Women's health

Good nutrition and regular exercise can help reduce the risk of conditions like osteoarthritis and osteoporosis, says Steve Titmarsh...

Women are also more susceptible to certain mental health problems. Good nutrition and regular exercise are the foundations of reducing the risk of developing these illnesses: they also play a part in recovery from them.  
A balanced diet containing essential elements such as calcium, iron and vitamin D with a good variety of foods containing enough fruit and vegetables is the foundation of a healthy lifestyle. That should be accompanied by moderation in alcohol, saturated fat, salt, sugar and processed foods, as outlined in the Eatwell guidance.1  
However, there are times, such as during pregnancy, when women have an increased need for certain nutrients, including iron, folate and vitamin D, as well as calcium in the latter stages and during breast feeding. In some cases a nutritional supplement might be recommended. For example, to reduce the risk of neural tube defects in neonates women are advised to take a folic acid supplement (400mcg daily) before conception and for the first 12 weeks of pregnancy.2  
Maintaining a healthy weight is important as obesity has been linked to an increased risk of cancer, diabetes and cardiovascular disease. A higher risk of joint and back pain as well as psychological problems like depression and low self-esteem have also been associated with obesity, along with complications of pregnancy such as pre-eclampsia and miscarriage.3 As well as calorie control, regular exercise is an important part of maintaining a healthy weight.4  
Osteoporosis, in which bone mass is lost and bone tissue deteriorates over time, increases the risk of fracture, especially of the hip, wrist and spine. In the UK more than three million people are thought to have osteoporosis.5 During their lives more than 1 in 3 women and 1 in 5 men will have a fracture due to osteoporosis: White women and men are at greater risk than other ethnic groups.6  
Although bone loss is part of ageing it can occur quickly in women after the menopause. Regular exercise – particularly weight-bearing and resistance exercise – stopping smoking, moderating alcohol intake and eating foods rich in calcium (leafy green vegetables, dried fruit, tofu and yoghurt, for example) and vitamin D (such as eggs, milk and oily fish) can all help reduce the risk of developing osteoporosis. The main source of vitamin D is from that produced in skin exposed to sunlight, so those who may not be able to achieve sufficient sun exposure may need to take a supplement.7  
The most common form of arthritis – osteoarthritis – is a result of the breakdown of cartilage between bones and results in painful, swollen joints that can be stiff and difficult to move. Any joint can be affected but most commonly it is the knees and feet – the joints that bear the most weight. The neck, lower back, hips and fingers can also be affected.  
Although people can have osteoarthritis at any age the condition most often occurs after around 50 years of age and affects more women than men. Obesity is a risk factor, as is overuse (such as sports), injury, and there is a genetic association.8,9 
Weight loss is recommended for people with knee and/hip osteoarthritis who are overweight, and muscle-strengthening exercise as well as exercise for general aerobic fitness is beneficial. Some people may find applying hot or cold packs to joints relieves pain. Devices such as a walking stick or splints, along with implements such as tap turners may be needed.10   
Key to management is a holistic approach, which takes account of person's function, quality of life, occupation, mood, relationships and leisure activities, with an individualised approach to providing information about the condition and recommendations about exercise.11 
Initial symptomatic treatment includes regular analgesics or topical pain relief with non-steroidal anti-inflammatory drugs. Rubefacients are not recommended.  
Recent evidence suggests that paracetamol may not be as effective as previously thought for osteoarthritis. NICE says it will review the evidence on the pharmacological management of osteoarthritis after the MHRA has finished its examination of the safety of OTC analgesics.11 
Nutritional supplements may be beneficial. An analysis of 69 randomised controlled trials found evidence (albeit of low quality) that some of the 20 oral dietary supplements tested had a moderate clinically meaningful short-term effect on pain and function among patients with hand, hip or knee osteoarthritis. 
Green-lipped mussel extract and undenatured type II collagen demonstrated clinically important effects for pain reduction among eight supplements investigated in the medium term. Pycnogenol, passion fruit peel extract, Curcuma longa extract, L-carnitine, Boswellia serrata extract, curcumin and MSM had large and clinically important effects on physical function in the short term.13  
NICE says glucosamine and chondroitin should not be offered.14  
Ongoing trials are looking into compounds that target a number of the biological processes thought to be implicated in the development of the disease. These may, for example, prevent cartilage degradation or promote cartilage matrix regeneration; reduce bone turnover or inhibit bone degradation. They also include biologics to address inflammation, and compounds targeting pain pathways.15 

Mental health 
Although men and women are equally affected by mental health issues, some mental health problems are more prevalent in women than men. Traditional societal roles and status can put women at greater risk of mental health problems.  
For example, women are generally more often their children’s main carer, as well as caring for dependent relatives, which may impact emotional health. More women than men work in low income and low status jobs and live in poverty. Women and girls who have been physically or sexually abused may have long-term mental health problems.16  
Around a quarter of women, compared with 10 per cent of men, need treatment for depression during their lives, while around 8–15 per cent of women are thought to have postnatal depression.  
The incidence of mental health problems is higher among older people, especially among those aged over 85 years and people living in care homes – again it is mainly women who are affected.16  
Other mental health problems that affect women more than men include self-harm; eating disorders; anxiety – women are twice as likely as men to be affected, and two-thirds of people with dementia are women.16  
Self-help techniques such as online cognitive behavioural therapy (CBT) and physical activity are recommended as initial treatment for mild depression.17 Counselling, CBT and relaxation techniques can help with anxiety disorder.18  



2. www.nice.org.uk/guidance/PH11/chapter/4-Recommendations#folic-acid-2

3. www.nutrition.org.uk/healthyliving/lifestages/women.html?limit=1&start=5

4. www.nutrition.org.uk/healthyliving/lifestages/women.html?showall=1

5. www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/osteoporosis

6. https://cks.nice.org.uk/topics/osteoporosis-prevention-of-fragility-fractures/background-information/prevalence

7. https://cks.nice.org.uk/topics/osteoporosis-prevention-of-fragility-fractures/management/management

8. www.versusarthritis.org/about-arthritis/conditions/osteoarthritis

9. www.arthritis.org/diseases/osteoarthritis

10. https://cks.nice.org.uk/topics/osteoarthritis/management/management

11. www.nice.org.uk/guidance/cg177

12. www.nhs.uk/conditions/osteoarthritis/treatment

13. Liu X, Machado GC, Eyles JP. Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. Br J Sports Med 2018;52:167–75.

14. www.nice.org.uk/guidance/cg177/chapter/1-Recommendations#education-and-self-management-2

15. www.ncbi.nlm.nih.gov/pmc/articles/PMC7199286

16. www.mentalhealth.org.uk/a-to-z/w/women-and-mental-health

17. https://patient.info/doctor/depression-pro

18. https://cks.nice.org.uk/topics/generalized-anxiety-disorder/management/management




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