When it comes to health, women’s needs differ from men’s. We look at some of the top conditions affecting women and how you can help customers to reduce their risk of developing them

Typically, women are more proactive at seeking medical treatment than men. In fact, a study by the National Pharmacy Association (NPA) has revealed that the average woman visits a pharmacy 18 times a year, compared with just four times a year for men. And it’s not just because of a variation in attitudes – women are at increased risk of several health conditions. So let’s take a look at how to prevent and treat the conditions that women are particularly susceptible to.

Heart disease

“Cardiovascular disease is disease of the heart and circulatory system,” says Maureen Talbot, senior cardiac nurse at the British Heart Foundation (BHF). “But when people think of heart disease, they think of coronary heart disease (CHD), which is the build up of fatty plaques in the coronary arteries, causing them to narrow and possibly trigger symptoms of angina or even a heart attack.” According to the BHF, CHD is the leading cause of death in the UK, killing more than 70,000 people each year. Around one in six men and one in 10 women die from CHD, while 2.3 million live with the condition.

“People expect the symptoms to be really obvious and distressing or painful, but often its just breathlessness when people exert themselves,” explains Maureen. Some sufferers experience pain or pressure in their chest, which may spread to their jaw, arms, back or neck, as well as sweating, dizziness and nausea. Yet, according to Maureen, the symptoms are easy to ignore, with many people not acknowledging the signs until a heart attack strikes. “People blow off their symptoms as not significant,” she explains, “for instance, if somebody walks up an incline daily to get their morning paper and starts to get a bit puffy, they may blow it off as just the start of a cold.”

Although rates of CHD are higher among men, the risk of developing the condition equals out between the sexes at around the age of 50. This is thought to be due to the decline of protective female hormones as women enter the menopause. “Women do get the disease, but they don’t assume it’s their heart because they think of it as a man’s disease,” says Maureen. “It’s important that they don’t ignore the symptoms, even mild ones, and see their GP. Everyone over 40 is entitled to a free heart health check”. While the menopause may be unavoidable, there are various lifestyle habits that can actively prevent the onset of CHD.

Maureen explains: “CHD is largely preventable – keep weight down, be physically active and don’t smoke.” Smoking is a major risk factor for CHD, with smokers being at least twice as likely to suffer a heart attack as non-smokers. “Nicotine increases the heart rate, so the heart has to work harder,” says Maureen. “The heart is a muscle and is pumping constantly, so it can only sustain those high beating rates for so long.”

Other chemicals in cigarette smoke can damage the lining of the coronary arteries and increase blood viscosity. As well as not smoking, women should:

  • Regularly eat unsaturated fats (e.g. olive oil and nuts)
  • Limit saturated fats (e.g. butter)
  • Have at least five portions of fruit and vegetables every day
  • Drink no more than two to three units of alcohol a day
  • Monitor their sugar intake to prevent diabetes, which doubles the risk of CHD
At the menopause, women may look at their overall health and think about how to reduce their risk of all chronic conditions

Managing other common complaints

Bacterial vaginosis (BV)

  • Prevent: avoid vaginal deodorants, scented personal care products and strong detergents. BV is also more common in women who use a coil contraceptive
  • Treat: with an OTC vaginal pH corrector. Antibiotic gels and tablets require a prescription.

Thrush

  • Prevent: avoid vaginal deodorants, scented personal care products and tight-fitting underwear
  • Treat: with an antifungal cream, pessary or tablets for thrush.

Cystitis

  • Prevent: avoid scented personal care products, tight clothing and synthetic underwear; wipe genitalia from front to back; don’t ‘hold on’ to urine; urinate after intercourse
  • Treat: by staying hydrated and relieving pain with OTC NSAIDs or other painkilling medicines.

Heavy periods

  • Treat: Tranexamic acid can be suitable for some women to reduce heavy menstrual bleeding over several cycles. If ineffective or bleeding is severe, refer to the pharmacist.

