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.

A Breath of Fresh Hope For Women Against Lung Cancer

A panel discussion titled ‘A Breath of Fresh Hope’ was held on 7 December 2023. This was a collaboration between the pharmaceutical division of Roche (Malaysia) Sdn Bhd and the Lung Cancer Network Malaysia (LCNM).

This panel discussion highlighted the alarming prevalence of lung cancer in non-smoking Malaysian women, the related medical implications of this prevalence, and the social stigma surrounding this cancer.

“Over 2.2 million lung cancer cases were reported in 2020 globally, and more than 770,000 of them were in women. Lung cancer is the third top malignancies seen in the global female population, after breast and colorectal cancers,” said Ms Deepti Saraf.

SHIFTING PUBLIC PERCEPTION OF LUNG CANCER
FEATURED EXPERT
DR ANAND SACHITHANANDAN
Consultant Cardiothoracic Surgeon and Co-Founder of Lung Cancer Network
Malaysia

“The majority of lung cancer cases affect smokers. Having said that, we are now starting to see increasing numbers of cases of lung cancer in non-smokers, of whom women are overrepresented,” said Dr Anand.

Lung cancer does not affect smokers only; there are other risk factors that could put one could be at risk.

Dr Anand Sachithanadan revealed that fewer than 2% of Malaysian women smoke, but lung cancer is one of the main cancers that affect women in Malaysia.

Thus, contrary to popular perception, lung cancer does affect people that do not smoke, as outlined below.


Common lung cancer risk factors. Click on the image for a larger, clearer version.


BE AWARE OF THE SYMPTOMS OF LUNG CANCER—EVEN IF YOU DO NOT SMOKE
FEATURED EXPERT
DR JENNIFER LEONG
Consultant Clinical Oncologist
Sunway Medical Centre

Dr Jennifer Leong told us, “Many women harbour the preconceived notion that because they don’t smoke, they are not at risk of lung cancer. At times, even when displaying typical symptoms, they can easily miss out on these symptoms and do not get the required medical attention in the earlier stages of disease, affecting their chances at longer survival.”

“While I wouldn’t say that lung cancer is preventable, it’s very much a curable disease provided that you can detect it early on,” she added.

On the other hand, ignoring or overlooking the early symptoms of lung cancer would lead one to seek medical treatment only when the cancer has advanced to a late stage, during which the chances of a positive outcome are far more diminished.

Dr Anand concurred with Dr Jennifer’s statement. He stated: “Lung cancer care has been revolutionized in the last four or five years, leading to significantly better outcomes for our patients as well as overall survival. Despite all these tremendous promises, the fact remains most patients are still being diagnosed late in stage.”


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


WOMEN SHOULD PRIORITISE THEIR OWN HEALTH AS WELL AS THAT OF THEIR LOVED ONES
FEATURED EXPERT
ASSOCIATE PROFESSOR DR CARYN CHAN MEI HSIEN
Consultant Health Psychologist
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

“Many women are expected to and are taught to prioritise the health of family, sometimes at the expense of their own health. Consequently, some women would ignore or dismiss their symptoms, or feel guilty when their medical treatments become a significant expense to the family,” said Associate Professor Dr Caryn Chan.

One unfortunate consequence of women putting the needs and well-being of others over their own is that they often neglect their own health.

Often, Associate Professor Dr Caryn Chan pointed out, they overlooked symptoms such as those of lung cancer, and seek medical attention only when their illness had deteriorated to an advanced stage.

This attitude on both the parts of women and society need to change. “Taking care of your health does not mean you are burdening the rest of the family,” Dr Caryn stated.

She also called for the family to come together to distribute caregiving and support responsibilities, typically delegated to a woman, across all capable family members. This way, a woman would have ample opportunity to also tend to her own needs and well-being.

