist and Fertility Specialist
Sunway Medical Centre Velocity
Click on image for a larger, clearer version.

  • 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.
  • 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


  • 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
Click on the image above for a larger, clearer version.

  • 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.
  • 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


  • 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.
  • 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.


  • 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


Medical Director
Clinic RX

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.


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!


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.


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


Consultant Clinical Oncologist
Subang Jaya Medical Centre

“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.

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


Consultant Clinical Oncologist
Sunway Medical Centre

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.”

Consultant Gynaecologist and Fertility Specialist
Sunway Medical Centre

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.


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.

A Free App for Women, Especially Marginalized Women


The University of Nottingham Malaysia (UNM) and Hanai Jiwa Ibu Sdn Bhd have developed an app, called Jiwa Ibu, to provide localised and tailored information on mental, women’s, maternal, and children’s health.

This app, developed in collaboration of the two entities with St George’s University of London, Universiti Malaya and Universiti Malaysia Sabah, serves to reduce the great disparity in access to healthcare between those residing in urban and rural communities. This is because rural communities have limited access to quality medical centres and professionals, and residents of those communities have to travel further in search of quality healthcare.


“For years, we’ve wanted to shift our focus to the rural and marginalised communities of Malaysia. Since the idea began, our team of eight dedicated women have run focus groups involving doctors, nurses, midwives, community nurses and everyday women, to better learn what the ideal women and maternal healthcare pathway should look like,” explains Hanai Jiwa Ibu Founder and CEO, Shamala Hinrichsen. “We don’t expect to solve the world’s problems, of course, but one tiny step forward is better than no steps at all.”

UNM and Hanai Jiwa Ibu recently inked a Memorandum of Understanding (MoU) to allow for the copyrighting and trademarking of the app, ahead of plans to work alongside Selangkah, Selangor’s healthcare app, to embed part of Jiwa Ibu into the system.

“The Jiwa Ibu app is expected to benefit 15 million women across Malaysia. During its initial alpha-test, the app was downloaded by 3,000 women, with 75% returning to the app within the span of one month from downloading,” shares Associate Professor Dr Joanne Lim Bee Yin of the UNM School of Media Languages and Cultures. “Based on the surveys and interviews that we carried out, 95% of respondents also shared that they wanted the app.


Jiwa Ibu will include a directory for doctors and healthcare centres within the vicinity of the user and other important resources, such as those for violence against women cases.

Users can also store and track their own health records and seek medical assistance through the app.

In an effort to be more accessible, the app will be made available in Bahasa Melayu, English, and other native languages.

Click here to download the app (link opens in a new tab) in the Google Playstore. The app is free.

The Iron In Every Woman

The Iron In Every Woman

May 8, 2022   Return


It can be great to be a woman living in 2019. We have our first female Deputy Prime Minister and more women in our government than before. Women have more access to education, career and social rights than before. Things can be better, of course, hence this year, for International Women’s Day, we are calling for #BalanceforBetter.

However, making great strides require iron in both fortitude and health. No matter how strong one’s fortitude can be, one also requires iron – the mineral– as it is an essential component of health. Unfortunately, iron deficiency in women is far more common than it should be.

Hence, HealthToday is pleased to invite you to join us this month as two experienced experts have kindly shared with us their insight on this subject.


Dr Jameela Sathar

Consultant Haematologist

Hospital Ampang

Iron Deficiency: It’s More Than Just Anaemia

Oxygen is essential to convert the calories in the food we eat into energy, which then powers many essential functions of the body. It is transported in red blood cells, and iron is needed to make these cells. Hence, if our body is a factory, then that of someone with iron deficiency (ID) is comparable to a factory that is running on low efficiency due to shortage of power.

Most people usually equate  ID to anaemia, a condition in which the red blood cells do not carry enough oxygen from the  lungs to the rest of the body. However, Dr Jameela Sathar explains that ID doesn’t spring up abruptly overnight – anaemia is actually the manifestation of advanced ID.

