Women with hepatitis B and/or C come from all social, educational, cultural, religious and economic backgrounds. The emotional and physical effects of hepatitis vary greatly from one woman to another and can be different to men. Some women may feel forgetful or vague; others may feel tired and depressed or short-tempered. Lifestyle choices are important in managing the effects of hepatitis.
Sex and hepatitis B
As hepatitis B is sexually transmitted it is important that safer sex practices (condoms, water-based lubricant, dams and/or gloves) be used until such time as a woman’s sexual partner is successfully vaccinated against hepatitis B.
There is no evidence to indicate that women with hepatitis B may experience a decreased sex drive. However, tiredness and depression may mean that there is little energy for sex. It is important to have open and honest communication between partners which may assist in increased understanding of individual needs. Reports indicate that hepatitis B treatment may reduce a person’s sex drive which could be as a result of the treatment side effects or hepatitis B related fatigue.
Some women living with hepatitis B may find it difficult to tolerate the oral contraceptive pill if the liver’s ability to break down substances in the pill is impaired. In addition, abnormal liver function may affect the way the body metabolises the contraceptive hormones which could result in reduced effectiveness of the pill. Women living with chronic hepatitis B should discuss their contraceptive options with a trusted and understanding doctor and take advice on oral and other forms of contraception available to them.
The risk of transmission from mother to baby is up to 90%. The baby should receive prophylactic treatment with hepatitis B immune globulin (HBIG) and hepatitis B vaccination should be started immediately after birth. This will reduce the risk of transmission down to less than 3%. Vaccination of the baby should be completed as advised by your doctor.
Women with hepatitis B should be made aware that this does not mean they can’t have a natural vaginal delivery. Hepatitis B is not, in itself, a medical condition requiring a caesarean delivery.
Studies have shown that breastfeeding does not increase the risk of hepatitis B transmission to the baby, especially if the baby has received the prophylactic treatment described above. Mothers with hepatitis B need to maintain good breast health while feeding their infant. Breast damage such as cracked nipples could create a possible risk of transmission as blood in the breast milk could enter through small tears or scratches in or around the baby’s mouth. If a mother has cracked nipples and wants to continue to breastfeed her baby it is recommended that she seeks specialist advice.
Most children living with chronic hepatitis B do not show any symptoms. Their liver function, growth and development are not usually affected; however, they may be at risk of long-term complications associated with hepatitis B. Monitoring of children with hepatitis B should be discussed with health care professionals.
All family members and close contacts should be vaccinated against hepatitis B. There is no need for children to be excluded from day-care or school and there is no need to advise staff of a child’s hepatitis B status.
Some women may experience menstrual irregularities, including shorter or missed periods. Changes in menstruation may occur for a number of reasons and should be discussed with a doctor as they may not be related to hepatitis B.
Hepatitis B virus is transmitted through sexual contact and through blood to blood contact. As menstrual fluids contain blood as well as other bodily fluids they are potentially a means of hepatitis B transmission. It is, therefore, sensible to take steps to reduce any risk of transmission through menstrual fluids. It is recommended that safer sex practices be followed during menstruation (condoms, dams, gloves and water-based lubricant), particularly if a sexual partner has any open cuts, wounds or abrasions.
The risk of hepatitis B transmission from used sanitary items will be reduced if the items are placed in leak-proof plastic bags in general rubbish or disposed of in hygienic disposal units. Hands should always be washed after handling blood-stained items. Clothing that is blood-stained should be soaked in cold tap water then washed in the usual manner in cold water.
Hepatitis B may aggravate the hormonal changes experienced by women as part of menopause. Additionally oral contraceptives and/or hormone replacement therapy (HRT) may not be well tolerated by some women with hepatitis B. It is recommended that any woman experiencing problems with menopause and/or HRT seek the advice of a trusted doctor.