BE MORE PROACTIVE IN DETECTING LUNG CANCER EARLY!
FEATURED EXPERT
MS. DEEPTI SARAF
General Manager
Roche Malaysia Sdn Bhd

“All of us have a part to play in raising awareness of lung cancer,” Ms Deepti Saraf reiterated while closing the panel discussion.

Be alert for symptoms.

If you, your loved ones, or your friends have symptoms, seek medical help.

If you are at high risk of lung cancer, consult your doctor.

The doctor can arrange for you to undergo regular screening to detect early the presence of cancer or other issues with your lungs.


This is an educational article brought to you by

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/

New Year, Healthier You? An Expert Shares a Health Screening Strategy to Help You Get Started

WORDS LIM TECK CHOON

FEATURED EXPERT
DR MURALITHARAN GANESALINGAM
Head of Department
Obstetrics and Gynaecology
School of Medicine
International Medical University (IMU)
FIRST, LET’S REFLECT: DO YOU NEED HEALTH SCREENING? 

Health screening benefits us, even when we believe and feel that we are healthy.

Dr Muralitharan Ganesalingam tells us: “The goal of screening tests is to detect changes in the body before they become unmanageable. In this way, you have the chance to modify your lifestyle and steer away from a particular illness.”

GO FOR HEALTH SCREENING FROM EARLY ADULTHOOD (SUCH AS WHEN YOU START WORKING) AND DO IT TWICE A YEAR AFTER YOU TURN 45

As Dr Murali puts it:

  • Generally, women between 19-24 years of age are considered to be at the peak of health.
  • From the age of 25, fat begins to accumulate, especially in the hips, thighs and abdomen, while muscle mass deteriorates.
  • From the age of 35, bone mass depletes at a rate of 0.5% to 1% each year.

There will be variations to this trend, as people are difference and hence their bodies age differently too. However, these changes with ageing prompt the recommendation given by Dr Murali, as health screening can help in detecting early the health issues that can arise alongside these changes.

Furthermore, health screening can be helpful in detecting the development of certain diseases that may not show obvious symptoms at the early stage.

PRIORITISE THESE HEALTH SCREENING TESTS
  • Blood pressure to check for hypertension. “This disease, known as the ‘silent killer’, progresses without noticeable symptoms and affects 3 in 10 Malaysians (approximately 6.4 million people), and increases the risk of stroke and heart attack,” explains Dr Murali.
  • Blood count to detect conditions like anaemia. On average, anaemia affects 3 in 10 women aged 15 to 49 years and can cause complications during pregnancy such as miscarriage and premature birth.
  • Blood glucose test to check for diabetes.
  • Body mass index (BMI) to monitor weight gain and help prevent obesity. Dr Murali points out that our national statistics show that 1 in 2 adults are overweight or obese, and 1 in 2 have abdominal obesity, of which women accounted for 54.7% and 64.8% respectively.
  • Lipids test to check for elevated levels of cholesterol, which can lead to heart disease. Around 4 in 10 Malaysians, approximately 8 million people, have raised cholesterol levels, with women being more likely to have higher levels than men. In spite of this, 1 in 4 people are unaware they have high cholesterol.
  • Kidney function and liver profile, as chronic kidney disease affects 1 in 7 Malaysians, and diabetes is a significant risk factor for this disease.

Dr Murali also recommends going for annual eye checks, hearing tests, and dental check-ups as we age.

Just for women
  • Pap smears to check for cervical cancer. “Because we have an efficient screening programme through the use of Pap smears, we have been able to reduce the incidence of cervical cancer substantially,” says Dr Murali. “It is the most significant advancement in the control of cancer, hence annual screening for cervical cancer is something I emphatically encourage.”
  • Breast examinations (see below) to check for breast cancer. Dr Murali points out that it is essential for all women to be disciplined about performing their own breast examinations as well as to go for an annual check by a doctor, who will advise if a mammogram is needed.
  • Bone mineral density scans to detect osteoporosis. Dr Murali explains that one’s bone mineral density decreases with age and the risk of fractures increases, hence postmenopausal women 50 years and older should be screened. “Women aged 65 years and older should be screened at least once a year, according to Malaysian guidelines,” he adds.