“You can go on for many years before developing anaemia,” she says about people who have ID.

We Need A Change In How We Usually Detect Id

In the blood, iron is stored in a protein called ferritin. Healthcare professionals measure the levels of ferritin in the blood as an indication of the levels of iron in the body, and someone with ID typically has less than 30 nanograms (ng) of ferritin for each millilitre (mL) of blood.

However, most hospital laboratories tend to diagnose someone with ID only when there is less than 13 ng of ferritin in 1 mL of blood. Dr Jameela feels that this value is too low as by that stage, the person already has developed anaemia.

Additionally, taking absolute numbers at their face value  may not give an accurate picture. For uncomplicated cases, the serum ferritin value of less than 30 ng/mL indicates ID, but Dr Jameela points out that for patients with inflammatory diseases (chronic heart failure, chronic kidney disease, rheumatoid arthritis, etc), serum ferritin below 100 ng/mL may also indicate ID.

Therefore, Dr Jameela advocates for a nationwide policy to adjust  the cut-off point in diagnosing someone with ID.

For members of the public, however, the take-home message is that we don’t necessarily have to develop anaemia if we have ID. Measures can be taken to improve ID before it reaches the anaemia stage.

The Hidden Consequences Of Anaemia

Aside from having to deal with the symptoms of ID listed previously, there are other downsides to having anaemia:

  • Patients with anaemia undergoing surgery have a higher incidence of needing blood transfusions. This increases the overall treatment cost and the risk of possible side effects of blood transfusions (infections, lung injuries, etc).
  • Higher risk of developing infections of the urinary and respiratory tracts.

Therefore, We Should See A Doctor If We Suspect That We Have Id

How do we know if we may have ID?

  • Hair loss
  • Brittle nails
  • Headaches
  • Pica (an appetite for substances with little nutritive value like ice)
  • Fatigue
  • Frequent infections
  • Depression
  • Concentration impairment
  • Taste disturbance
  • Anaemia/pallor.

The doctor will typically order a blood test that specifically measures our ferritin levels. If the test shows low ferritin levels, we will receive appropriate treatment.


Associate Professor Dr Ina Ismiarti Shariffuddin

Consultant Paediatric Anaesthesiologist

University Malaya Medical Centre

Iron & The Pregnant Woman

During pregnancy, a woman needs even more iron than normal, as her body needs to increase red blood cell production in order to nourish the child she is carrying. Hence, iron intake is an important consideration, as it now potentially affects the well-being of both the mother and child.

How much iron does a pregnant woman need?

According to Assoc Prof Dr Ina Ismiarti Shariffuddin:

  • A 55 kg woman requires about 1,000 mg of iron throughout her pregnancy.
  • During the second and third trimester, she needs about 500 mg of iron for red cell expansion. 300-350 mg of iron needs to be transferred to the foetus through the placenta for foetal development, while the remaining 100-200 mg is stored as standby in case of blood loss during delivery.

Mothers-to-be should consult their gynaecologist on how much iron they should take in their diet.

ID symptoms that pregnant women should watch out for

These include:

  • Breathing difficulties.
  • Fainting.
  • Tiredness.
  • Heart palpitations (rapid heartbeat).
  • Sleep difficulties.

Assoc Prof Dr Ina cautions that severe ID can lead to heart failure and further complications to the delivery at a later date. It can also increase the risk of developing perinatal infections, pre-eclampsia and bleeding. The baby can also be affected by severe ID, as he or she faces an increased risk of being prematurely born, halted growth while still in the womb, and low birth weight.


How ID in pregnant women is treated

Assoc Prof Dr Ina shares that iron pills and supplements containing iron, vitamin B12 and folic acid specially formulated for pregnant women can be offered to overcome ID.

Intravenous iron – which is given through a drip – is considered for those whose pregnancy has entered the second trimester onwards, as well as for those who do not respond well to iron pills.

