Women’s Health Challenges in Colombia: Cardiovascular Disease, Postpartum Depression & Cervical Cancer

In Colombia, women’s health faces a number of significant challenges. According to Karen Dueñas, a cardiologist and specialist in women’s cardiovascular health at the Cardioinfantil Foundation (LaCardio), these include inequities in access to medical services, increasing rates of various diseases, delayed diagnoses, and a tendency to delay seeking medical attention due to prioritizing other responsibilities, such as childcare or household duties.

“We are seeing a vicious cycle,” Dueñas explains, noting that “we have a number of gaps that lead to delays in diagnosis and, in the treatment of diseases at any level, because women consult doctors less often and, when they do, their symptoms may be attributed to emotional states rather than an underlying illness.”

The World Heart Federation (WHF) highlights a similar trend globally with cardiovascular diseases, which the World Health Organization (WHO) identifies as the leading cause of death for women worldwide. “Some symptoms of heart disease in women may differ from those in men, leading to more frequent misdiagnosis or dismissal of symptoms as being related to anxiety,” the organization points out.

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A recent report, “Falling Birth Rate, Changes in Fecundity and the Main Causes of Mortality in Colombia in 2024,” published by the DANE (National Administrative Department of Statistics), shows that ischemic heart disease, diabetes mellitus, and chronic lower respiratory diseases were the leading causes of death for women. However, women often perceive the risks of different diseases differently. A survey conducted by the Colombian Society of Cardiology and Cardiovascular Surgery among 2,008 women found that women believe breast and cervical cancer are the main health problems affecting them.

“This result is remarkably striking,” Dueñas notes. “In Colombia, one in 30 women who have cancer dies, but one in three women dies from cardiovascular disease,” she adds. This perception of risk is important, as it may explain why some conditions do not receive the attention they require. It is crucial to be aware of warning signs of various psychological and physical illnesses that may affect women, to ensure timely and comprehensive healthcare, which, according to the Ministry of Health, “encompasses physical, mental, and social care, focusing on gender equity, reducing gaps, and addressing violence.”

Cardiovascular diseases, the leading cause of death in women

“I was very tired. I thought it was age, menopause, and even came to believe it was anemia. After going around in circles, I decided to see a general practitioner and was told I had severe heart failure,” recalls Natalia Tobón Franco, a 61-year-old lawyer. In Colombia, Dueñas, a candidate for a master’s degree in cardio-oncology, explains that cardiovascular diseases continue to be the leading cause of death in Colombian women, and women face a particular risk that often goes unnoticed: “they present with different and sometimes less obvious symptoms, which delays diagnosis and timely treatment.”

The World Heart Federation (WHF) indicates on its website that “the fact that women continue to be underrepresented in clinical trials is one of the reasons why patients and their doctors are not sufficiently aware of the symptoms and presentations of CVD specific to each sex.” An additional factor contributing to this situation, in Dueñas’s opinion, is that women often delay seeking medical attention, either because they lack the time, are dedicated to caregiving, or are busy with household chores, and ultimately minimize their symptoms.

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Dueñas, a member of the Colombian Society of Cardiology and Cardiovascular Surgery, assures that she has “known cases of patients who experience chest pain, say it’s a palpitation, and prefer not to come for a consultation,” she says, warning that “a lack of risk identification, ignoring symptoms, and delayed consultation” have resulted in 46 Colombian women dying each day from these preventable diseases.

The development of these diseases, details the Ministry of Health on its website, is mainly due to the presence of risk factors mostly related to people’s lifestyles, such as smoking, an unhealthy diet, physical inactivity, and excessive alcohol consumption. Other factors, such as obesity, high blood pressure, dyslipidemia, and high blood glucose levels, should also be considered. Importantly, Dueñas notes, it is essential to be attentive to symptoms, including extreme and unexplained fatigue, shortness of breath, pain in the neck, jaw, or back, nausea, dizziness, or cold sweats.

Dueñas adds, considering these risk factors, it is important to implement the Eight Essential Steps for Cardiovascular Health, which are divided into two main areas: behaviors (such as a healthy diet, exercise, quitting smoking, or getting enough sleep) and health factors (including weight control, cholesterol, blood sugar, and blood pressure). “It is essential to prevent and avoid late diagnoses,” she concludes.

Postpartum depression: 1 in 7 women are diagnosed with this condition

Not all motherhood stories begin with sublime events, unconditional love, or romanticizing the process. Some have a different beginning. As is the case with Silvia Cifuentes. In an interview with the Vos Podés podcast, she recounts that, after several attempts, in 2020, amid the health measures implemented due to COVID-19, she became pregnant. Alicia was born in France, but that day, far from being a good memory, opened the door to a diagnosis that, whereas common among women, is rarely discussed: postpartum depression.

