Her youth

Puberty usually starts at about the age of nine and ends at around 17 years of age, said Dr Julinda Lee, a consultant gynaecologist at Pacific Healthcare Specialist Centre.

During this time, girls develop breasts, undergo growth spurts and start to menstruate due to the release of the hormone oestrogen. The body is, in fact, being prepared for pregnancy.

Once the menstrual cycle becomes ovulatory - meaning that an egg is released - pregnancy can occur. The hormone progesterone, which prepares the uterus for pregnancy, is also produced, said Dr Lee.

Progesterone and oestrogen play a big part in regulating the menstrual cycle each month.

Her child-bearing years

Before the start of a period, women may complain of mood swings, fluid retention or stomach cramps - symptoms known as pre-menstrual syndrome (PMS).

This is because the body is sensitive to the fluctuations of oestrogen and progesterone, said Dr Loh Keh Chuan, a consultant endocrinologist at Loh Keh Chuan Diabetes, Thyroid & Hormone Clinic.

Each woman reacts differently to these hormonal fluctuations but PMS can be managed with adequate rest and exercise.

When a woman is pregnant, oestrogen and progesterone levels rise to support foetal development. Pregnancy, however, may also bring about certain health challenges. About 10 per cent of all pregnant women, for example, develop gestational diabetes, said Dr Loh.

Dr Julinda Lee, a consultant gynaecologist at Pacific Healthcare Specialist Centre, said that if the condition is untreated, the baby may be larger than normal, increasing the risk of birth injuries or a difficult labour.

The condition usually disappears after delivery, but the mother will have a higher risk of developing diabetes later in life.

Going for a general health screening and not being overweight before pregnancy can help women reduce their risk of getting gestational diabetes, said Dr Loh.

Pregnancy can cause the loss of abdominal muscle tone. The abdominal wall, which provides support for organs like the bladder and intestines, stretches to cater to the increasing size of the uterus, causing a loss in muscle tone.

This increases the risk of lower back pain in future pregnancies and later in life, said Dr Lee. Organs may tilt forward when a woman is standing, increasing stress on her lower back. Pilates or leg raising exercises at home may help prevent loss of muscle tone, she said.

Her golden years

A woman nearing the end of her childbearing years enters the perimenopause stage or the transition to menopause. This usually starts around the age of 45 but can begin as early as 35 for some, said Dr Julinda Lee, a consultant gynaecologist at Pacific Healthcare Specialist Centre.

Now, the declining number of eggs in the ovaries causes hormonal changes. The woman has irregular periods and has a higher risk of getting fibroids and cysts.

Menopause (when a woman has not had a period for 12 months) occurs usually from around the age of 50. Her oestrogen levels decline, resulting in symptoms like hot flushes, vaginal dryness and disturbed sleep, said Dr Lee.

Menopausal women are also at a higher risk of heart disease and osteoporosis.

Heart disease is the leading cause of death in women aged 65 and older, said Dr Soon Chao Yang, an interventional cardiologist at Nobel Heart Centre.

This higher risk of developing heart disease is partly because of the decrease in oestrogen, which has a cardioprotective effect. Women who have early menopause are twice as likely to develop heart disease compared to those who have not, said Dr Soon.

For a healthy heart during the golden years, avoid smoking, exercise regularly and control cholesterol and blood pressure levels.

Reduced levels of oestrogen also increase the risk of osteoporosis as the hormone protects against bone loss, said Dr Leong Keng Hong, a consultant rheumatologist at Leong Keng Hong Arthritis and Medical Clinic.

One should start young to delay or prevent osteoporosis. This is because bones grow fastest during puberty and peaks in one?s 20s. After that, bone loss exceeds bone formation, said Dr Leong. Lifestyle measures to protect against osteoporosis include ensuring adequate calcium and vitamin D intake and exercising regularly.

Waning supplies of oestrogen are sometimes supplemented through hormone replacement therapy (HRT). In HRT, oestrogen is commonly combined with progestin, a synthetic version of progesterone, and can be taken in a variety of ways including orally or applied as a cream. However, studies have shown that long-term HRT may increase breast cancer risk and blood clots.

Dr Loh Keh Chuan, a consultant endocrinologist at Loh Keh Chuan Diabetes, Thyroid & Hormone Clinic, said HRT should be considered only if a woman is severely affected by menopausal symptoms. Treatment should not exceed five years.

While oestrogen has its benefits, over-exposure to it may have its drawbacks. Younger menstruating women and those who have later menopause increase their risk of breast cancer, said Dr Lim Siew Eng, a senior consultant in the department of haematology-oncology at the National University Cancer Institute, Singapore.

Women aged 40 and above should go for a mammogram, or breast screening, every year and once every two years after menopause.

[email protected]

This article was first published in Mind Your Body, The Straits Times.