A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Many women notice changes in their breasts, such as localised tenderness, an itchy nipple or a slight pulling of the skin. These changes are often caused by benign conditions, including hormonal changes, irritation or infection.

Breast cancer does not always present as a painless lump, however. It can sometimes appear in less typical ways, and recognising persistent or unexplained changes can help people seek timely assessment.

India’s breast cancer burden

GLOBOCAN 2022 estimates recorded 192,020 new breast cancer cases and 98,337 deaths in India in 2022. These estimates placed India third globally for the number of new cases and first for the absolute number of deaths. These are estimates for 2022, not current annual counts.

Changes in skin, shape and nipple

A tumour can involve the breast’s supporting fibrous structures and surrounding tissues, causing skin tethering, dimpling or a new change in breast shape or symmetry. Any new, unexplained change deserves clinical assessment.

Changes in the nipple also deserve attention. A nipple that newly flattens, turns inward or deviates to one side should be assessed. Spontaneous discharge from one nipple—particularly bloody or clear discharge—can be a warning sign, although it is not always caused by cancer. Persistent itching, burning, flaking or eczema-like crusting of the nipple may be associated with Paget’s disease of the breast, a rare malignancy involving the nipple–areola complex that is often associated with an underlying breast carcinoma.

Unexplained swelling or persistent lumps in the armpit or above the collarbone can sometimes be an early sign of breast cancer. These findings also have non-cancerous causes and need assessment rather than self-diagnosis.

Also read: Why Peak Incidence For Breast Cancer In India Occurs Between Ages 40–50, Compared To 60–70 In The US & Europe

Pain, redness and swelling

Breast cancer can be painful, even though pain alone is not a reliable way to tell whether a change is cancerous. A painful lump should not be ignored, and a painless lump should not be assumed to be harmless.

Inflammatory breast cancer can be particularly difficult to recognise. It may cause rapid breast enlargement, heaviness, redness, warmth and swelling, sometimes without a distinct lump. The skin may develop a pitted appearance resembling orange peel. Because these symptoms can resemble mastitis or other skin conditions, infection may initially be suspected. However, persistent or worsening redness and swelling, especially when symptoms do not improve as expected with treatment, require prompt reassessment and investigation for an underlying malignancy.

How the diagnosis is confirmed

Any persistent or suspicious breast change warrants clinical assessment. Depending on the person’s age and symptoms, evaluation may include diagnostic mammography and targeted ultrasound. Further imaging or biopsy may be needed when indicated. A suspicious finding should not be dismissed solely because initial imaging is reassuring.

Persistent or suspicious nipple and skin changes require timely specialist assessment. If Paget’s disease or another malignancy is suspected, biopsy may be necessary without a trial of topical treatment. Suspected inflammatory breast cancer requires prompt imaging and tissue diagnosis; a skin punch biopsy may also be indicated.

Also read: Breast Cancer in Young Women: What You Should Know

Common causes of delay

People may delay seeking help because they expect a symptom to become painful, hope it will go away, or assume that redness or itching is due to irritation. Breast symptoms other than a lump can also be associated with longer diagnostic journeys. The length of delay varies between individuals and healthcare settings, so precise comparisons should be interpreted in the context of the study and the interval it measures.

Repeatedly treating persistent skin redness or nipple crusting with antibiotics, moisturisers or steroid ointments without reassessment can delay appropriate investigation. Treatment may be reasonable when infection or a skin condition is suspected, but symptoms that persist, recur or worsen need further evaluation.

When to seek medical advice

A new breast lump, unexplained skin dimpling, new nipple inversion, spontaneous bloody discharge, or persistent redness and swelling warrants prompt medical assessment. Unexplained fullness or swelling in the armpit or above the collarbone should also be checked. Most breast changes are benign, but symptoms should not be ignored or self-treated indefinitely. A healthcare professional can decide whether imaging, biopsy or other investigations are needed.

Early assessment can improve the chance of diagnosing breast cancer at a treatable stage. In general, breast cancer diagnosed while localised has a better prognosis than disease that has spread to distant parts of the body, although outcomes also depend on tumour biology, treatment, and other clinical factors.

By Dr. Arun Kumar Sharma, Consultant, Surgical Oncology, Fortis Hospital Jalandhar

Fertility health is influenced by metabolic health, but body weight or waist size alone cannot show the complete picture.