An overview of how to perform breast self-examination at home. Click on the image for a larger, clearer version. If you are unsure or you have concerns, you can consult your doctor for more information.


FINAL ADVICE

“It is important for you to speak to your regular doctor about any health concerns and discuss what health screenings may be beneficial for you, based on your age, lifestyle and family history,” Dr Murali emphasizes.

You Aren’t Alone When It Comes to Infertility, Experts Say, So Here’s What You Can Do About It

WORDS DR KHINE PWINT PHYU & ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN

FEATURED EXPERTS

DR KHINE PWINT PHYU
Senior Lecturer in Obstetrics and Gynaecology
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN
Head of School
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
THE INCIDENCE OF INFERTILITY IS ON AN UPWARD TREND WORLDWIDE
  • Infertility is defined as not being able to conceive after 1 year of unprotected sexual intercourse.
  • In women above 35, this duration is sometimes shortened to 6 months.
  • The World Health Organization estimates that 1 in 6 people are affected by infertility.
  • In Malaysia, there is a drop in fertility rates from 4.9 children per woman of childbearing age in 1970 to 1.7 in 2021.
CAUSES ARE VARIED, INVOLVING ISSUES IN EITHER PARTNER OR BOTH AND IN SOME CASES, THE CAUSES ARE DIFFICULT TO IDENTIFY

Female factors of infertility

  • Anovulation, or ovulation disorders, are situations where no eggs are released from the ovaries during the menstrual cycle. These disorders can be caused by:
    • Hormonal imbalances such as seen in polycystic ovary syndrome (PCOS) and excessive prolactin secretion.
    • Eating disorders.
    • Extremes of body weight.
    • Strenuous exercises.
    • Stress.
    • Chronic illnesses.
  • Blockage of fallopian tubes, caused by previous pelvic infections, inflammation of tubes, and pelvic adhesions which may be related to past surgery at the abdomen and pelvis. When the tubes are blocked, it will affect the transport of sperm to meet the eggs to achieve successful implantation and pregnancy.
  • Endometriosis, which is the presence of tissue that is normally found in the inner lining of the uterus, outside the uterine cavity, which may affect the function of the ovaries, uterus, and fallopian tubes.
  • Congenital abnormalities (malformations that develop before birth) of the uterus.
  • Uterine fibroids (non-cancerous growths which develop in and around the womb).

Male factors of infertility

  • Low sperm count, which can be seen in men with genetic defects, chronic health problems such as diabetes, liver or kidney diseases, or sexually transmitted infections like gonorrhoea. Abnormalities such as undescended testis and varicoceles (swollen veins within the scrotum) can also be causes.
  • Premature ejaculation.
  • Blockage or injury to the reproductive organs.
  • Usage of certain medications can affect sperm movement, quality, or lead to coital dysfunction.
  • Environmental and lifestyle factors such as use of tobacco, heavy alcohol, marijuana or steroids, exposure to toxins and exposure of the external genitalia to high temperatures.
BOTH PARTNERS NEED TO BE INVOLVED WHEN IT COMES TO FERTILITY TREATMENT

To support health education and increase awareness regarding numerous infertility issues faced by couples across the globe, World Infertility Awareness Month is observed every year in June. Many couples are not even aware they are infertile; hence this month serves to alert them of issues that may affect them as well as their available solutions.

While the causes of infertility are varied and can affect both partners, the burden and stigma are often shouldered by the female partner. In our part of the world, both issues are particularly pronounced.

Couples with fertility issues should therefore see a doctor in a timely manner to receive a proper assessment and effective treatment. As age is an important factor in conceiving, early medical intervention often leads to positive outcomes in a couple’s fertility journey.

Both partners should be involved in fertility consultation and management. The primary issues to address include if the woman is ovulating regularly, if the sperm cells in semen are healthy, if there are coital issues and any problems with fertilization and implantation, and if the woman is able to maintain the pregnancy.