Period pain

  • Treat: with OTC NSAIDs or other painkilling medicines. Exercise, heat therapy, massage, TENS machines and relaxation techniques such as yoga can also be effective.

Osteoporosis

“Osteoporosis is crudely defined as a chronic condition where bones become more fragile and break more easily,” says Sarah Leyland, senior osteoporosis nurse at the National Osteoporosis Society. This is a natural part of the ageing process, during which the inner structure of the bones weakens, making them less able to withstand force. “Bones aren’t dead – they’re constantly changing, and bone tissue is always being replaced,” says Sarah. “This gets out of balance as we age, so more bone tissue is lost than is rebuilt.”

According to the National Osteoporosis Society, one in two women and one in five men over the age of 50 suffer fractures, mainly due to poor bone health. Women are at greater risk as the decline in oestrogen during the menopause causes a rapid reduction in bone density. Women’s slighter frames and greater life expectancy may also heighten their risk. Sarah explains: “Women’s bones are smaller than men’s, so they have less bone tissue to lose. They also tend to live longer, so reduced oestrogen coupled with age means less bone density.”

A woman’s diet during her youth can determine her future risk of fractures. Studies suggest that girls tend to have lower calcium intakes than boys. This is important since calcium, along with adequate vitamin D exposure, is essential for the maintenance of healthy bones. Also more common in girls are eating disorders, which can disrupt the production of sex hormones in severe cases. Other risk factors include:

  • Early menopause (before the age of 45)
  • Early hysterectomy or ovary removal
  • Family history of fractures
  • BMI under 19
  • Pre-existing inflammatory conditions (e.g. Crohn’s Disease)
  • Pre-existing hormone disrupting disorders (e.g. overactive thyroid)

Women should adopt healthy habits early in their lives by eating a calcium-rich diet, getting sensible sun exposure, not smoking, monitoring their alcohol intake, performing weight-bearing exercises like running, and maintaining their balance and co-ordination to reduce the risk of falls. However, adopting these habits at any age will help a woman to reduce her risk. “At the menopause, women may look at their overall health and think about how to reduce their risk of all chronic conditions,” says Sarah. “It’s a time to re-address their diet and exercise levels.”

Signs of osteoporosis include a stooped spine and reduced height. However, many women are not diagnosed with the condition until after a fracture. TENS machines, heat therapy and complementary therapies such as acupuncture can help to relieve pain, while yoga or Pilates can increase muscle and core strength. The emotional impact of a diagnosis must also be considered. “People feel differently about themselves and their body when they have osteoporosis,” says Sarah. “It’s this stereotype of turning into a stooped old woman, and men also get distressed, feeling they’ve got a ‘woman’s disease’.”

Digestive problems

Heartburn is a burning sensation behind the breastbone that occurs because of the reflux of stomach acid into the oesophagus. This happens as the sphincter (a ring of muscle at the bottom of the oesophagus) relaxes and opens due to pressure on the stomach. Besides a sore feeling in the chest, sufferers may complain of an acidic taste in their mouth or throat. In severe cases, sufferers may wake with a cough caused by acid entering their lungs while lying down.

“There’s certainly a link between heartburn and pregnancy,” says Dr Nick Read, medical advisor at The IBS Network. “This may be due to progesterone weakening the sphincter or the baby causing increased abdominal pressure.” Equally, being overweight puts pressure on the stomach. Alcoholic and acidic drinks like fruit juice can irritate the stomach, while high-fat food delays the stomach from emptying, making the sphincter more likely to relax. OTC treatments for heartburn can be recommended. However, it is also important to advise customers on the self care measures that can help prevent heartburn recurring and manage symptoms. These include maintaining a healthy weight, eating slowly, monitoring fat and alcohol intake, and eating regular, small meals.

