Women are constantly on the go both at work and home. Active
in Sports at all levels, women now look at exercise as a vital
part of life. Through the years many people feel that women's
health needs have not been met by the male dominated medical
profession. Recently, the medical profession has become less
male dominated with more research being undertaken on women's
health issues. Articles on a variety of Women's Health issues
and Women and Sports Medicine are being published with increasing
frequency. Self help books and guides to women's health are readily
available. There are many good sources of information on women's
health on the Internet.
Musculoskeletal Injuries In Women
While many injuries occur in both women and men, some are more
common in one sex or the other. Many of those that occur in both
are discussed in detail in other sections of this home page.
One of the most readily discerned differences between women and
men is a wider pelvis in women. This results in a higher incidence
of "knock knees" which may increase the Q (Quadriceps Angle).
This can result in patellofemoral
Hormonal differences are thought to be one of the factors
that influence both a possible tendency towards more ligamentous
laxity in women and certain injuries. This has not yet been
accurately and precisely documented by research. It is clear
however that the changes that occur during pregnancy certainly
result in many changes in a woman's body, both temporary and
longer lasting. Ligamentous laxity certainly increases during
pregnancy as the time to parturition comes closer. Feet and
ankles swell, more weight is carried in an unusual location
and a variety of mechanical structures may be affected. The
back is one of those frequently affected parts. Back pain is
a commonly occurring problem during pregnancy. A woman with
pre-existing scoliosis, will usually have an increase in the
curvature occur with each pregnancy.
The shape of a particular woman's foot may not meet the manufacturers
concept of the average woman. This may necessitate a switch
to a man's shoe for the individual with a wide forefoot. If
this results in the heel being too wide, a thicker sock or
one with more heel padding might prevent some of the heel instability
that can occur. Shoes can also aggravate pre-existing foot
problems and create additional problems for those with the
tendency for certain problems to occur. High heeled shoes can
speed up the process of bunion and hammer toe formation. The
abnormal tight shape of the forefoot can also squeeze your
toes and cause corns to form and aggravate ingrowing nails.
One of the best ways to see how your shoe fits your foot is
to draw an outline of your foot on paper and than place your
dress shoe over it. You might be surprised to see that there
is no room for your last two toes! To get an idea of which
way your toes might move over the years you can place short
pencils (or link sausages) in the inner and outer border of
the shoe. If they point towards each other significantly, your
toes may one day do that also.
shape of a particular woman's foot may not meet the manufacturers
concept of the average woman. ..”
Urinary stress incontinence occurs frequently in elderly patients.
It is also found in younger, active women. Some studies (Nygaard
et. al. Obstetrics & Gynecology 1990: 75(5):848-851) have reported
up to 47% of active women may experience this problem at some
time. Stress incontinence is the leakage of urine during physically
stressful activities. These activities may include coughing,
lifting, running and even laughing or sneezing.
If you have this a problem it should be mentioned to your
internist or gynecologist who can thoroughly evaluate the pelvic
muscles, check for bladder infection, check the sacral nerves
and evaluate if low estrogen in a peri-menopausal woman is
contributing to the symptoms. The primary care physician may
also evaluate a variety of other possible causes and, if necessary,
refer you to a urogynecologist. Besides muscle weakness and
the causes just mentioned other possible contributing factors
include pregnancy, vaginal births, neurological dysfunction,
obesity and gynecological surgery.
Abnormal functioning of the pelvic support muscles are a
frequent cause of this condition. Important structures in this
area include the urethral sphincter, pubocervical fascia, and
a variety of ligaments and muscles.
For a woman without other significant causative factors "Kegel
Exercises" can be helpful. These exercises tone the pubococcygeal
muscle and improve the tone of the external urethral musculature.
The best way to experience what this exercise should feel like
is to stop the flow of urine while urinating. That will contract
the muscles that you should be exercising. The muscles around
your vagina and anus should be contracted with the feeling
that they are being lifted up and in. However, it is recommended
that you perform this exercise at other times rather than when
voiding to avoid changing your voiding patterns. Patty Kulpa,
M.D., writing in the July 1996 Physician and Sports Illustrated,
recommends starting with 1 set of 10 contractions performed
3 times a day. Hold each contraction for 5 seconds and then
gradually work your way up to holding the contractions for
10 seconds. She recommends increasing the number of sets per
day to 20 sets of 10 per day. It is possible that you may find
a significant improvement occurring at a level of 5 sets of
10 per day.
Female Athlete Triad
The female athlete triad is a combination of eating disorder
with weight loss, amennorrhea and osteoporosis. This triad may
result in irreversible bone loss, decreased serum estrogen levels,
psychological abnormalities and death. The eating disorder may
include moderate restriction of food intake, occasional bingeing
and purging (bulimea) to severe food restriction (anorexia nervosa)
and regular binging and purging (bulimea nervosa). It has been
estimated that female athletes may have an incidence of eating
disorders ranging somewhere between 15% and 62%. (Physician and
Sports Medicine, Vol24:7, 1996, p. 67-86). Anorexics have a body
weight less than 85% of normal. The definition of anorexia nervosa
also includes the absence of three or more consecutive menses
and a distorted body image. Bulimea nervosa behavior disorder
includes bingeing and purging regularly at least twice a week
for 3 months or more. Bulemic purging may involve either vomiting
or the use of laxatives.
