Medsarticles. Medical Weblog

HBV infection is passed on when body fluids or secretions from an infected person get into another person’s body through a break in the skin or a lining membrane. HBV has been found in blood, semen, vaginal secretions, saliva, urine, breast milk, discharges, sweat and even tears.

Hepatitis В is of particular concern for women because a woman who is a chronic carrier (see below) or who develops hepatitis В infection during pregnancy may pass the infection on to her baby, usually during birth. Children infected this way usually become carriers.

HBV is very easy to catch. You can pick it up through sexual contact, blood transfusion, sharing syringes and needles, contaminated instruments (such as those used for tattooing, ear piercing, acupuncture, dental and medical procedures), mouth-to-mouth contact and by contact of any infected fluid with a cut or abrasion on any body surface.

Hepatitis В is not strictly classified as an STD because it is not exclusively passed on by sexual contact, though this is probably the most common means of transmission in Western countries. Homosexual men and men or women with many sexual partners are those most likely to be infected through sex. Catching the virus from blood transfusion, which was once believed to be the most common means of infection, is now rare because of screening of donors. (Blood from transfusion services in Australia and many other countries is now tested for hepatitis В and C, HIV and syphilis). People at most risk of catching hepatitis В non-sexually include health workers who come in contact with blood or secretions from infected people, intravenous drug users and mentally handicapped people living in institutions.

Many women suffer silently and unnecessarily from urinary incontinence, which affects about 5-6 per cent of Australians – over 800 000 of us. Women are eight times more likely to be affected than men. Also, many more people experience occasional ‘accidents’ with involuntary loss of small amounts of urine. A recent survey in Sydney found that 54 per cent of women had experienced loss of bladder control at some time during their adult lives, so if incontinence has ever troubled you, you’re not alone.

Loss of bladder control is a humiliating experience. The possibility of unpredictable, embarrassing accidents can have a profound effect on confidence and self-esteem, and may lead to depression, anxiety, social withdrawal and isolation. Many sufferers are too ashamed and embarrassed to talk about their problem, even to their doctors.

The belief that they have too much facial and body hair is a distressing problem for many women. They may fear that they be a hormonal imbalance and become depressed and withdrawn, believing that their appearance is flawed by excessive hair. But how much is too much? This perception depends on your inherited background and where you live.

In our society the image of female beauty promoted by fashion, advertising and the media makes facial or body hair on women a disfiguring blemish. We go to all kinds of trouble to remove it even from sites such as our legs and armpits, where it is normal and inevitable that hair will grow. In other societies, where the majority of women have a genetic tendency to grow more and darker (and thus more noticeable) facial and body hair, moderate female hairiness is quite acceptable.

In the past excessive hair growth has often been considered a cosmetic rather than a medical problem. In recent years the factors that influence hair growth have become more clearly understood; most women with unwanted hair can now be helped by medical as well as cosmetic treatment.

Before discussing the problem of excessive hair, let’s look at a few facts about hair in general.

Types of hair

There are three types of hair. Lanugo hair grows prenatally and is seen mainly on premature infants – fine, darkish hairs that disappear shortly after birth. There are two types of post-natal hair: vellus and terminal. Vellus hair is fine, short and pale, and grows all over the body except on the palms and soles, around the nails and on some parts of the genitals. Terminal hair is thicker, longer, and often strongly coloured. It is seen after birth on the scalp, eyebrows and lashes.

The tiny organs, from which hairs grow, the hair follicles, lie below the surface of the skin. Hair growth is not continuous, but goes through cycles of growth and rest. At the end of the resting phase the hair falls out and a new hair begins to grow. The length of each phase of the cycle varies with the site of the hair. The growing cycle is longest in scalp hair (three years) and shortest in arm and thigh hairs (a few months), which explains why scalp hairs grow to greater length. Each follicle goes through its cycle independently of other follicles, resulting in constant slight hair loss rather than the seasonal moult that occurs in many animals.

We are all (men and women) born with the same number of hair follicles. During life various factors influence some of the vellus hair follicles to produce terminal hairs. The number and situation of follicles normally converted to terminal hairs depend on sex and other inherited factors, both racial and familial. At puberty the production of androgens (male hormones) in both sexes converts vellus hair to terminal hair in the armpits and pubic regions.

