Prof. Shyam Fernando, a consultant physician and Professor in Clinical Medicine discusses common ailments that could hit you By Smriti Daniel This week we take a look at five important conditions that affect women and can pose serious threats to their emotional and physical health. Guiding us through the list is Prof. Shyam Fernando, a [...]

The Sundaytimes Sri Lanka

Women, listen to your body


Prof. Shyam Fernando, a consultant physician and Professor in Clinical Medicine discusses common ailments that could hit you

By Smriti Daniel

This week we take a look at five important conditions that affect women and can pose serious threats to their emotional and physical health. Guiding us through the list is Prof. Shyam Fernando, a consultant physician and Professor in Clinical Medicine at the Faculty of Medicine, University of Colombo.

In the case of some of these diseases, such as osteoporosis and heart disease, women become more vulnerable as they grow older. Others, like depression, can strike at any age. In order to successfully combat the disease and claim their health, women need to be both aware of their bodies and actively engaged with improving their health, says Dr. Fernando.

Heart Disease

As cases of coronary heart disease are on the rise, it is increasingly being identified as a leading killer of both genders. However, the cases of heart disease we hear about are overwhelmingly restricted to men which can sometimes make us forget that women are vulnerable too. This is why women who present with unusual symptoms like breathlessness, fatigue don’t always ring the heart attack alarm bell, says Dr. Fernando. In fact the warning symptoms of a heart attack can differ widely across individuals and include not just a classic symptom like chest pain running down the arm, but breathlessness (panting), neck pain, jaw pain or ‘gastritis.’

Women are more vulnerable to depression than men. Pic courtesy

“Women are protected from coronary heart disease during their reproductive life by the presence of female hormones in the body,” he says. When these wane during and after menopause, the risk of coronary heart disease increases to the same level as that in men. Among the risk factors for heart disease are: increasing age, a family history of the disease, smoking, high blood cholesterol and blood pressure, a sedentary lifestyle, weight problems and diabetes.

While a family history of heart disease might be dispiriting, women should remember that almost every other risk factor on the list can be managed by lifestyle changes that focus on a healthy diet and plenty of exercise.

Breast Cancer

Women are sometimes afraid to show a lump they’ve found to a doctor, preferring to ignore it in the hope it will simply go away, says Dr. Fernando, explaining that this is not really a good idea. Caught early, breast cancer can be treated effectively and it is far from being the death sentence women can perceive it as. “It is not the end of the world if managed properly,” says Dr. Fernando.

Tied to gender and age, breast cancer occurs most often in women over the age of 50. A family history, where a close relative has had breast, uterine, ovarian or colon cancer puts you at further risk, while a strong genetic component has also been identified. However, these aren’t the only factors. Women who have never had children or have had them only after the age of 30 are more at risk, says Dr. Fernando. Alcohol use – more than a glass or two a day – has been linked to breast cancer as has undergoing Hormone Replacement Therapy for several years. Ironically, exposure to radiation to treat previous cancers can trigger an episode of breast cancer.

However, none of these are set in stone – women with more than one risk factor have come out unscathed, while others with no family history have developed the cancer. It varies from individual to individual.

The trick might just lie in focusing on the elements within your control: watch your weight, get plenty of exercise, quit smoking and teach yourself how to examine your breast and then do it regularly. You are your own first line of defence.


Though osteoporosis is not painful at all, it can weaken your bones so that fractures result from even the most trivial falls. “Fractures are painful and debilitating. In some cases, even without a fall, vertebrae can get fractured causing a backache,” says Dr. Fernando.

Most of these strike the lumbar vertebrae, the hip and the wrist. However, osteoporosis is eminently treatable, particularly if young women are provided enough calcium and exercise in the crucial years of their childhood and adolescence. This is because our bodies have built up most of the bone mass by the age of 30, says Dr. Fernando, after that, it’s a process of maintaining old bone. Though that might sound discouraging for those of us who have passed that critical mark, it’s still not too late to do what you can for your bones. To help your body repair bone damage, you must provide it with adequate calcium, Vitamin D and weight-bearing physical activity.