To answer these questions, thorough evaluation should be done through taking a detailed medical and personal history, sexual history and performing a physical examination for both partners. The next steps would then be to test the couple with baseline investigations as well as specific evaluations.

Some common assessments include tests to ensure the fallopian tubes are patent (open and lacking blockage), tests to confirm ovulation, sperm counts, and ultrasound to look for abnormalities in the uterus, fallopian tubes, and ovaries.

MANAGING & TREATING INFERTILITY

Sometimes, simple lifestyle modification measures such as weight management, adequate exercise, cessation of smoking, and the limitation on alcohol consumption can solve infertility.

As for natural methods, frequency of sexual intercourse can be an issue and it is recommended that at least 3 times a week increases the probability of conceiving.

Timed intercourse during a women’s fertile period may be a strategy as well. Women usually ovulate about 12 to 14 days before the start of a next menstrual cycle and the fertile period is the five days before ovulation, the day of ovulation, and the day after ovulation.

The treatment for fertility issues depends on the cause. For women who experience problems with ovulation, medications to induce ovulation may be employed. As for women with endometriosis, fibroids, or other tubal diseases, surgery may also improve outcomes. For men, prescribing medications to improve sperm quality may help and surgery may be employed for men with structural abnormalities in their reproductive system.

When more simple methods are not successful, more complex procedures may be employed such as intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI). For couples with unexplained infertility, increasing coital frequency in combination with IUI often results in successful pregnancies.


References:

  1. Ferlin, A., Raicu, F., Gatta, V., Zuccarello, D., Palka, G., & Foresta, C. (2007). Male infertility: role of genetic background. Reproductive biomedicine online, 14(6), 734–745. https://doi.org/10.1016/s1472-6483(10)60677-3
  2. Lipshultz, L. I., Howards, S. S., & Niederberger, C. (2009). Infertility in the male (4th ed.). Cambridge University Press. http://dlib.sbmu.ac.ir/site/catalogue/134959
  3. Krausz C. (2011). Male infertility: pathogenesis and clinical diagnosis. Best practice & research. Clinical endocrinology & metabolism, 25(2), 271–285. https://doi.org/10.1016/j.beem.2010.08.006
  4. Poongothai, J., Gopenath, T. S., & Manonayaki, S. (2009). Genetics of human male infertility. Singapore medical journal, 50(4), 336–347.

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.

Advice from a Fertility Specialist on Infertility & Mother’s Day Blues

WORDS LIM TECK CHOON

FEATURED EXPERT
DR LIZA LING PING
Consultant Obstetrician & Gynaecologist and Fertility Specialist
TMC Fertility

“For most, Mother’s Day is the one Sunday a year where mothers from all walks of life are especially honoured for their dedication, love and sacrifice. At the same time, the celebration can be a painful experience for those coping with infertility,” says Dr Liza Ling Ping, a fertility specialist.

She adds that for women facing infertility issues, the constant reminders of the joys of motherhood during that day may affect them mentally, physically, as well as emotionally.

START WITH SELF-COMPASSION

Be kind and shower care to yourself, the same kindness and compassion that you offer others.

“Increasingly, research has shown that self-compassion can help reduce anxiety and increase resilience,” explains Dr Liza.

She asserts that infertility is a medical condition. It does not represent your worth as a woman and a human being.

Hence, Dr Liza calls for more self-empathy. “Avoiding harsh self-criticism,” she says, “and you can make room for coping with infertility as best as you can.”

SEEK SUPPORT

While it can be hard to speak out about infertility, Dr Liza recommends talking to others that are in a similar situation, or even supportive friends and family, as doing so can be helpful in processing your feelings.

“From what I’ve seen, exchanging experiences with others going through the same thing can lessen the loneliness,” she adds.

ACKNOWLEDGE YOUR FEELINGS 

“Think about how you truly feel about Mother’s Day and how you’d like to spend it,” Dr Liza advises.