Irritable bowel syndrome (IBS) is a common but poorly understood digestive disorder that is thought to affect 15 per cent of the population at any one time. Although definitions vary, IBS is generally associated with abdominal discomfort coupled with a change in bowel habits, occurring at least three times a week. “IBS is an illness, not a disease,” says Dr Read. “We can all have symptoms – it’s simply a state of being.” Symptoms usually begin in early adulthood and reappear after stress or eating certain foods. Keeping a food diary can help sufferers to identify triggers. “It’s a combination of mood and food,” says Dr Read. “Be aware of your body. Ask yourself: ‘Why am I getting symptoms on a Monday morning?’”

IBS typically occurs with diarrhoea and/or constipation. According to NHS Choices, twice as many women than men suffer, particularly from constipation. This may be because of hormones, since symptoms often worsen during pregnancy or at the end of the menstrual cycle. However, Dr Read believes that stress plays a major role in heightening gut sensitivity. “Women have more to cope with in this day and age,” he says. “Evidence shows that women are more right-brain dominated and are therefore more attuned with their bodies, so tend to have more sensitive guts.”

Cutting back on foods that are rich in insoluble fibre, such as nuts and whole grains, can help to prevent diarrhoea, while antispasmodics will ease stomach cramps. Taking laxatives, staying hydrated and eating soluble fibre such as oats can treat constipation. Both hypnotherapy and cognitive behavioural therapy can help in the treatment of IBS, while off-loading concerns may reduce the risk of mental illness in sufferers. “There’s a tremendous overlap between IBS, chronic fatigue syndrome, anxiety and depression,” says Dr Read. “At The IBS Network, we encourage people to manage themselves with the assistance of a healthcare professional, and this relates to pharmacies.”

It is important to note that sudden weight loss, blood in the stools and a sudden or severe change in bowel habits is not IBS and needs referral to a GP.

Regular exercise is important at every stage of a woman’s life

 

Bladder weakness

Urinary incontinence (UI) or bladder weakness affects twice as many women as men, with over nine million UK women suffering to some degree. “Anatomy has a huge influence on this,” explains Debbie Gordon, strategic and clinical affairs manager at the Bladder and Bowel Foundation. “A woman’s anatomy means that the pelvic floor is adversely affected by gravity, and continence is governed by strong pelvic floor muscles. Weakness that develops following a trauma, coupled with gravity, has detrimental effects on the continence of a woman.”

UI is most commonly defined as ‘stress’ or ‘urge’ incontinence. “Stress UI is a result of weak pelvic floor muscles,” says Debbie. “Women may complain of small amounts of leakage when they laugh or cough.” This is particularly common during pregnancy and breastfeeding, but can also be caused by childbirth or reduced oestrogen post-menopause. Urge UI, or overactive bladder, is the frequent passing of urine. Debbie explains: “Urge UI is habitual toileting unnecessarily or ‘just in case’, therefore unwittingly training the bladder to hold less.” Other causes include:

  • Neurological conditions (e.g. dementia)
  • Certain medicines (e.g. antidepressants)
  • Caffeine

Treatment depends on the type and severity of the UI. Firstly, sufferers should maintain a healthy weight and regularly practise pelvic floor exercises. If the condition persists, duloxetine can be prescribed for stress UI, but produces adverse side effects in around one in 10 patients. In severe cases, bladder training or surgery may be required.

To help customers manage their symptoms, bladder weakness pads and pants are available in various absorbencies to suit different degrees of bladder weakness.

 

Discretely does it

While discussing conditions such as bladder weakness, thrush and cystitis may be a daily occurrence for pharmacy staff, it can be highly uncomfortable for customers. “Pharmacy staff can help to minimise this embarrassment by making the customer aware that they can have a conversation in a consultation room or an area where they won’t be overheard”, says an NPA spokesperson. The following tips will also help you to build rapport with customers:

  • Use effective questioning to initiate conversations
  • Minimise physical barriers (e.g. the counter)
  • Let them know if their condition is common
  • Synchronise your body language
  • Show empathy and understanding throughout your conversation and when discussing possible treatments and solutions.

Further information

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