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Posted: 12 Jan 2013 03:35 PM PST

Many underestimate the importance of a good sports bra. But unless you want pendulums for breasts, a proper sports bra with sufficient support is vital in helping to maintain your comfort and health while you're working out.

A GOOD friend, some say, is like a bra. She is supportive, uplifting and above all, stays close to your heart.

For the avid exerciser, a good sports bra is indeed a bosom buddy. Like your most trusted confidante, it will never leave you hanging; never let you down, even as you flounce and flounder through life's precarious terrain.

Many underestimate the importance of a good sports bra. Just as you wouldn't run a marathon in your flip-flops, you shouldn't exercise without a proper, supportive bra either. Unless you fancy sagging pendulums for breasts.

When you exercise without proper support, your breasts will bounce in a figure eight, causing wear and tear on the supporting ligaments. This may cause breasts to stretch and sag over time.

The larger your cup size, the greater the force on your breasts, and the more support they need to avoid damage to connective tissues and ligaments.

Wearing an unsuitable bra during your workouts may also lead to painful chafing when the breasts rub against the fabric. A sports bra that pulls moisture away from the skin will help you stay dry and comfortable while you sweat it out.

While breasts will naturally succumb to gravity with age, you can fight the sag by wearing a sports bra that provides sufficient support while you exercise.

The number one thing you need to know when you're sports bra-shopping is that, not all sports bras are created equal. That bra that stretches with you in a pretzel pose during yoga might not hold up to an intense session of running. That bra that boosts a B-cup might be too tight or uncomfortable for someone with larger breasts.

For optimum fit and comfort, it is important to pick the right style of sports bra to go with your type of exercise, whether it is a session of high-impact circuit training, dancing or lifting weights.

Generally, the more intense and physical your form of exercise, the more supportive your sports bra is required to be. Also keep in mind that larger breasts will need more support, even when you engage in lower-impact activities.

Here are a few things to consider when looking for a sports bra:

Style

There are generally two different types of sports bra – a shell-style bra that compresses the breasts, or a two-cup bra that encapsulates each breast.

In most cases, a shell-style bra will work for those with smaller cup sizes, say an A or a B, or for low to moderate impact workouts, such as yoga or line-dancing.

However, if you have Dolly Parton's proportions, you should look for a sports bra that encapsulates each breast in a separate chamber instead. Bras that have two separate cups with a divider between them will help reduce bounce, and offer better support than the simple shell bra.

Wide shoulder straps

The devil is in the details. In this case, it's in the size of your bra's shoulder straps. Believe it or not, the simple shoulder strap can help determine whether your sports bra is a loser or a keeper.

For starters, straps should be wide, and they should feel comfortable on your shoulders.

Those who are well endowed, in particular, should keep a lookout for bras with wide shoulder straps. This is because they help distribute weight better than narrow straps, and can help prevent potential health problems such as back pain and poor posture.

Out-of-the-way seams

When shopping for a sports bra, you'll want to keep an eye out for seamless fabrics, seams with rolled edges, or seams that are covered to help prevent chafing. Just imagine being rubbed raw in the most delicate of places while you exercise. Ouch!

So, make sure that the seams of your exercise apparel are in places that won't get in the way during your workout. You can start by looking for strategically placed seams and stitching that will allow room for some stretching, and help cushion the breasts, but doesn't allow them to bounce.

Moisture-wicking fabric

The fabric of active wear has one main purpose, and that is to wick away sweat and moisture from your skin, and out to the exterior of the fabric. Most active wear, including sports bras, usually work in such a way so as to help keep the wearer cool and dry.

As a rule of thumb, you should avoid sports apparel that are made of 100% cotton, because once you start sweating, they'll stay wet. This can spell disaster for your skin, especially when you've planned a long workout.

The moisture that is trapped between the garment and your skin can irritate the skin and result in rashes.

Many moisture-wicking fabrics are made from polyester blends, which absorb very little water, letting you stay comfortable and dry. The general consensus is that these fabrics work very well, and that's probably backed up by the extraordinary price tags attached to them.

When in doubt, always get the bra with the most support. A higher-impact bra will work for a lower-impact sport, but never the other way around.

While trying it on, try jumping up and down, swinging your arms, and moving around in the dressing room. If a bra pokes, rubs, slips, bulges or constricts your breathing, put it back.

More importantly, make sure that your breasts are supported, and not bouncing around in the bra. To make the most of your sports bras, rotate them so that you can get at least a year's use out of each one.

In any case, just remember that the only thing that should be bouncing up and down while you're working out, are the balls of your feet!

> Fiona Ho is a certified personal trainer and a CrossFit enthusiast on a perpetual hunt for the perfect sports bra.