She adds: “Don’t feel guilty for saying no to family events or large celebrations of motherhood if you feel that these might be triggering for you. You may instead choose to spend the day with your partner or friends—or even alone—to do something you personally enjoy to take your mind off things.”

GO FOR A DIGITAL DETOX

Just go offline on Mother’s Day.

Alternatively, Dr Liza advises to make use of temporary internet filter and blocking apps to choose which websites or social media platforms you’d like to avoid.

“While completely shutting off the online world may not be feasible for all, even a partial digital detox can help create a safe space for yourself,” she says.

CELEBRATE THE MUMS IN YOUR LIFE

“Some women may find greater comfort in embracing the celebrations and redirecting their energy towards their loved ones,” shares Dr Liza.

She explains that doing so may help you recognize your own pain while simultaneously appreciating others.

“Furthermore, by focusing on other mothers who enriched your life, including your own, you can encourage more positive associations with the day instead of negative feelings alone,” she says.

A Women Physique Category Runner-Up on Bodybuilding, Muscles & More!

WORDS LIM TECK CHOON
PHOTOS JASMINE WONG

Jasmine Wong, a wealth planner for Prudential, was named the 1st runner-up in the Women Physique Category of the Mr/Ms Penang 2022 bodybuilding championship. We really appreciate that she manages to take time to speak to us about her training, diet, and challenging society’s perception that muscular women are somehow not ‘feminine’.

WHO SAYS MUSCULAR WOMEN AREN’T ATTRACTIVE? 

Jasmine:
Everyone has different body goals. The most important thing is that you are clear with what yours are and that you are happy with them.

My personal honest opinion is that women who lift weights are attractive. It tones up your muscle and exude confidence. Lifting weights forces you out of your comfort zone. It trains you to be a better person as a whole.

Hence, I would love to inspire more women to be fitter and achieve more success in life. That’s what female empowerment is all about!

HOW JASMINE DOES HER WORKOUT ROUTINES

Jasmine:
I hit the gym after working hours. and I usually spend around 1 to 1.5 hours there, 5 to 6 days a week.

Each day, I train specific muscle groups: biceps and triceps, chest, back, shoulders, and 2 sessions of leg days with abs in between these days.

Rest days are equally important for muscle recovery and letting you come back stronger for the next training day.

Before stepping into competition, I enjoyed Les Mills workout programmes and I also sourced plenty of workout ideas from YouTube. One of my favourite workout selections is by Caroline Girvan.

GETTING READY TO COMPETE 

Jasmine:
I was doing my workouts all by myself before I decided that I wanted to compete. After coming to that decision, I realized that I had many limitations in my workout and training—I certainly wasn’t ready to compete yet!

Fortunately, my husband found me a professional trainer, Lilian, who is a 5-time world champion and a 2-time Malaysian Book of Records holder. Thanks to her tutelage and supervision, I finally achieved the 1st runner-up position in the Women Physique Category of the Mr/Ms Penang 2022 bodybuilding!

Therefore, I would strongly encourage anyone that is serious about competing or even just wanting to make sure that they are doing things correctly—go engage a good coach or personal trainer!

EATING HEALTHY, BALANCED MEALS EVEN WHEN YOU’RE BUSY & ALWAYS ON THE GO

Jasmine:
Food intake is crucial. The whole idea of eating well is important. Complex carbs, lean protein, and good fibre are good selections for a balanced diet.

Food preparation, or food preps as we like to call it, for competition and off season are completely different. Food prep for an upcoming competition must be very precise, as only specific foods are allowed. For off season, however, I try my best to prep most of my meals during weekdays. Oats is my breakfast routine. I’m Cantonese, so soup is a must and the slow cooker is my BFF in the kitchen!

Prep something you like so that your eating habits are enjoyable and hence sustainable. For myself, I add packets of Chinese herbs and chicken breast into my slow cooker overnight, to enjoy a delicious meal next day with brown rice, stir-fried vegetables, and of course cili padi.

