Women’s Health Concerns

Interview with Dr Greta Manning

Health care problems for women vary by age. Abnormal Pap smears and cancer of the cervix is more common in younger women. Breast cancer is more common in middle-aged and older women. For these reasons health care recommendations are different for different age groups.

Women 18 to 39 years old:

Every year:

• breast exam
• Pap smear until you have had three normal ones and if you are still with the same sexual partner; then you can have one Pap smear every 3 years, unless you change partners or have an abnormal Pap smear
• dental exam.

Every 2 to 3 years:

• blood pressure check
• height and weight measurement
• physical exam, including a pelvic exam, to screen for cancers of the breast, thyroid, lymph nodes, ovaries, and skin.

Every 5 years: cholesterol check.

Women 40 to 65 years old:

Every year:

• physical exam, including a pelvic exam and rectal exam, to screen for cancers of the breast, skin, thyroid, ovaries, uterus, lymph nodes, and rectum; exam includes a Pap smear every 1 to 3 years, depending on your personal history
• dental exam
• mammogram if you are 40 years old or older (may start as early as age 35 if there is a strong family history). Between the ages of 40 and 49, your physician may opt for just a baseline mammogram, then one every two to three years. However, at age 50, it should be yearly.

Every 1 to 2 years:

• height and weight measurement
• blood pressure check
• stool sample checked for blood
• vision and glaucoma check.

Every 3 to 5 years:

• cholesterol check
• blood sugar check
• sigmoidoscopy or colonoscopy after age 50 to screen for colon cancer (may begin earlier if strong family history of colon cancer).

Women over 65 years old:

Every 6 months: dental exam.

Every year:

• weight measurement
• blood pressure check
• mammogram
• physical exam, including a pelvic exam, to screen for cancers of the skin, breast, thyroid, ovaries, uterus, lymph nodes, and rectum
• stool sample checked for blood.

Every 1 to 3 years:

• blood count
• cholesterol check
• blood sugar check
• hearing check
• vision and glaucoma check
• Pap smear (consider discontinuing if previous regular screenings have always produced normal results).

Every 5 years: consider a sigmoidoscopy or colonoscopy to screen for colon cancer.

Immunizations Needed

Every young woman needs to be protected against rubella (German measles). If you are not immunized and become infected with the measles virus during pregnancy, the baby could also become infected and develop severe deformities and disabilities. If you do not know if you are protected against German measles, you can check with a blood test, or you can be vaccinated if you are not pregnant.

You should also have the following vaccinations as an adult:

• vaccination against the flu every year, especially if you are over 65 years old or have significant heart or lung disease
• vaccination against tetanus at least every 10 years to protect against lockjaw
• vaccination against pneumococcal pneumonia at age 65 or if you have significant heart or lung disease

You should expect your health care provider to counsel you regularly on other ways to stay healthy. Some of these may include:

• Breast self-exams: Check your breasts every month.
• Substance use: Don't use tobacco. Avoid using alcohol and drugs while driving, swimming, boating, etc.
• Diet and exercise: Try to maintain your weight at a comfortable, healthy level. Limit fat and cholesterol. Include a lot of grains, fruits, and vegetables in your diet. Get regular physical activity or exercise.
• Injury prevention: Use lap and shoulder belts while driving. Use motorcycle and bicycle helmets. Try to prevent falls. Practice safe handling of firearms. Install smoke detectors. Set your hot water heater to less than 120 degrees F. Get CPR training.
• Dental health: Visit your dentist regularly. Floss and brush your teeth with fluoride toothpaste daily.
• Sexual behavior: Prevent sexually transmitted diseases by avoiding high-risk sexual behavior and by using condoms.
• Osteoporosis: You should make sure you are getting plenty of calcium and vitamin D in your diet. You should discuss this with your physician during your routine health check ups.
• Hormone use: During or after menopause, discuss this with your health care provider.

	High blood pressure?
	Hypertension has no symptoms. In fact, it is called the silent killer because it can cause damage to major organs such as the heart or kidneys before you are aware that your blood pressure is abnormally high. The best way to learn if your blood pressure is normal or high is to have it checked regularly by a health care professional such as your primary care physician. You will be given a diagnosis of hypertension if your blood pressure level is consistently over 140/90 mmHg.

	What you can do if you have high blood pressure?
	If you have high blood pressure or mild hypertension, your doctor will probably advise lifestyle modifications first to see if they help you lower your blood pressure. The usual recommendations are to stop smoking, exercise regularly, lose weight, cut back on salt intake, consume alcohol in moderation, if at all, and eat a low-fat diet that includes plenty of fruits and vegetables. Your doctor may prescribe medication if your condition is severe or if lifestyle changes do not sufficiently lower your blood pressure.
		Is hypertension inherited?
		Experts believe that at least some cases of hypertension are influenced by your genetic makeup. If one or more of your family members have had hypertension or conditions associated with it, such as stroke, heart disease, or kidney disease, your risk is higher than average. That does not mean that you will develop hypertension, but you should exercise caution by having your blood pressure checked regularly and making lifestyle changes that reduce your risk.

	Can hypertension be cured with drugs?
	Drugs can help you control your hypertension, but they cannot cure it. You may be able to cut back on the amount of drugs you take, or possibly even eliminate them after a time, if you make significant lifestyle changes that help maintain your blood pressure at a manageable level.