Implants and injections

Posted: 12 Jan 2013 03:35 PM PST

These are two useful contraceptive methods that can be used by most healthy women.

CONTRACEPTIVE implants and injections are hormonal contraception. Unlike the combined oral contraceptive (COC) pill, they contain only progestogens that are similar to the hormone, progesterone, produced by the ovaries. They are long-acting, effective contraceptive methods.

These implants and injections release progestogens continuously and steadily into the bloodstream, which thickens the mucous in the cervix, thereby preventing sperm from entering the uterus.

The progestogens also make the lining of the uterus thin, thereby making it less receptive to the implantation of a fertilised egg on it. It also prevents the release of an egg from the ovaries (ovulation).

They are a reliable and reversible contraceptive method that is suitable for women who want to use hormonal contraception but do not want to take oestrogens, or who have conditions which make them unsuitable for the COC.

The implants and injections are very effective as they are more than 99% reliable, ie less than one in 100 women who use it will get pregnant each year.

Advantages

The primary advantage of contraceptive implants and injections is that they provide protection against pregnancy soon after the implant is inserted (or the first injection is given).

They are long-acting, and fertility returns to normal after its use is stopped.

Implants are effective for about three or five years, and each injection for eight or twelve weeks.

The advantages of implants and injections are that they do not affect the sexual act, and are options for those who are cannot use contraceptive methods that contain oestrogen, ie COC, contraceptive or vaginal ring. Implants and injections can be used during breastfeeding as it does not affect the latter. They may provide some protection against cancer of the endometrium and pelvic inflammatory disease, due to the thickening of the cervical mucous (which may prevent bacteria from entering the uterus).

Implants may reduce heavy or painful periods after about a year of use. Injections may reduce heavy, painful periods, and relieve premenstrual symptoms in some women.

Disadvantages

There may be some disadvantages of contraceptive implants and injections that have to be considered.

They do not provide protection against sexually transmitted infections (STIs). They may cause periods to change significantly in the first year of use, becoming irregular, heavy, light and short, or stopping altogether (amenorrhoea).

The altered periods usually settle down after about a year of use, but they can sometimes continue for as long as the implant is fitted, or the injected progestogen remains in the body.

These changes are not harmful, but some women do not find them acceptable. Additional medicines may be prescribed if there is prolonged bleeding.

The effects on periods usually resolve soon after the removal of the implant.

However, it usually takes between eight to 12 weeks for injected progestogens to leave the body, so disrupted periods will continue during this time, and for some time afterwards. It can take between three months and a year for the periods to return to normal.

Users of contraceptive implants and injections may also have headaches, acne and tender breasts. Users of injections may also have mood changes and loss of sex drive (libido). These side effects usually resolve after a few months, but if they persist, medical attention should be sought.

Rarely, infection may occur at the site of insertion of the implant or injection, for which antibiotic treatment may be necessary. There is also a very rare risk of allergic reaction to the injection.

Injections may be associated with weight gain of about two to three kg over a year, although some women may lose weight.

They can cause thinning of the bones, but this does not increase the risk of bone fracture. The bone replaces itself when the injections are stopped, so it is unlikely that the injections will lead to long-term problems.

Women who are at increased risk of developing osteoporosis will usually be advised to use another contraceptive method.

Implants and injections are unsuitable for women who may be pregnant, want to have regular periods, or who have bleeding between periods or after sexual intercourse. They are also unsuitable for women who have had a clot in a blood vessel (thrombosis), breast cancer (currently or previously), migraine or liver disease.

The injection is unsuitable for women who have diabetic complications, liver cirrhosis, or who are at increased risk of developing osteoporosis.

Implants

Contraceptive implants contain either levonorgestrel or etonogestrel.

The levonorgestrel implant comprises six small silicone rods that are inserted, by the doctor, just below the skin of the upper arm under local anaesthesia. The small wound is then covered with a dressing, usually without the need for stitches.

The rods, which are left in place for up to five years, constantly release a small amount of levonorgestrel into the bloodstream. It is immediately effective if inserted on the first day of the period.

The etonorgestrel implant is a single rod that is inserted in a similar manner as the levonogestrel implant. The rod, which is effective for three years, releases etonorgestrel in a steady and controlled manner during this time. Its insertion and removal is faster than that of levonorgestrel implants.

Implants may be used until menopause, the average age of which is about 50 years.

As long as the implants are used in accordance with their duration of action, there is very effective protection against pregnancy, with 0.1 pregnancies in 100 women in one year of use.

An implant can be removed at any time by a doctor. The removal takes a few minutes under local anaesthesia. Upon removal, there is no longer any protection against pregnancy and the normal menstrual cycle is usually restored rapidly.