Therefore, expecting mothers should see a gynaecologist if they suspect that they may be suffering from ID. Prompt measures to manage ID would go a long way to ensure the safe delivery of a healthy baby. HT

Five Reasons Why Malaysian Women Can’t Conceive, and What Can be Done about Them

Five Reasons Why Malaysian Women Can’t Conceive, and What Can be Done about Them

May 8, 2022   Return


Dr Agilan Arjunan

Consultant Gynaecologist & Fertility Specialist KL Fertility Centre


Infertility cuts deep into the heart. It hurts for a couple who long for a child, but can’t conceive despite trying so hard, and the hurt is made more intense by the fact that the joy of pregnancy and childbirth is all around them. Other couples share stories, photos, and Facebook posts of their parenthood experiences, making a couple’s inability to conceive seem even more unfair.

Yet, the door to parenthood may not be closed permanently. As fertility treatments become more advanced, we are starting to have more control over our chances of conceiving a child. There are still many things that are up to chance, but we also have more options than before to address difficulties in conceiving. This month, fertility specialist Dr Agilan Arjunan takes a look at some of the main causes of infertility among Malaysian women.


Dr Agilan had touched on this in recent articles but it’s worth bringing up again because a woman’s advancing age remains the most common cause of her difficulties in conceiving a child.

  • A woman’s most fertile period is usually during her mid-20s.
  • Her fertility begins to decline after the age of 30.

However, starting a family in the early twenties is not an option for every woman. A woman these days is more likely to be able to commit to starting a family in her thirties or even forties, a time when her fertility is on a decline.

What can we do about this? A fertility specialist can run a test called the anti- Müllerian test to estimate how many primordial follicles remain in a woman’s ovaries. For this test, the woman only needs to provide a sample of her blood. Once the test result is in, the fertility specialist can advise on the next best step.

In-vitro fertilization (IVF) may be helpful when it comes to selecting the highest quality egg cell for fertilization, therefore overcoming the issue of lower quality eggs produced at a later age.

Another option is for the woman to have her eggs frozen when she is at a more fertile age. These eggs can be thawed and used when she is ready to start a family at a later age.

To understand why fertility drops with age, we first need to understand how the ovaries work.

Dr Agilan shares that a woman only has approximately 10% of her egg reserve remaining by the time she turns 30, and the reserve continues to deplete until she reaches menopause and, hence, the end of her childbearing days.

  1. The ovaries release a mature egg cell during a woman’s menstrual cycle (typically around day 14), and new life is formed when a sperm cell fertilizes this egg during sexual intercourse.
  2. The egg cell develops from a pre- existing cell in the ovary called the primordial follicle. This process occurs under the infuence of hormones such as the follicle stimulating hormone (FSH).
  3. Now, the woman is born with a set number of primordial follicles. No new primordial follicles will be made after she is born. Therefore, once all her primordial follicles are used up, she will no longer be able to produce any more egg cells.
  4. Another issue that arises is that the quality of the egg cell produced tends to decrease with the woman’s age. This may occur even when a woman still has a good number of primordial follicles. This is because the good quality eggs tend to be released during the woman’s most fertile period. Egg cells produced at a later age tend to have a higher risk of being abnormal.


Figure A. Blockage in the fallopian tube can prevent a mature egg cell from being fertilized by a sperm cell.

As indicated in Figure A, the fallopian tube is a tube-like structure that provides passage for the mature egg cell to travel from the ovary to the uterus. During sexual intercourse, it will encounter a sperm cell during its journey, and the subsequent fertilization will give rise to new life.

These days, fallopian tube issues are increasingly common. These issues include blockage and damage which prevent the egg cell from ever meeting the sperm cell.

Dr Agilan explains that these issues arise because more women are becoming sexually active at a younger age. This increases their risk of developing pelvic inflammatory disease (PID), especially if they do not practice safe sex. Some women may not realize that they have PID because its symptoms can be either absent or very mild.

Other possible causes of fallopian tube issues include ruptured appendix and a previous ectopic pregnancy (which happens when an embryo attaches itself into the fallopian tube instead of the endometrium in the uterus).

