It's the drawback of our times -- stress and tension seem to have become a permanent part of our day to day lives.

Women, though, seem to have more on their plate as they juggle their career and their home. Yet, there is the expectation that they will come out smelling of roses.

How do you, as a woman, cope? With the tension of managing a career and a home? Meeting expectations from bosses and from in-laws? Worrying about your children's education in today's competitive times?

Is all this taking its toll on your health? What can you do about it?

Part  I: Health problems affecting women

Alcoholism

~ What is it?

Alcoholism can be defined as a condition in which a person drinks to a point where the habit interferes with his or her daily routine.

"As drinking is no longer a social taboo for women, alcoholism among women is on the rise today, especially among the higher middle class and the affluent class," says Mukta Puntambekar, clinical psychologist and deputy director, Muktangan De-addiction Centre, Pune.

~ Causes

Women often cite stress or family problems as the reason for resorting to alcohol. The other reasons cited by women alcoholics include grief, loneliness, depression and boredom. Mukta adds that social factors like availability of alcohol, social acceptance of its use, peer pressure and stressful lifestyles, encourage alcoholism.

She says there is a rise in the number of women OPD patients at her centre, especially among the 20-30 age group. The main causes, she says, is the openness with which alcohol can be consumed today, the increasingly popular club culture, easy availability, etc.

~ Effects

"Alcohol affects women more quickly than men. Women become intoxicated after drinking smaller quantities of alcohol as compared to men," says Mukta.

The physical damage caused by alcoholism is similar in both sexes. Alcohol affects a woman's heart, liver, brain, kidneys, stomach, intestines, muscles, eyes and sexual organs as much as that of a man.

"However, a greater percentage of female alcoholics die from suicides and alcohol-related accidents. Alcoholic women are more likely to suffer from low self-esteem than their male counterparts," she says.

Dr Shilpa Joshi, a practising gynaecologist in Pune, adds that alcohol can also lead an increase in menstrual problems like painful menstruation, heavy flow, premenstrual discomfort, irregular or absent cycles and infertility in extreme cases.

~ Treatment

Dr Joshi says many alcoholics do not even realise when they turn to alcoholism. "Female alcoholics became dependent later than men, but have a more rapid development of dependence," she adds.

"Once the problem has been recognised, total abstinence from alcohol is the only effective treatment," says Mukta. One of the most important aspects of alcohol counselling and treatment is to find out which behaviour patterns lead to drinking.

"Women alcoholics find it difficult to cope with the treatment as they have little or no family support," she says.

Postpartum depression

~ What is it?

Depression after pregnancy is called postpartum depression; hormonal changes in a woman's body trigger symptoms of depression.

~ Causes

Experts believe the sudden and rapid hormonal changes in a pregnant woman/ new mother may lead to depression, just as smaller hormonal changes can affect a woman's mood before she gets her menstrual period.

"Some factors that contribute to postpartum depression include fatigue and interrupted sleep patterns. You may feel overwhelmed with having to deal with a new baby. You may doubt your ability to be a good mother. Sometimes, women think they have to be 'super mom' or perfect; this kind of expectation is not realistic and can add to a woman's stress level," says Dr Manisha Risbud, a Pune based gynaecologist.

The other causes of the depression include unhappiness over hers looks, a sense of loss about her past life that was carefree and, possibly, career-oriented.

~ How to deal with it

Taking adequate rest. Eat nutritious food. Exercise moderately. This will help you stay fit and fight depression. It is also important for the new mother to receive her family's full support and the attention of her spouse. If the depression lasts for more than a month, psychiatrist treatment and anti-depressant drugs may be required.

"Adequate rest has a major impact on her emotional and physical well-being. Babies need well-rested parents to care for them," says Joshi.

In extreme cases, women could suffer from a severe form called 'postpartum psychosis'. In such cases, the patient needs to be hospitalised for treatment.

Infertility

Dr Risbud explains that there are rising cases of infertility amongst women. "Procreation, one of the most natural instincts, is challenged today by lifestyle, aspirations and work pressures," she says.

~ What is it?

Infertility is defined as the inability to conceive after at least one year of intercourse while not using any contraceptive method.

~ Causes

Lifestyle factors, including obesity, are the prime reason. A BMI (Body Mass Index) of over 30 is definitely a disadvantage in conception.

Smoking is more harmful than the statutory warning on packs.

Multiple cases of sexually transmitted diseases can block the (fallopian) tubes and prevent conception.

"Stress affects the sensitive balance of female neuro hormones. And leads to anovulation, ie, ovulation does not happen," says Dr Risbud.

Some of the medical causes of infertility are thyroid, diabetes and hypertension.

~ Treatment

There is no generic treatment; infertility management will depend on the cause of infertility. In case the problem stems from a lack of ovulation, drugs need to be given to induce ovulation or correct it.

If the fallopian tube is blocked, it may need to be surgically cleared through laparoscopy or open microsurgery. If the problem lies in the cervix, this can be overcome with procedures such as intrauterine insemination (in which the semen is injected into the uterine cavity) or procedures such as IVF (In Vitro Fertilisation) or GIFT (Gamete Intra-Fallopian Transfer).

Part  I: Health problems affecting women