Transcript Women`s Health

Women’s Health
Bryan E. Mosora D.O.
Intern/IM Resident
Women in your Practice
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Special considerations with regards to health
maintenance and prevention
Important to understand cultural issues
Women are not the same as a men!!!
Women in your Practice
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Typically more involved with there healthcare
then men. This equals more opportunity to
play a preventative role
Usually will be armed with information from
various sources, i.e. magazines, internet,
television.
Important role of the physician is to help her
sort through the garbage and address
meaningful issues
Issues
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Breast cancer
Ovarian Cancer
Cervical Cancer
Uterine cancer
Menopause/HRT
Heart Disease
Diabetes
Depression
Statistics
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213,000 cases of breast cancer per year with
41,000 deaths.
9,700 cases of cervical cancer per year with
3,700 deaths
41,200 cases of uterine cancer per year with
7,350 deaths
20,200 cases of ovarian cancer per year with
15,310
Breast Cancer
Breast Cancer
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The most common cancer in women, no matter
your race or ethnicity.
The most common cause of death from cancer
among Hispanic women.
The second most common cause of death from
cancer among white, black, Asian/Pacific
Islander, and American Indian/Alaska Native
women.
Risk Factors
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Research has shown that the following
conditions increase a woman's chances of
getting breast cancer:
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Personal history of breast cancer.
Family history..
Certain breast changes.
Genetic alterations.
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5% to 10% of all breast cancer.
Warning Signs
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New lump in the breast or underarm (armpit).
Thickening or swelling of part of the breast.
Irritation or dimpling of breast skin.
Redness or flaky skin in the nipple area or the breast.
Pulling in of the nipple or pain in the nipple area.
Nipple discharge other than breast milk, including
blood.
Any change in the size or the shape of the breast.
Pain in any area of the breast.
Detection
Signs of Breast Cancer
Detection
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Regular self breast exam is nearly as good as
mammography in terms of the size of the
lesion that can be detected.
Second only to regular breast exam by a
skilled physician
The Breast Exam
The Breast Exam
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Women should undergo breast examination by
a clinician as part of their normal health
maintenance program.
This should be done every two to three years
from age 20 to 40, and annually after the age
of 40.
Breast cancer
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Over 50 years: All women over the age of 50
years should have annual mammography
examinations.
40-50: The National Cancer Institute
recommends that these women get a
mammogram every 1-2 years.
Under 40 years: Most women under the age
of 40 years do not need annual mammograms
Prognosis
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STAGE 0. In Situ ("in place") disease in which the cancerous cells are
in their original location within normal breast tissue. STAGE I. Tumor
less than 2 cm in diameter with no spread beyond the breast
STAGE IIA. Tumor 2 to 5 cm in size without spread to axillary
(armpit) lymph nodes
STAGE IIB. Tumor greater than 5 cm in size without spread to axillary
lymph nodes
STAGE IIIA. Tumor smaller than 5 cm in size with spread to axillary
lymph nodes which are attached to each other or to other structures,
STAGE IIIB. The tumor has penetrated outside the breast to the skin
of the breast or of the chest wall or has spread to lymph nodes inside
the chest wall along the sternum
STAGE IV. A tumor of any size with spread beyond the region of the
breast and chest wall, such as to liver, bone, or lungs
Prognosis
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The clinical stage of breast cancer is the best indicator
for prognosis (probable outcome).
Five-year survival rates for individuals with breast
cancer who receive appropriate treatment are
approximately:
95% for stage 0
88% for stage I
66% for stage II
36% for stage III
7% for stage IV
Ovarian Cancer
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Ovarian cancer is the fifth leading cause of
cancer death in women
The leading cause of death from gynecological
malignancies.
The second most commonly diagnosed
gynecologic malignancy
Ovarian Cancer
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The risk for developing ovarian cancer appears
to be affected by several factors:
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Early age of first pregnancy
Multiparity
Later age of final pregnancy
Tubal Ligation
Symptoms
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digestive symptoms, bloating, distention or cramping
abdominal or low-back discomfort
pelvic pressure or frequent urination
unexplained changes in bowel habits
nausea or vomiting
pain or swelling in the abdomen
loss of appetite (anorexia)
unexplained weight gain or loss
pain during intercourse
vaginal bleeding in post-menopausal women
Diagnosis
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a complete medical history to assess all the
risk factors
a thorough bi-manual pelvic examination
CA-125 assay
one or more various imaging procedures
a lower GI series, or barium enema
diagnostic laparoscopy
Prognosis
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Stage I: Cancer is confined to one or both ovaries.
