Gynecologic ills common in diabetics
January 15, 2006 12:50 am
WE ALL KNOW that smoking can lead to lung cancer or emphysema. But did you know that it also can increase the likelihood that you'll develop osteoporosis or cervical cancer?
Most of us also are aware that diabetes can cause heart or kidney problems. But how many know that people with diabetes also are at risk for uterine cancer or sexual dysfunction?
Many of the most common diseases and conditions in this country can cause gynecologic problems. But many women don't know what they need to be looking for, or when to be concerned.
Obesity, which has reached epidemic proportions in the country, often leads to irregular periods and can lead to an increased risk for endometrial cancer (cancer of the lining of the uterus).
Other gynecologic conditions that are exacerbated by obesity are fibroid formation and infertility.
Related to obesity, diabetes affects approximately 21 million people in this country (close to 10 percent of the population), with many of them developing conditions such as cardiovascular and kidney disease.
But diabetic women also are at increased risk for endometrial cancer, as well as abnormal vaginal bleeding.
Endometrial cancer usually presents with abnormal vaginal bleeding. But the effect that diabetes has on hormone regulation can cause abnormal bleeding even without cancer being present.
Women may develop irregular periods or may have no period at all, and abnormal bleeding can sometimes develop way before diabetes ever does. Diabetic precursors such as insulin resistance (often involving polycystic ovarian syndrome, a condition marked by infertility and abnormal periods) are notorious saboteurs of a normal, monthly period.
Diabetes also can lead to frequent yeast infections. In fact, the initial diagnosis of diabetes is often made because a woman starts having recurrent yeast infections.
Because of the vascular damage that diabetes can cause, sexual dysfunction is another gynecologic condition that diabetics often face. Vascular damage from hypertension also can cause sexual dysfunction.
Women with these conditions may experience a new onset of inability to achieve orgasm or to become well lubricated during intercourse. The female sexual response is very complicated, however, so other reasons must be addressed--such as the state of the relationship and medications that an individual may be taking.
Women with hypertension also are at increased risk for endometrial cancer, so any hypertensive, obese or diabetic woman with abnormal vaginal bleeding should address it immediately.
This is not to say that women without these conditions should ignore abnormal bleeding, but if these conditions are present, the likelihood of developing the disease is higher.
Excess hormones
Thyroid diseases are another group of conditions that can wreak havoc on a woman's health. Too much or too little thyroid hormone can lead to infrequent to nonexistent periods, or to just the opposite--heavy, frequent bleeding.
Excess thyroid hormone (whether from the disease itself or from over-supplementation) also can lead to osteoporosis, which is a weakening of the bones that can lead to fractures and major disability. Therefore, in some women with thyroid disease, a bone density scan is warranted to make sure the bones are healthy.
Weight-bearing exercise, calcium and vitamin D supplementation can help offset bone loss.
Smoking also increases the risk for osteoporosis (along with the many other negative effects that smoking has on our health). Women who smoke also need to pay extra attention to exercising and getting an adequate intake of calcium and vitamin D.
Smoking also can have negative effects on women who have HPV. We now know that the vast majority of cervical cancers are caused by HPV, or human papilloma virus. It's a sexually transmitted virus that approximately 75 percent of all women will be exposed to at some point in their lives. Smoking greatly increases the chances that the virus will persist in the cells and lead to pre-cancers or full-blown cancer.
The immune system is a major defense against persistent HPV infection, and an immune system exposed to cigarette smoke can't protect the body from unwanted invaders such as viruses and bacteria as well as an immune system that is free from this exposure.
Fortunately, even women with cervical pre-cancer can improve their chances of getting rid of the disease without invasive treatments, by stopping the use of tobacco.
These are but a few of the most common medical conditions that can impact a woman's gynecologic health. Women with these conditions should pay extra attention to their gynecologic health and get the appropriate evaluations when necessary.
Intuitive eating
Now, for just a little update on intuitive eating, an approach I wrote about last month. Unfortunately, I can't say that I've lost too much weight yet. But I also unfortunately can't say that I've been practicing the methods of intuitive eating like I should.
However, I am encouraged to report that I have noticed significant behavioral changes. I've noticed a real decrease in the quantity of food I eat as well as in my intake of fast foods (an area that has been particularly hard for me). I find now that I (or my body, rather) rarely want them, preferring home-cooked foods instead. As a result, I feel more in control of my life, which is huge.
My dietitian and I have had multiple conversations about how the focus needs to be on being fit and healthy--with weight loss as a byproduct of a healthy lifestyle--and that focusing primarily on weight loss can actually sabotage my efforts. I guess old habits and cultural pressure die hard, but I think I'm starting to get it.
As Barbara Birsinger (that's my dietitian) says, intuitive eating is a process, and on that vein I definitely see improvement. In this, as in any program to improve wellness and change habits, patience is a virtue.
I'll keep you posted!
DR. ARLENE LEWIS welcomes reader comments and questions. She can be reached by writing to her at Free Lance-Star, 616 Amelia St., Fredericksburg, Va., 22401 or by e-mail at
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Gynecologic Ills Common In Diabetics 