Alina Uribe, a perinatal psychiatrist and professor at the Javeriana University, explains that postpartum depression defines emotional changes that occur after the arrival of the baby and can last up to a year after birth. In Silvia’s case, she began to perceive strange when she picked up Alicia for the first time and, she confesses, for a moment, she didn’t recognize her. It was like a feeling of “disconnection.” She thought it was a bout of sadness due to the situation her family was going through. Her mother-in-law was facing the final stage of an aggressive lung cancer, and her aunt, who was like a second mother, had just passed away.

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The confusion between postpartum sadness and postpartum depression, clarifies Gustavo Perdomo, a psychiatrist at the Santa Fe de Bogotá Foundation, is common. The key, he adds, lies in the symptoms, as those presented in postpartum depression are more intense and last longer. “They can interfere with your ability to care for your baby and perform other daily tasks,” he comments. Common symptoms include mood swings, anxiety, sadness, irritability, feeling overwhelmed, crying, difficulty concentrating, problems with appetite, or sleep disturbances. It is also important to remember that women who have previously suffered from this condition or who have been diagnosed with a mental illness are more prone to developing it.

According to an article led by Karen Carlson, of the University of Nebraska Medical Center and Nebraska Medicine, and compiled by the National Institutes of Health, perinatal depression, as it is also known, affects approximately 1 in 7 women during pregnancy or the first year after childbirth. However, they warn that “up to 50% of cases remain undiagnosed due to the stigma surrounding the condition and patients’ reluctance to reveal their symptoms.”

In Colombia, Uribe, founder and director of Mente Fértil, indicates that there is an increasing awareness among healthcare professionals of this condition; and in many hospitals, they are implementing a screening scale after childbirth to assess the risk of postpartum depression. The key, she adds, is to have early psychological support, monitoring from other specialties, and a support network that is organized. “Postpartum depression is treatable, and recovery is possible,” she assures, noting that “seeking help is an act of responsibility, of love; not of weakness.”

Cervical cancer, the leading cause of cancer death among women aged 30 to 59

In 2017, Nathalia Carvajal was diagnosed with cervical cancer, the leading cause of cancer death among women aged 30 to 59, according to the Ministry of Health. Initially, she explains in a video by the Caldas Section of the Cancer League, it was an endocervical tumor, commonly known as adenocarcinoma, a type of cancer that originates in the glandular cells of the inner canal of the cervix and represents between 20% and 25% of cervical cancers, according to the National Cancer Institute of the United States. She adds, “it is closely related to persistent infection with the human papillomavirus (HPV).”

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The first time it was established that HPV could be the cause of cervical cancer was in 1976, when German scientist Harald zur Hausen identified the first types of this virus and found that it was present in patients whose cervix had changed at the cellular level to develop cancer. Then, in the mid-1980s, Nubia Muñoz Calero, a Colombian physician and scientist, set out to corroborate this causal relationship.

Muñoz needed to gather more evidence to prove this relationship; from the International Agency for Research on Cancer (IARC), she led a study that consisted of following hundreds of women from different countries, including Colombia. The results showed that the human papillomavirus is indeed the main cause of this type of cancer. Since then, Colombia has set a clear goal: to eradicate this disease, which, according to the National Cancer Institute, has caused between 4,500 and 5,000 new cases and nearly 2,200 deaths annually in recent years. That is, five Colombian women die each day from this type of cancer.

To Gloria Inés Sánchez, PhD in Molecular Microbiology and Immunology, even as these figures are concerning, the country has implemented a series of strategies to prevent women from reaching a diagnosis of invasive cervical cancer. “Prevention is based on the fact that we can detect what are called precancerous stages,” she comments, explaining that, if these stages are detected, ablative treatments can be performed to completely eliminate the possibility of developing invasive cancer.

Also, she recalls, there is the vaccine against the human papillomavirus, which has been included in the Expanded Program on Immunization for girls between the ages of 9 and 17 since 2012. “The vaccine has nothing to do with fertility, it will not motivate the start of sexual activity in girls and boys,” Sánchez adds, a professor and coordinator of the Infection and Cancer group at the Faculty of Medicine of the University of Antioquia, and comments that vaccination has led some countries, such as “England, Sweden, or the Netherlands, to announce that they have eliminated cervical cancer in populations that were vaccinated 15 years ago.” Carvajal says that is her peace of mind: “I have a protected daughter and the security that she will not suffer from cancer and live in the same situation as her mother in the future.”

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