When people think about metabolic health, weight and waist size are often the first things that come to mind. However, these numbers do not always tell the full story.

A person can have a normal body weight and still have problems such as insulin resistance, high blood sugar, abnormal cholesterol or high blood pressure. These factors can influence hormonal and reproductive health and may affect fertility in some people.

Understanding metabolic health is therefore important not only for preventing diabetes and heart disease, but also as part of overall reproductive health.

Why Metabolic Health Matters For Fertility?

The body's metabolism and reproductive system are closely connected. Problems with blood sugar regulation and insulin sensitivity can affect hormone function and, in some women, may contribute to irregular ovulation or menstrual cycles. Metabolic health can also be relevant to male fertility.

Obesity, diabetes and poor metabolic health may be associated with changes in sperm quality and reproductive function. This means fertility care should consider the health of both partners rather than focusing only on reproductive organs.

Also read: Egg Freezing Is Rising, But Are We Freezing Fertility or Buying Time?

Your Waistline Does Not Tell The Whole Story

Waist circumference and body mass index (BMI) can provide useful information, but they are only part of a health assessment.

Two people with the same weight or waist measurement can have very different blood sugar, cholesterol, blood pressure and fitness levels. Someone who appears slim can still have insulin resistance or other metabolic concerns. This is why health should not be judged only by appearance or a weighing scale.

What Should You Monitor?

Depending on individual risk factors, doctors may recommend checking blood pressure, blood sugar, cholesterol and other metabolic markers. Family history, age, physical activity, diet and existing medical conditions can also influence risk.

Women with irregular periods or difficulty with ovulation may benefit from discussing metabolic health with their doctor. Men with fertility concerns should also consider their overall health and lifestyle.

How Can You Support Metabolic and Fertility Health?

A balanced diet, regular physical activity, adequate sleep and stress management can support both metabolic and reproductive health. Meals should include vegetables, fruits, whole grains, protein sources and healthy fats.

Regular exercise does not have to mean intense workouts. Walking, strength training, cycling or other activities that can be maintained consistently can be beneficial.

Tips for better metabolic health:

• Do not judge health only by weight or waist size.

• Get blood sugar, blood pressure and cholesterol checked when advised.

• Eat a balanced, nutrient-rich diet.

• Stay physically active.

• Get adequate and regular sleep.

• Avoid smoking and tobacco.

• Manage stress.

• Discuss irregular periods or fertility concerns with a doctor.

The connection between metabolic and reproductive health is often overlooked. A healthy-looking waistline does not always mean that metabolism is healthy.

Looking at blood sugar, blood pressure, cholesterol, lifestyle and other individual factors provides a more complete picture. Taking care of metabolic health can therefore be an important part of taking care of fertility health too.

Turning 40 is an is an important milestone in a woman’s life. Careers are often in full swing, family responsibilities are complex, and the invisible load of emotional caregiving peaks. Amidst these demands, health often takes a back seat.

Many women rely on a cursory annual check-up or only seek medical advice when an undeniable symptom forces their hand. But staying healthy after 40 requires more than reacting to illness. At 25, your body forgives you. At 55, it punishes you. But between 40 and 50, it negotiates. This is the critical window to adopt a proactive, personalized approach that secures your physical independence and cognitive sharpness for the next four decades.

Perimenopause Affects The Hormones, Bones, and the Heart

As women navigate their 40s, they enter perimenopause-the transitional phase leading to menopause. This isn't just about hot flashes and irregular periods; it is a profound biological shift. Before menopause, estrogen acts as a physiological shield. It maintains vascular elasticity, improves glucose metabolism, suppresses inflammation, and preserves bone density by keeping the cells that break down bone in check.

However, when estrogen levels plummet during menopause, this shield drops. The consequences are systemic. The cardiovascular risk gap between men and women narrows rapidly, and heart disease risk skyrockets. Without estrogen’s protective effect, women also face an accelerated loss of bone density, vastly increasing the lifetime risk of osteoporosis and fractures.

Furthermore, this hormonal shift accelerates sarcopenia-the loss of muscle mass and quality. Women often experience a sharp decline in lower body strength during their late 40s, which is pure biology, not laziness. Recognizing these changes early is crucial because the years leading up to perimenopause are the optimal time to build cardiovascular and metabolic resilience.