Stage II: Cancer is found in one or both ovaries
and/or has spread to the uterus, fallopian tubes, and/or
other body parts within the pelvic cavity.
Stage III: Cancer is found in one or both ovaries and
has spread to lymph nodes or other body parts within
the cavity
Stage IV: Cancer is found in one or both ovaries and
has spread to other organs such as the liver or lung.
Prognosis
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Stage I cancer 95% survival rate at 5 years
post diagnosis
Stages III and IV may have a survival rate of
17-30% at five years post-diagnosis.
Cervical Cancer
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Worldwide, it is the second-most common
cancer of women.
Human papilloma virus (HPV) infection is
responsible for >90% of the cases of cervical
cancer
An effective vaccine for the two most common
strains of HPV has recently been licensed
Genital warts (HPV)
Normal Cervix
Cervical Cancer
Diagnosis
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The early stages of cervical cancer may be
completely asymptomatic
Vaginal bleeding, contact bleeding or (rarely) a
vaginal mass may indicate the presence of
malignancy
In advanced disease, metastases may be
present in the abdomen, lungs, or elsewhere.
Diagnosis
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Diagnosis is made by doing a biopsy of the
cervix.
Often involves colposcopy, or a magnified
visual inspection of the cervix aided by using
an acetic acid (e.g. vinegar) solution to
highlight abnormal cells on the surface of the
cervix.
A Pap smear is insufficient for the diagnosis.
Colposcopy
Treatment
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Prevention may be the best treatment
Merck has developed a vaccine against four
strains of HPV, called Gardasil.
Targeted at girls and women of age 9 to 26.
Vaccine only works if given before infection
occurs.
They are targeting girls before they begin
having sex.
Uterine Cancer
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Uterine cancer is the most common cancer of
the female reproductive system
There are two different types of uterine cancer:
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endometrial cancer
uterine sarcoma (less common)
Endometrial Cancer
Risk Factors
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Obesity
Use of Tamoxifen
Use of unopposed estrogen
Hypertension (high blood pressure)
Polycystic ovarian syndrome and/or skipping menstrual
periods for months at a time
Family history of endometrial, ovarian or colon cancer
Never having had children
Menopause at a late age
Endometrial hyperplasia (excessive build up of the uterine
lining)
Diabetes
Signs and Symptoms
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Bleeding after menopause (experienced by
over 90% of endometrial cancer patients)
Change in bowel or bladder habits and/or pain
during intercourse
A thickened endometrial lining (which can be
seen on an ultrasound of the uterus)
Prognosis
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The American Cancer Society estimates that 41,200
women will be diagnosed with uterine cancer in
2006, and of those 7,350 will die.
A woman’s chance of developing this cancer through
out her life time is about 1 in 38.
This cancer is 40% more prominently found in white
women.
On average the five-year survival rate is at 84%, and
this percentage increases if the cancer is detected in
early stages.
Menopause/HRT
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Menopause occurs as the ovaries stop
producing estrogen, causing the reproductive
system to gradually shut down.
Technically, menopause refers to the cessation
of menses
The average onset of menopause is 50.5 years
Menopause
Sign and Symptoms
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The clinical features of menopause are caused
by the lessening in the amount of estrogen in
the woman's body.
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hot flashes, hot flushes, including night sweats
sleep disturbances
Sign and Symptoms
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Urogenital atrophy
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dyspareunia
itching
dryness
bleeding
urinary frequency
urinary urgency
urinary incontinence
Sign and Symptoms
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Skeletal
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osteoporosis
joint, muscle pain
back pain
Skin, soft tissue
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breast atrophy
skin thinning
decreased elasticity
Sign and Symptoms
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Psychological
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mood disturbance
irritability
fatigue
decreased libido
memory loss
Treatment Options
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While menopause is a natural stage of life, some
symptoms may be alleviated through medical
treatments.
Most notably, Hormone Replacement Therapy (HRT),
has been used to reduce osteoporosis.