What can we do about this?

If fallopian tube issues are suspected to be the cause of a woman’s difficulty in conceiving, a type of X-ray test called hysterosalpingography can be performed to confirm that this is indeed the case. Once this is confirmed, there are a few options depending on the nature and location of the damage or blockage.

  • laparoscopic surgery can be done to repair fallopian tube damage.
  • If the fallopian tube damage isn’t too close to the uterus, surgery may be able to repair the damage. However, there is risk of scar tissues forming at the site of surgery during the healing process, causing the fallopian tube to be blocked.
  • In-vitro fertilization is most likely the best option for couples wishing to have a child despite the presence of damaged or blocked fallopian tubes. The fertility specialist can extract eggs directly from the ovaries, bypassing the fallopian tube altogether.


The innermost layer of a woman’s uterus is called the endometrium. It is here that  the embryo, which develops from a mature egg cell that has been fertilized by a sperm cell, implants itself to develop into a baby. If no fertilization occurs, the lining tissue thickens and breaks down before exiting the body as menstrual flow.

“Endometriosis arises when tissues from the endometrium grow outside of their usual place in the endometrium,” says Dr Agilan. “They may grow in the fallopian tubes, ovaries and even in the pelvis.”

These cells thicken, break down and bleed during the menstrual cycle, and this becomes a problem as the blood and broken-down tissue cannot exit the body. This leads to irritation in the surrounding tissue as well as formation of scars and cysts.


Consequently, someone with endometriosis can experience great pain. Her fertility is very likely to be affected as well, as endometriosis can reduce both the number of eggs as well as quality of these eggs.

What can we do about this? Treatment of endometriosis, which typically involves hormone therapy, makes it harder for a woman with endometriosis to conceive, as it prevents ovulation. Therefore, if the woman wants to have a child, the fertility specialist will recommend temporarily stopping treatment.

If necessary, laparoscopy can be performed to reduce the severity of endometriosis and improve the chances of pregnancy. Intrauterine insemination (IUI) may also be useful as this procedure allows the injection of sperm cells directly into the uterus, therefore improving the chances of a successful fertilization.


Polycystic ovary syndrome (PCOS) is a lifelong condition that give rise to several bothersome, uncomfortable and even painful symptoms, as seen in Figure B. According to Dr Agilan, it affects about 20% of women worldwide, and in Malaysia, it is especially common among Indian women.

Depending on the severity of her PCOS, the affected woman’s ovaries may fail to regularly release eggs. Dr Agilan shares that it is not unheard of for women with PCOS to not have their period for up to six months, perhaps even a year. This naturally affects their ability to have children.

What can we do about PCOS? Dr Agilan notes that more than 50% of women with PCOS have higher than normal levels of the hormone insulin, even though they are not diabetic.

“The higher the insulin levels, the harder it is for the woman to form a mature egg cell and ovulate,” he says.

Therefore, a way to increase the woman’s chances of conceiving a child is by reducing the insulin level. This is done by prescribing metformin, the staple medication for people with diabetes.


“These problems include the presence of fibroids, which can affect the ability of a fertilized egg to implant into the endometrium or displace the fallopian tube and make it difficult for the sperm cell to meet the egg cell,” Dr Agilan says.

Another, rarer condition is adenomyosis, which is a type of endometriosis. In this case, endometrial tissues are found in the wall of the uterus, giving rise to an enlarged uterus, heavy and/or prolonged bleeding during menses and pain.

What can we do about it? Because problems with the uterus usually affect the ability of the woman to stay

pregnant – which is to say, it may prevent an embryo from being implanted or staying implanted in the endometrium – there is no simple “one size fits all” solution. The fertility specialist evaluates the patient and considers the best options on a case by case basis. HT

Guys aren’t left out! Dr Agilan will turn the spotlight on the main reasons why men have a hard time making babies in the next Woman’s Health and Fertility column. Watch out for it!

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