Injections

Contraceptive injections contain either depot medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN). There are other injections that contain both oestrogen and progestogen, but these are not available in Malaysia.

The site of the injection is usually the muscle of the buttock, or sometimes, the upper arm.

DMPA injections are given every twelve weeks. The first three NET-EN injections are given at eight-weekly intervals, after which the injections are given every 12 weeks.

Disruptions of the period are not uncommon. There is amenorrhoea in about 45 to 50 in 100 women after the injections have been used for more than a year.

It may take up to a year for periods to start again in some women. This may be acceptable to some women, but others, especially those who want a pregnancy at a later date, may find this unacceptable.

As long as the injections are used in accordance with the prescribing directions, there is very effective protection against pregnancy, with 0.3 pregnancies in 100 women in one year of use.

About 70% of women gain weight with DMPA, with an average of 2.5kg after one year of use. About 20% of women gain weight with NET-EN, with an average of 5kg after one year of use.

About 70% of women conceive within a year of stopping DMPA or NET-EN.

There have been concerns raised about the link between DMPA and cancer. However, data from the World Health Organization suggest that there is no long-term increased risk of breast, cervical and ovarian cancer.

On the other hand, there is a marked reduction in the risk of endometrial cancer.

Timing it

Contraceptive implants or injections can be inserted or given at any time in the menstrual cycle, provided the user is not pregnant.

Implants and injections that are inserted or given during the first five days of the onset of periods, or within 21 days of childbirth in non-breastfeeding mothers, provide immediate protection against pregnancy.

If inserted or injected at any other time of the menstrual cycle or after 21 days of childbirth, there will be no protection for the following seven days; so another contraceptive method, eg condoms, will have to be used during this time.

There are reports of heavy and irregular bleeding when injections are given within the first few weeks after childbirth.

Injections are usually given six weeks after childbirth for breastfeeding mothers.

Implants can be inserted immediately after a miscarriage or abortion, with immediate protection against pregnancy.

Implants and injections are useful contraceptive methods. They provide excellent protection against pregnancy when used in accordance with the prescription directions. They can be used by most healthy women except those who have conditions which render them unsuitable.

> Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Process and implications of menopause

Posted: 12 Jan 2013 03:34 PM PST

Topics surrounding hot flashes and vaginal dryness are not the sexiest ones around, to be sure. Yet, menopause is a stage of life that will inevitably roll around as a woman ages. It is hence important to understand the process and implications of menopause so that women may continue living normal, productive lives towards their sunset years.

CONVERSATIONS surrounding menopause are not the kind that usually find their way around the coffee table. Hot flashes and vaginal dryness are not the most comfortable topics to talk about after all.

Then we have Madonna, who at 54, still finds it appropriate to routinely flash her lady parts at tens of thousands of people during her recent MDNA world tour.

To her credit, the legendary singer is in incredible shape. Madonna, hailed as the queen of pop, has a killer physique that has defied the ravages of time, and more importantly, the all-too-common, if unforgiving, symptoms of menopause that include weight gain, thinning hair and dry, itchy skin.

If anything, the American singer, known for her flamboyant and hypersexual performances, makes menopause look like an urban myth.

Unfortunately, most of us in the real world do not have access to Madonna's team of top stylists, dieticians and personal trainers (not to mention plastic surgeons, but let's not go there).

Worse, menopause is a phenomenon that affects all women, and more often than not, has deeper implications beyond just waking up to tighter pants or physical discomfort.

The advent of menopause heralds a confusing period of time that can affect a woman's health, relationships and overall quality of life.

Essentially, menopause marks a time in a woman's life when her periods (menstruation) eventually stop, and the body undergoes changes that no longer allow her to conceive.

It is a natural event that normally occurs in women aged between 45 and 55.

In the process, periods occur less often, and eventually stop, signalling an end to a woman's fertility. Sometimes, this happens suddenly, butusually, periods stop slowly over time.

In all accounts, menopause will bring about adverse and permanent changes to the female body.

Dr Teresa L. Knight, CEO of the Women's Health Specialists Centre of St. Louis, Missouri, United States, details the process of menopause during a recent talk at the American ambassador's residence in Kuala Lumpur.

"Women are born with all the eggs that they will ever have. These eggs age with us, and are eventually used before the end of our lives," she tells the female-majority audience at the talk.

Most women will experience changes in mood, weight, food cravings and breast tenderness throughout the month during their active reproductive years, which typically begins from ages 12 to 14 years, with menarche, a girl's first menstrual period.

"These symptoms occur due to the hormonal changes that occur in the female body following the release of an egg during ovulation and the body's preparation for possible fertilisation and pregnancy," she says.

This monthly process that begins in adolescence will end in middle age as menopause when a woman literally runs out of eggs to grow and ovulate.