A large, randomized, controlled trial (the Women's
Health Initiative) found that women undergoing HRT
had an increased risk of:
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Alzheimer's disease
Breast cancer
Heart disease
Stroke
Heart Disease
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Heart disease isn't just a man's disease.
Heart attack, stroke and other cardiovascular
diseases are devastating to women, too.
Coronary heart disease, is the leading cause of
death for American women.
Nearly twice as many women in the United
States die of heart disease and stroke as from
all forms of cancer, including breast cancer.
Heart Disease
Heart Disease
Heart Disease Risk Factors
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Increasing age — As women grow older, their risk of
heart disease and stroke begins to rise and keeps
rising with age.
Heredity (family history) — Both women and men
are more likely to develop heart disease or stroke if
their close blood relatives have had them.
Race is also a factor.
Black women have a greater risk of heart disease and
stroke than white women.
Previous heart attack
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Women who've had a heart attack are at higher risk of
having a second heart attack.
Risk Factors
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Tobacco smoke
High blood cholesterol
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Research has shown that low levels of HDL cholesterol
seem to be a stronger risk factor for women than for men.
High blood pressure
Physical inactivity
Obesity and overweight
Diabetes mellitus
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Compared to women without diabetes, women with
diabetes have from two to six times the risk of heart
disease and heart attack
Diabetes mellitus
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About 10 million American women have
diabetes
3 million of them don’t even know it
Diabetes increases a woman’s risk of
developing heart disease 3- to 7-fold,
compared with 2- to 3-fold in men
Women with diabetes are 2 to 5 times more
likely to die of heart disease than women
without diabetes
Diabetes
Diabetes in Pregnancy
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Nearly all pregnant women should be tested for
gestational diabetes during the 24th to 28th weeks of
pregnancy.
Gestational diabetes occurs in about 4% of
pregnancies
Causes macrosomia which can lead to:
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shoulder injuries during birth,
breathing problems,
higher risk of developing obesity and type 2 diabetes later
in life.
Diabetes in Pregnancy
Depression
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Women experience
depression twice as
often as men
Women with depression
more frequently
experience guilt,
anxiety, increased
appetite and sleep,
weight gain and
comorbid eating
disorders.
Risk Factors
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Family history of mood disorders
Personal past history of mood disorders Loss of a
parent before the age of 10 years
Childhood history of physical or sexual abuse
Use of an oral contraceptive, especially one with a
high progesterone content
Use of gonadotropin stimulants as part of infertility
treatment
Persistent psychosocial stressors (e.g., loss of job)
Loss of social support system or the threat of such a
loss
Diagnosis
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Psychological Symptoms
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Depressed mood
Reduction of interest and/or pleasure in activities,
including sex
Feelings of guilt, hopelessness and worthlessness
Suicidal thoughts (recurrent)
Diagnosis
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Physical Symptoms
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Sleep disturbance (insomnia or hypersomnia)
Appetite/weight changes
Attention/concentration difficulties
Decreased energy or unexplained fatigue
Psychomotor disturbances
Treatment Strategies
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Identify any relationship between depression
and menstruation, pregnancy, the perinatal
period or the perimenopausal period.
A possible relationship between depression
and medications such as birth control pills or
agents used in hormone replacement therapy
must also be explored.
If there is a link to any treatable cause of
depression, it should be addressed first.
Treatment Considerations
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Absorption of antidepressants may be enhanced in
women because they secrete less gastric acid than
men.
In addition, gastrointestinal transit time may be
slower in women, especially during high
progesterone phases of the reproductive cycle, thus
enhancing the absorption of antidepressant
medications.
Another difference is the higher ratio of body fat to
muscle in women;
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this ratio becomes even greater with age and increases the
volume of distribution for many drugs.
Treatment Considerations
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Because of these biologic differences,
antidepressant plasma concentrations may be
higher in women.
Thus, female patients with depression may
require lower dosages of antidepressants than
their male counterparts.
Also, women frequently experience sexual side
effects, they generally do not report these
effects unless specifically asked.
Summary
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Women have many issues that of course
require special attention.
Important not to forget about the similar
disease processes that could affect them as
equally as their male counterparts.
And finally……..My favorite woman!!!
We Are Outta Here!