Be smart when it comes to food selection while eating out. I’m on the go most days, so I pack my food along with me and eat in the car. Most of my appointments with my clients are done over coffee—Americano is my favorite!—or Chinese tea.

MAKE FITNESS A PART OF YOUR LIFE

Jasmine:
Proper time management according to your personal values is always a key challenge. Most of the time, we struggle to make time for ourselves.

If hitting to gym is tough with your tight schedule, start with 15 to 30 minutes of quick workout at home, 3 to 4 sessions a week.

Once you are used to making fitness a part of your daily routine, you will find it easier to adjust your daily schedule to allocate more time to exercising.

Trust me, you will never feel the same again when fitness is a regular part of your life!

Get in touch with Jasmine Wong on her social media and more by clicking here. The link opens in a new window.

MIASA Launches Young Advocates for Mental Health Programme on International Women’s Day

WORDS LIM TECK CHOON

In conjunction with International Women’s Day, the Mental Illness Awareness and Support Association (MIASA) hosted a half-day event at Royale Chulan, The Curve (Kuala Lumpur) on March 11, 2023.

TRANSCENDING ALL BOUNDARIES: BE REVOLUTIONARY

The theme of International Women’s Day this year, ‘Transcending All Boundaries: Be Revolutionary’,  calls for the championing of efforts that will empower women in spite of continuing challenges faced across many sectors of society.

The Founder and President of MIASA, Puan Anita Abu Bakar, outlines the different barriers faced by women due to various cultural and societal norms, which are further compounded and exacerbated for those who have a particular disability or struggles with their mental health.

“When women find it hard to talk about difficult feelings, they tend to internalize them,” she says. “This can lead to depression, eating disorders, and self-harm.

She shares that past statistics indicated that around 1 in 5 women faces a mental health challenge such as depression and anxiety.

“So, today, we want to let every woman know that there is help, there is support, there is recovery when facing mental health issues. No one has to struggle alone. You don’t have to struggle alone,” she asserts.

BREAKING DOWN BARRIERS ACROSS ALL GENDERS, BECAUSE MENTAL HEALTH ISSUES DON’T DISCRIMINATE 

While MIASA champions and supports the efforts to empower women across various social and political sectors of life in Malaysia, the association also is well aware that mental health issues do not discriminate based on one’s gender.

Hence, to achieve the goals and objectives of the association, Puan Anita highlights that broad discussions of gender stereotypes and gender equity should not be restricted to only barriers faced by women.

“In our work within the mental health field in particular, we have a front-row seat to witness the harmful effects gender stereotypes can have not only on women but men too, namely when it comes to expressing one’s feelings. For example, we know that many young boys are implicitly taught to believe that they need to ‘man up’ and that crying is a sign of weakness for example,” she explains.

“So let’s take this opportunity to acknowledge those barriers and boundaries as well, and ensure that all of us, man and woman alike, work harmoniously together to ensure gender equity from all sides,” she concludes.

LAUNCH OF YOUNG ADVOCATES FOR MENTAL HEALTH PROGRAMME TO ACHIEVE GENDER EQUITY THROUGH A ZERO-STIGMA GENERATION 

This inaugural programme from MIASA will build on the importance of building a generation free of stigma and discrimination—the zero stigma generation.

The MIASA Young Advocates for Mental Health programme is a 6-month programme that provides a platform for young people to:

  • Learn about mental health and mental health conditions
  • Understand the stigma and discrimination around mental health
  • Acquire qualities and skills of an effective advocate
  • Receive access to the different resources that support people struggling with mental health issues.

“It is a programme that also goes beyond acquiring knowledge; it provides participants hands-on experience with mental health peers through the shadowing sessions,” Puan Anita further elaborates.


For more information on MIASA and its mental health services as well as programmes, you can visit their website by clicking here (link opens in a new tab).

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