	Does my race, age, or gender influence whether I will develop hypertension?
	African-Americans and Mexican-Americans have higher rates of hypertension than non-Hispanic whites. Age is also a factor; hypertension typically begins to develop between 35 and 55. However, children can develop hypertension as well. Both men and women are at risk for hypertension. Men face a higher risk up to age 55, while women are more at risk after that age.
Questions about Cholesterol: What is Cholesterol? Cholesterol is a fatty substance in your body. Cholesterol can be both helpful and harmful to your body. On the good side, it helps build the hormones and nerve cells your body needs. But when you have too much cholesterol, the walls of your blood vessels can thicken. This can cause heart attacks and strokes. What about Measuring Cholesterol When you get your cholesterol checked, your health care provider will tell you how high your cholesterol is: If your total cholesterol is 199 mg/dL or below, that is healthy. 200 to 239 mg/dL, it is a little high. 240 mg/dL or above, it is too high. Your health care provider may also check the two main types of cholesterol in your blood. One type is HDL or "good" cholesterol. The other type is LDL or "bad" cholesterol. HDL helps prevent heart disease. It helps your body get rid of cholesterol. LDL leaves fat on the inside of the blood vessels. When you have too much LDL, you have a higher chance of heart disease. It's good to have high HDL and low LDL. Normal HDL levels in women are approximately 10 mg/dL higher than in men. If your HDL is 45 mg/dL or above (women); 35 mg/dL or above (men), that is healthy. 35 to 44 mg/dL (women); 21 to 34 mg/dL (men), it is a little too low. 35 mg/dL or below (women); 20 mg/dL or below (men) that is not healthy. If your LDL is: 130 mg/dL or below, that is healthy. 130 to 159 mg/dL, that is a little high. 160 mg/dL or above, that is not healthy. Current treatment guidelines recommend medication for most persons with LDL above 130 mg/dL. How can we keep our cholesterol low? Most of the time, you can help lower your cholesterol by eating right and getting the exercise you need. It's important to eat healthy foods to keep a healthy weight. Eat fruits, vegetables, beans, and whole grains every day. Eat less fat. Stay away from saturated fat, like that in butter and meat. Use oils like sunflower, safflower, canola, olive, or corn. Stay away from palm or coconut oil. Eat chicken, turkey, and fish instead of red meat. It also helps to: Check food labels for fat and cholesterol. Take the skin off before you eat chicken or turkey. Use egg whites instead of whole eggs. Drink skim milk instead of whole milk. Use low-fat yogurt or cottage cheese instead of sour cream. Follow your health care provider's advice for exercise. You may want to swim, jog, walk, or bicycle. You should exercise at least 20 minutes every other day. Any amount of exercise, however, is better than no exercise at all. Can high cholesterol be hereditary? High cholesterol may be a problem in your family. Know your family history. Talk about it with your health care provider. Remember, to take care of your cholesterol: Eat healthy. Exercise often. Check your cholesterol every year. Menopause

What is Menopause?

• Menopause is a natural part of aging. It refers to the time in a woman's life when her periods (menses) stop and she is no longer fertile.
  
• The age in which women experience menopause varies greatly. Most women reach menopause at around 51 years of age.

What causes us to go through menopause?  

• Menopause happens due to a sharp decrease of female hormones in the body. Scientists do not know what triggers the ovaries to stop working and hormone levels to change.
  
• Certain factors can influence the age at which menopause begins.

Symptoms  

• Symptoms of menopause can very widely from woman to woman. The most common symptoms associated with the transition into menopause include irregular periods, hot flashes, night sweats, and vaginal dryness.

Risk Factors  

• Falling estrogen levels also can have hidden effects, such as bone loss and cholesterol changes that increase heart disease risk [].
  
• Loss of the female sex hormone progesterone increases risk of abnormal thickening of the uterine lining (endometrial hyperplasia) and cancer in some women.

Diagnosis  

• A menopause diagnosis is made after a woman over the age of 45 has gone an entire year without having a menstrual period.

Prevention and Screening  

• Be sure to get enough calcium and vitamin D to prevent bone loss during and after menopause.
• Keeping blood pressure under control and cholesterol and blood sugar in check can help lower heart disease risk.
• Perimenopausal women who experience abnormal vaginal bleeding should undergo further evaluation to check for endometrial hyperplasia and cancer.

Drug Therapy  

• Your doctor is the best source of information on the drug treatment choices available to you.

Other Therapies  

• Low-dose oral contraceptives may be helpful for some perimenopausal women who experience excessive bleeding, such as menstrual periods that are coming too close together or very heavy periods.
• Hormone replacement therapy (HRT) may be used to treat particularly bothersome menopausal symptoms, or to treat or prevent certain diseases. It is important to discuss the risks and benefits of HRT with your clinician.
• New forms of estrogen-like hormones, called selective estrogen receptor modulators (SERMs), are being evaluated as a possible alternative to standard HRT.

Prognosis  

• Most women get used to the symptoms of menopause over time. However, women who feel that their quality of life would be significantly improved by relief of menopause symptoms may want to discuss the risks and benefits of short-term hormone therapy with their clinician.

Follow-up  

• Postmenopausal women should have yearly gynecological exams (pelvic and breast exams) and tests that are appropriate for their age and risk factor profile.

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