"When there are no more eggs present to grow, women experience symptoms from the lack of hormones. These symptoms are what we refer to as menopause."

During menopause, a woman's ovaries stop making eggs, and they produce less oestrogen and progesterone. Changes in these hormones result in menopausal symptoms.

These symptoms vary from woman to woman, although the first thing that most would notice is their menstrual cycles starting to become irregular.

Other changes that normally follow include decreased sex drive, mood changes, difficulty in sleeping (insomnia), hot flashes, night sweats and extreme fatigue.

More severe changes like vaginal infections and vaginal dryness can take a toll on a woman's sex life and relationships, Dr Knight points out.

According to a study done by Universiti Kebangsaan Malaysia 's Department of Obstetrics and Gynaecology, the average age for menopause in Malaysian women is 51.

However, some women experience menopause earlier due to natural causes, or following surgery, illness or treatments that destroy the ovaries, says Dr Knight.

When you have not had a menstrual period for more than 12 consecutive months, you are considered postmenopausal.

Menopause can last up to five years or more, and symptoms such as weight gain could translate to more serious health problems, including high blood pressure and heart diseases, Dr Knight elaborates.

Other physiological changes that may occur due to the decrease in hormones include changes in cholesterol levels and loss of bone density.

"Women of Asian descent are particularly vulnerable to losing bone density or developing osteoporosis after menopause," the doctor notes.

Although osteoporosis can strike at any age, women are at the greatest risk for the disease after menopause.

This is mostly due to decreased oestrogen levels in a woman's body after menopause, as oestrogen plays a vital role in helping to prevent bone loss.

Because the bone density of Asian women who are over the age of 50 and are postmenopausal is significantly lower than any other group, they have the highest incidence of osteoporosis.

The National Osteoporosis Foundation (NOF) recently reported that up to 20% of Asian women over the age of 50 display symptoms of osteoporosis, compared to only 10% of non-Asian white females.

In the case of African American women, only 5% of those examined showed any symptoms.

In the first five to seven years following menopause, a woman can lose up to 20% of bone mass.

Despite the various challenges faced by menopausal women, many chose to suffer in silence, especially in Asia, where topics on sex are still deemed taboo, says Dr Knight.

"Women tend not to share these problems with other women. They stop feeling sexy and feel unfeminine," she adds.

Some of these symptoms can be alleviated by making certain dietary changes, such as avoiding caffeine, alcohol and spicy foods, and eating soy products, as soy contains oestrogen.

Antidepressants have also been known to help with mood swings and hot flashes.

However, Dr Knight recommends hormone replacement therapy (HRT) for those who are experiencing severe hot flashes, night sweats, mood issues, or vaginal dryness.

HRT are medications containing female hormones to replace the ones the body no longer produces after menopause.

Generally, women who experience menopause naturally are typically prescribed oestrogen, along with progesterone or progestin (progesterone-like medication).

This is because oestrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer.

Incidentally, women who have had their uterus removed (hysterectomy) do not need to take progestin.

The benefits of hormone therapy are very much dependant on whether you take systemic hormone therapy or low-dose vaginal preparations of oestrogen.

Systemic hormone therapy or systemic oestrogen comes in pill, skin, patch, gel, cream or spray form.

This type of treatment remains the most effective treatment for relief of menopausal symptoms such as hot flashes and night sweats.

Oestrogen can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse. As such, low-dose vaginal preparations of oestrogen, whether in cream, tablet or ring form, can effectively help minimise such discomforts.

Despite the benefits of HRT, some studies have looked at the risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes and blood clots.

While current guidelines support the use of HRT for the treatment of hot flashes, the standard rule remains that HRT may only be started in women who have recently entered menopause. It should not be used in women who started menopause many years ago.

Women who wish to take HRT should also have a low risk for stroke, heart disease, blood clots or breast cancer. Also, the medicine should ideally not be used for more than five years.

"Hormone supplementation or replacement will halt the symptoms that result from the lack of hormone production," says Dr Knight.

To mitigate the risks of oestrogen therapy, a lower dose of oestrogen or a different oestrogen preparation – such as a vaginal cream or skin patch, rather than a pill – may be administered.

Regular physical exams and Pap smears are also recommended to detect any complications that may arise as early as possible.

Understanding menopause is more important than ever as woman are now living longer.

The average lifespan of Malaysian women today is 77 years, compared to just 54 years in the 1960s.

Advances in medicine and better nutrition have contributed to a longer lifespan, and most women will now live beyond the age of menopause.

It is hence, imperative for women everywhere to understand the process of menopause, as well as treatment options, so that they can continue living normal, productive lives.

Kredit: www.thestar.com.my

Ahad, 13 Januari 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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