10.JAN.2019 7 MIN READ | 7 MIN READ

When faced with women’s health issues, you shouldn’t suffer in silence. Take charge of your body and learn about common health concerns of women over 40.

Singapore has the fastest ageing population in Asia, and life expectancy among women has gone up to 85 years in 2017. As health issues tend to arise with age, it’s important for women to be well-prepared for any eventuality.

Here’s what you should know about common health problems faced by women over 40.

Cervical cancer

Cancer of the cervix is one of the most common female cancers, so sexually active women are advised to go for a Pap smear every year. The Pap smear tests for presence of precancerous or cancerous cells on the cervix, or the opening of the womb. Your doctor may also recommend an ultrasound scan of the pelvis to detect growths such as ovarian cysts and fibroids. Recovery and survival rates are better when cervical cancer is detected early. In fact, the 5-year survival rate for early stage cervical cancer (stage 0 and stage 1A) is about 93%.

The human papillomavirus (HPV) causes cancer of the cervix. There are more than 100 types of HPV that can infect humans, but HPV types 16 and 18 cause 70% of cervical cancer cases.

In the recent decade, vaccination against HPV has been developed to provide very high protection against types 16 and 18, with minimal risks and complications. HPV vaccination is advocated for prevention of cervical cancer. For sexually active women over the age of 25, HPV vaccination can still be considered, as most will have the potential to benefit from it.

Urinary incontinence and pelvic organ prolapse

Women's health after 40 - Urinary incontinence
Urinary incontinence (leakage of urine) and pelvic organ prolapse (dropping of the womb, bladder or bowel through the vagina) are common urogynaecological problems. In fact, as many as 50% of women may suffer these conditions, yet few are seeking help. These issues can affect not only a women’s quality of life and sexual health but also her work life.

Stress urinary incontinence (SUI) is the uncontrollable leakage of urine on exertion. The woman may leak urine during actions such as running, jumping, sneezing, laughing and coughing. Causes include childbirth, menopause, obesity, chronic lifting of heavy loads, chronic cough, and constipation.

A national survey on 3,500 females in Singapore by Dr Chong revealed that 13.5% of them suffered from SUI. In fact, 35.6% of women – that’s more than 1 in 3 – aged above 50 may suffer from the condition. Many women did not seek treatment for SUI because:

  • They were too embarrassed to talk about it, even with close friends or relatives
  • They did not know it is a problem
  • They did not know it can be treated and did not know where to seek treatment

Many women accept urinary incontinence as part and parcel of growing old. It is estimated that only less than 30% of the female sufferers worldwide have sought treatment, even though SUI and pelvic organ prolapse can be prevented. At Gleneagles Hospital, for instance, there is a screening clinic to detect these problems early, and a prevention clinic that teaches patients prevention techniques.

Mild SUI can be treated with pelvic floor exercises. If these do not work, or if the SUI is moderate or severe, surgery is usually the next option. The good news is SUI can be resolved with tension-free vaginal tape surgery – a simple procedure that causes minimal pain, has low complication rates and success rates of up to 95%. It involves putting a permanent sling under the bladder neck. Both the patient and their spouse will not be able to feel the tape. This 10-minute surgery is done through the vagina and the patient can safely go home on the same day. More than 10,000 cases have since been performed with positive outcomes.

Just over 1 out of 10 women may suffer a pelvic organ prolapse in her lifetime. Pelvic organ prolapse can be mild, moderate or severe. When mild, the prolapse remains within the vagina. It is moderate if the prolapse is at the door of the vagina, and severe when the prolapse is outside the vagina. Once a prolapse has occurred, it will not recover on its own – it can only worsen. Pelvic floor exercises can help to prevent a prolapse from worsening but it will not cure it. Severe prolapse can be challenging to treat, and therefore it is important to diagnose the problem and seek treatment early.

Conventional surgery for severe bladder prolapse has a success rate of 70% at most, and most general gynaecologists do not perform these procedures.

Urogynaecologists use hitching surgical techniques and a net (mesh) to prevent recurrence. A success rate of 94.6% is possible when surgery is done with Prolene mesh, a polypropylene (plastic) mesh implant used to support and stabilise the vaginal wall and pelvic floor. This technique requires special training, but when performed by an experienced surgeon, complications are minimal and success rates are high. As the surgery is done through the vagina, there are no scars, and the patient can be up and about in 1 – 2 days.


Women's health after 40 - Infertility
The quality of eggs in females decreases gradually from the age of 25, more quickly after 35, and very steeply from 40.

Many couples face the problem of conception due to stress and starting a family at a later age. Fertility success rates decline with age, and pregnancy complications for the mum-to-be and the foetus increases. A third of fertility problems are due to female factors, a third to male factors and a third to both.

Couples are encouraged to consult a specialist for prenatal wellness checks if they experience unsuccessful conception after trying conscientiously for 6 – 12 months.

Menopause-related issues

Menopause is unavoidable, but the discomforts often associated with it can be alleviated. Symptoms include hot flushes, insomnia, mood swings, and depression. There are ways to effectively manage these symptoms and improve the woman’s quality of life.

Menopause is also linked to increased risks of osteoporosis. The best way to combat this is through weight-bearing exercises. By adopting healthier lifestyle habits, such as not smoking and eating more calcium-rich foods (and even bone-forming medications, in certain cases), many fractures can be avoided.

Another common issue experienced by menopausal women is vaginal atrophy (dryness), which can cause vaginal discomfort, frequent urination, and thinning of the vaginal and bladder tissues. This can lead to infection, and in many people, painful sex.

The latest treatment for vaginal atrophy is the FDA-approved laser vaginal treatment, a simple in-clinic procedure that causes minimal pain and complications, and has helped many patients, especially those facing problems with sexual intercourse.

Although often a taboo topic, sexual intercourse is still regarded as an important part of a couple's relationship. Women with concerns about their sex lives are usually unaware that treatment can be simple and effective. Vaginoplasty, or the tightening of the vagina, in carefully selected cases, has helped many improve their sex lives. This surgery is done vaginally, as a day procedure with minimal pain and complications. It is important to seek treatment early so the couple can grow old, including sexually, together.

Prevention and early detection is key

Women's health after 40 - Prevention and detection
Ladies, do not suffer in silence. Instead, empower yourselves. Do not be embarrassed to talk about your health issues. Many procedures are available to help you in simple, non-painful, non-complicated and yet very successful ways. Some are so simple but unfortunately, many do not know about these options or where to go for them.

It is important for women to go for yearly health checks. This will not only discover problems early, but can also help to prevent problems later. Sexually active women should go for regular cervical cancer screening. From the age of 40, women should consider going for a mammogram every 1 – 2 years to screen for breast cancer. After menopause, women (especially those in high-risk groups) can consider undergoing the bone density test to check for osteoporosis.

Prevention is better than cure. Have regular health checks and get treated early. It is possible to age gracefully, and live long – and well!


Article contributed by Dr Christopher Chong, obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital


Life expectancy at birth. (16 May 2018). Retrieved 19 November, 2018, from https://www.singstat.gov.sg/find-data/search-by-theme/population/death-and-life-expectancy/visualising-data

Survival Rates for Cervical Cancer, by Stage. (n.d.). Retrieved 21 November, 2018, from https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html

Chong Yew Luen Christopher
Obstetrician & Gynaecologist
Gleneagles Hospital

Dr Christopher Chong is a urogynaecologist and obstetrician & gynaecologist practising at Gleneagles Hospital, Singapore.