As males progress through puberty, androgens cause terminal hair growth to develop further in an orderly sequence on the upper lip, chin and cheeks, lower legs, thighs, forearms, abdomen, buttocks, chest, back, upper arms and shoulders. The amount of this hair growth is enormously variable between men: there are as many men with a sparse beard and little or no body hair as there are men with heavy beards and body hair.

Terminal hair also develops on the lower legs and forearms in the majority of women. Whether this growth is stimulated by sex hormones is uncertain, but as it tends to be proportional to the amount of terminal hair in other sites it seems probable that it occurs more in those women whose hair follicles are more sensitive to androgens.

Excessive hair growth

There are two types of excessive hair growth, hirsutism and the less common hypertrichosis.

Hirsutism refers to the androgen-stimulated growth of coarse terminal hair in women on the ‘man the abdomen and lower back and fronts of the thighs. Note that a few со hairs around the nipples are common a normal.

Hypertrichosis is excessive growth both vellus and terminal hair. It is usually not caused by hormones. The main causes
of hypertrichosis are certain drags, thyroid disorders, after inflammation of the skin and in some metabolic disorders. This sort of excess hair disappears six to twelve months after the cause is corrected. Hypertrichosis may also occur in patches, alone or associated with a mole.

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Bleeding between periods

Except for slight spotting at the time of ovulation, all bleeding between periods (and after sex) needs investigation. The most important causes to rule out are cancer of the endometrium or cervix. Other causes include infections and other inflammations of the cervix and uterus, polyps of the uterus and cervix, and hormonal disorders. Ectopic pregnancy and incomplete or missed abortion must be excluded if there is unexpected bleeding and any possibility of pregnancy.

Painful periods (dysmenorrhoea)

There are two types of period pain.

• Primary dysmenorrhea occurs in young women who have normal reproductive organs.

• Secondary dysmenorrhea is menstrual pain that develops in women who have previously had painless periods. It is always a symptom of problems in the reproductive organs.

There seems no doubt that mood сchanges around the menopause are influenced by a lack of oestrogen, but your feelings about
getting older and reaching the end of your fertile years also play a part in your emotional response. Physical symptoms can also affect your mood. If your sleep is disturbed by frequent sweats, it’s not surprising that you feel tired, lethargic and irritable during the day, and have trouble concentrating and making decisions.

Physical symptoms may make difficulties for you at home, at work or socially because your family, colleagues and friends don’t understand what’s happening to you. Some women may be embarrassed or unwilling to complain of menopausal symptoms because of the old attitudes (which still prevail in some quarters) that it’s bad form to speak of such things that women should ‘put up with it grow old gracefully’. There’s no graceful about drenching hot flushes,
splitting headaches or depression!

Other women have told me that; are afraid to admit to menopausal toms for fear of being assumed to be ‘over the hill’ or ‘past it’ and thus less competent, rather than being judged fairly on their performance. In a society that values promise and smooth face of youth maturity, older women are often caricatured as unattractive, ill-tempered or doddery figures of derision. Such attitudes don’t do anything for the self-esteem and confidence of middle-aged women. Other things may be causing emotional stress. Middle age can be hectic! You may lie worried about the health of your partner, elderly parents or others. Middle-aged women take on the biggest load of caring for the older generation. This can take a big toll on their physical and emotional energy.

Your own or your partner’s retrenchment may bring financial problems you didn’t expect. Retirement can be hard to adjust to.

Loneliness may follow marriage breakup or death of your partner. Your children maybe growing up and moving away from home, leaving a gap in your life that’s hard to fill, though I think the ‘empty nest’ has been overemphasized as a cause of depression in middle-aged women. Many women are relieved when the children become independent, leaving them extra time (and funds!) to devote to themselves and their partners and friends, careers and other interests. Nevertheless, when the children leave home, it certainly changes the marriage dynamics. It’s a time of life when everything that happens points unswervingly to the fact that we are no longer young: grey hairs! wrinkles! spectacles needed for reading! grandchildren! And then there’s the menopause, a clear signpost that we have arrived at middle age.

Reaching middle age means taking a new look at yourself and your place in your family and community. Be proud of your maturity: don’t deny it! It’s time to review what you want from the rest of your life; time to make some plans so that you can enjoy the years ahead to the full. Let one of these plans be to take steps to ensure the best possible health for the rest of your life.

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