Also read: Breast Cancer At 26 Sent This US Woman Into Menopause Before 30: What Is The Hidden Toll Of Treatment

Prevention: A Structured 40s Dashboard

Preventive care should not be a blind fishing expedition; it should be a targeted dashboard. A standard master health checkup often misses the most critical markers. Women in their 40s must advocate for specific, scientifically recommended screens.

Fasting sugar isn't enough. Ask for Fasting Insulin to catch insulin resistance years before diabetes develops. Track your ApoB (the most accurate marker for plaque-causing cholesterol) and Hs-CRP (a marker for chronic inflammation). Thyroid disorders are 5-10 times more common in women, especially post-pregnancy.

Request a full panel (TSH, Free T3, Free T4) rather than just TSH. Bone Density (DEXA Scan) check is a must to establish a baseline in your 40s. The goal is to catch osteopenia early, while it is still entirely reversible through targeted nutrition and resistance training. Cancer Screening is crucial.

Annual or bi-annual mammograms starting at 40 are essential. Because Indian women often have dense breast tissue, a targeted breast ultrasound may also be necessary. Co-testing with a Pap smear and HPV DNA test every 3-5 years remains the gold standard for cervical cancer prevention.

Everyday Habits Make A Lasting Difference

You cannot out-supplement a sedentary lifestyle. A personalized health plan must be anchored by non-negotiable daily habits. Walking is great for cardiovascular baseline health, but it does nothing to preserve muscle or bone density. Strength training twice a week is the fountain of youth.

Lifting weights forces the body to build bone mass and creates a "glucose sink" that regulates blood sugar and combats the metabolic slowdown of perimenopause. A balanced meal rich in protein and vegetables is a must. The average Indian diet is dangerously deficient in protein. Ensure you are getting 30 grams of high-quality protein at every major meal.

Adopt the "fiber-first" sequencing rule: eat your vegetables/salad first, protein second, and carbohydrates last to drastically blunt post-meal blood sugar spikes. Prioritize sleep with reverence. Deep sleep is the only time your brain flushes out neurotoxins. Protect this phase by enforcing a "digital sunset" 45 minutes before bed and finishing your last meal three hours before sleeping to keep your core body temperature cool.

Also read: World Menopause Day 2026: Perimenopause Can Begin In Your Late 30s. What Changes Should You Watch For?

Mental Wellbeing Deserves Equal Attention

Women routinely balance professional commitments and caregiving, leaving little room for their own emotional needs. The chronic stress of this "invisible load" elevates cortisol, which actively drives abdominal weight gain, sleep disruption, and systemic inflammation.

You cannot eliminate stress, but you can change how your nervous system responds to it. Build small pockets of autonomy into your day-whether it is 10 minutes of box breathing (inhale 4, hold 4, exhale 4, hold 4) before a meeting, or simply a 15-minute walk without your phone.

We are the most digitally connected generation in history, yet modern urban women are increasingly lonely. Social isolation shifts the brain into a hyper-vigilant survival mode, carrying a mortality risk equivalent to smoking 15 cigarettes a day. The antidote is deep, meaningful connection. Maintain your "Third Place" outside of work and home- this could be a library or a badminton court, and please prioritize rituals with friends that don't revolve around digital screens.

Make Your Health Plan A Yearly Conversation

To ensure these screenings and habits don't fall by the wayside, implement the "Birthday Protocol." Schedule your comprehensive health screening during your birthday month every year. Rather than simply asking if your reports are "normal," use the data to have a purposeful conversation with your physician.

Ask three questions: What are my top three health risks based on this data? What specific lifestyle adjustments should I make over the next 12 months? What markers are we monitoring next year? Good health after 40 is not about attempting a flawless, restrictive lifestyle overhaul overnight. It is about the consistency of small, science-backed habits. Start with one or two achievable changes this month, whether that means adding a strength-training session, scheduling a pending screening or establishing an earlier bedtime.

Build on those habits gradually and review your progress with your healthcare professional. The goal of good health after 40 is not simply to prevent illness or add more years to life. It is to preserve strength, independence and the freedom to live those years well. An annual check-up is the perfect starting point to a thoughtful, personalised strategy that can eventually help women stay healthy, strong, active, cognitively sharp and in total control of their entire wellbeing in all the years that lie ahead.

By Dr. Navin Gnanasekaran, MD, Longevity Physician, Head of Radiology - Apollo Hospitals Chennai, Co-founder -LIVF Women & Author of The 100 Year Blueprint