Amennorrhea is the absence of menses. Primary amennorrhea
is defined as occurring if a female who has reached the age
of 16 has not had the development of menses or a female has
not developed menses for two years after the development of
secondary sex characteristics. This is often associated with
low serum estrogen levels. The low estrogen leads to decreased
bone mass and possible increased heart risk. This occurs because
of the important role that estrogen plays in maintaining bone
mass and in lowering risk of heart disease. Infertility may
also be more likely to occur among female athletes with this
type of reproductive system dysfunction.
One should always remember that the absence of a period,
while implying infertility, does not assure it. When ovulation
resumes, it will occur before the first period.
The female athlete may attempt to hide the symptoms of this
disorder. Some of the signs include preoccupation with food
and weight, worry about becoming overweight, frequent eating
alone, trips to the bathroom immediately after and during meals,
and feet pointing towards the toilet in a bathroom stall (while
silently vomiting). Some of the other signs and symptoms include:
- Stress Fractures
- Decreased concentration
- Dry Skin
- Enlargement of Parotid glands
- Hypothermia or Cold intolerance
Pregnancy and Exercise
Post Menopausal Osteoporosis
Osteoporosis is a problem that usually occurs in postmenopausal
women and older individuals in general. It is a primary cause
of fractures in the elderly. The mass of the bone decreases,
which makes the bones more fragile. Activities which in a normal
person would not cause an injury could result in a broken bone
in an individual with osteoporosis. Tripping and falling or getting
bumped which would not hurt a person without this condition could
easily result in injury to a person with severe osteoporosis.
Exercise is often thought to be an aid in the delay of osteoporosis.
In some cases however, in the highly motivated elite athlete,
over training combined with weight loss may be counter productive
and may result in contributing to osteoporosis. In the post
menopausal patient with osteoporosis the proper use of medications,
such as calcium, vitamin D, estrogens, fluorides, and other
new drugs such as alendronate which inhibits bone resorption
have led to major research efforts, few answers and much controversy.
An article on Alendronate appeared recently in the New England
Journal of Medicine. ("Effect of Oral Alendronate on Bone Mineral
Density and the Incidence of Fractures in Post Menopausal Women".
Liberman et al., New England Journal of Medicine Nov. 30, 1995,
Vol 333 #22 p. 1437)
Cortical bone mass appears to peak at about 35 years of age
according to the National Institutes of Health Consensus Development
Conference Statement of April 2-4, 1984. NIH
Statement online .
Peak bone mass occurs earlier for trabecular bone. A variety of factors affect
the timing and quality of this peak mass. Sex, race, nutritional status,
exercise, and overall health all affect peak mass. Bone mass is about 30
percent higher in men than in women. The bone mass is approximately 10 percent
higher in blacks than in whites. Following the attainment of peak bone mass,
the mass subsequently declines throughout life. Immediately following menopause
the bone mass decreases rapidly for 3 to 7 years.
Bone is a dynamic substance. It is not static as many lay
persons think. It changes continuously. Use, disuse, and overuse
each affect bone density and mineralization. Osteoclasts are
cells that bone. After a fracture or other bone injury they
are the cells that are active first. Osteoblasts are the cells
that create new bone. In normal bone, there is a close relationship
and balance between bone resorption and formation. Mechanical
forces, hormones, and other factors that influence local regulatory
systems have an impact on bone remodeling.
The NRC reports that studies indicate a daily requirement
of about 1,000 mg of calcium for premenopausal and estrogen-treated
women. Postmenopausal women who are not treated with estrogen
may require about 1,500 mg daily for calcium balance. Therefore,
the RDA for calcium has been thought to be too low. The conclusion
they reached was that "It seems likely that an increase in
calcium intake to 1,000 to 1,500 mg a day beginning well before
the menopause will reduce the incidence of osteoporosis in
postmenopausal women. Increased calcium intake may prevent
age-related bone loss in men as well."
A readily available source of calcium in the U.S. are milk
and dairy products. An 8 ounce glass (240 ml) of milk contains
275-300 mg calcium. Skim or low fat milk contains as much calcium
as whole milk and would be a superior source since it contains
less fat. Calcium supplementation is recommended for those
unable to take 1,000 to 1,500 mg calcium by diet.
Vitamin D is vital to permit normal calcium absorption. Sunlight
is important to allow natural production of Vitamin D. Supplementation
is possible, but Vitamin D is toxic in large amounts.
According to the American College of Sports Medicine Position
Statement On Osteoporosis and Exercise (Med. Sci. Sports Exerc,
Vol 27:4, pp. i-vii, 1995) there is no evidence that exercise
alone or exercise with calcium supplementation can prevent
the rapid decrease in bone mass in the immediate post menopausal
years. Exercise was still recommended for women in this age
group because of the overall benefit of physical activity.
Additional (older material) - by Dr. Pribut
April 1998 Looking
For Women's Health Resources On The Net
February 1998 Women's
Internet Resources: Osteoporosis
Links To Cancer Sites