Among the risk factors for osteoporosis are belonging to the female gender and aging. A small, thin boned frame, a family history of the disease, hormonal disorders, being on long term steroid medications, a diet low in calcium and vitamin D join the list alongside the usual suspects: a sedentary lifestyle, smoking and excessive alcohol consumption.


Women are more vulnerable to depression than men. In South Asian cultures like ours, the demanding role of being homemakers can have women prioritising their families above themselves, cautions Dr. Fernando, explaining that this might lead them to neglect or supress symptoms of depression. If left untreated, clinical depression can worsen and even last for years. People struggling with depression can have trouble concentrating, remembering critical details or even making simple decisions. They might be fatigued and apathetic, plagued by feelings of guilt, worthlessness or helplessness. Their sleep cycle might fall out of routine – veering between insomnia or oversleeping – ditto with their appetite. Suicidal thoughts are not uncommon.

For a woman struggling with depression it could help to understand that the problem might not be so much one of emotional resilience as a hormonal imbalance – women are particularly vulnerable to the latter postpartum (just after delivering their child) and around menopause.

Other risk factors for depression include a previous depressive episode, a family history of depression, a history of heart problems, the use of certain medications, substance abuse, serious chronic illness, vitamin deficiencies and thyroid disease, as well as emotional stressors like marital problems, job loss, or the death of a loved one.

While a severe episode might require medication and therapy, some women have found it useful to cultivate their own interests and find things that they love to do. It could mean finding a meaningful, rewarding job that you enjoy, spending time with friends who surround you with love and empathy, focusing on the good you can do for others through volunteer work or even something as simple as adopting a pet can create an emotional buffer.

Autoimmune Diseases

Your immune system is your defence against foreign agents such as microbes attacking your system. “Occasionally, due to mysterious reasons, our own immune system can turn against our organs and start attacking them. It is like a country’s army attacking that country’s own institutions!” says Dr. Fernando. These so called auto-immune disease can affect several organs in the body, such as joints (eg. rheumatoid arthritis), blood vessels (vasculitis), thyroid gland (thyroiditis), brain and kidneys (eg. lupus).

Dr. Shyam says that thyroid disease and lupus are some of the common autoimmune diseases in women. Someone with thyroxine hormone deficiency (hypo-thyroidism) can resemble a toy with a dying battery, explains Dr. Shyam, listing symptoms like weakness, slow speech, feeling excessive cold and fatigue. Other symptoms include constipations, heavier menstrual periods, thin, brittle hair and fingernails, weight gain, thickening of skin and thinning of eyebrows. Treatment involves simply replacing the thyroid hormone that is lacking and that can then bring your blood hormone levels back to normal – most people will need to take the medication for life but can otherwise live completely normal lives.

The prognosis for systemic lupus erythematosus, known simply as lupus, is unfortunately not as good. The condition affects the skin, joints, kidneys and brain among other organs. Joint pain is one of the most common symptoms, while some patients even develop arthritis. Other symptoms include, fatigue, fever, hair loss, mouth sores, sensitivity to sunlight, skin rash and swollen lymph nodes. Depending on what part of the body is affected, the disease’s symptoms vary – in the lungs it can lead to coughing up blood and difficulty breathing. In the digestive tract it is associated with abdominal pain and nausea.

There is no cure for the disease, but the disease activity can be controlled effectively with medication. The medication used are to over-power the self-attacking immune system, but that opens the door to attacks by enemies from outside such as germs.

Whatever the issue, the first lesson is listening to your body. If you notice dramatic or disturbing changes, you should consider approaching your doctor for advice. In some cases, a first round of examinations might not turn up anything. If you still feel strongly that something is wrong, seek a second opinion. In many cases, catching a disease early allows doctors to treat it more successfully.

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