Guidelines for Womens Health in Every Decade

1
Guidelines for Womens Health in Every Decade

• Dr. Lan A. Bui
• Assistant Director of Obstetrics Gynecology
  Residency Program
• Oakwood Hospital and Medical Center

2
Leading Causes of Death for American Women

• Heart disease (356,000)
• Stroke (100,000)
• Lung cancer (68,000)
• Chronic Obstructive Pulmonary Disease (64,000)
• Breast Cancer (42,000)

3
Healthy Heart Goals For Women

• From The American Heart Association
• Total Cholesterol Less than 200 mg/dL
• LDL (bad) Cholesterol LDL cholesterol goals
  vary.
• For people who don't have heart disease and one
  or no risk factors, the goal is less than 160
  mg/dL.
• For most people with two or more risk factors,
  the goal is less than 130 mg/dL.
• For people who have heart disease, or diabetes,
  the goal is to keep the LDL below 100 mg/dL.
• HDL (good) Cholesterol 50 mg/dL or higher
• Triglycerides Less than 150 mg/dL
• Blood Pressure Less than 120/80mmHg
• Fasting Glucose Less than 100 mg/dL
• Body Mass Index (BMI) Less than 25 Kg/m²
• Waist circumference Less than 35 inches
• Exercise A minimum of 30 minutes most days, if
  not all days of the week.
• Eat a balanced diet emphasizing a variety of
  fruits, vegetables, grains, low-fat or non-fat
  dairy products, fish, legumes and sources of
  protein low in saturated fat (nuts, poultry and
  lean meats).
• Don't smoke if you smoke, stop.
• Schedule regular visits with your doctor.

4
Important at any age

• Exercise
• Smoking cessation
• Healthy diet
• Alcohol in moderation
• Stress reduction

5
Outline

• Health in our 20s
• Health in our 30s and 40s
• Health in our 50s
• Health at 60 years and beyond

6
Health in our 20s

• Exercise At ANY age!!!
• Blood pressure check every 1-2 years
• Immunizations
• Breast Exams (Self-Breast exams and Clinical
  Breast exams) Monthly/Annually
• Pap smears When do we start? How often?/When can
  we stop?
• STD testing
• Regular Dental exams/cleanings (every 6-12
  months)

7
DENTAL HEALTH AND CARDIAC DISEASE

• Individuals with periodontal disease are almost
  twice as likely to suffer from coronary artery
  disease than those without periodontal disease.
• Inflammation caused by periodontal disease
  increases plaque build up, which may contribute
  to swelling of the arteries of the heart.

8
DENTAL HEALTH AND CARDIAC DISEASE

• Researchers suggest periodontal disease may cause
  oral bacteria to enter the bloodstream and
  trigger the liver to make C-reactive proteins,
  which are a predictor for increased risk for
  cardiovascular disease.
• Additional studies have pointed to a relationship
  between periodontal disease and stroke
• "This data clearly stresses the importance of
  regular dental checkups to ensure a healthy,
  diseased-free mouth." (American Academy of
  Periodontology)

9
Health in our 30s and 40s

• Mammograms (beginning at age 40, earlier if
  family history of breast cancer)
• Diabetes screening Test every 3 years beginning
  at age 45, earlier screening if risk factors
• Family Hx of Diabetes
• Women who had gestational diabetes during
  pregnancy
• Women who have given birth to a baby over 9
  pounds
• High blood pressure
• Sedentary lifestyle
• Morbid obesity
• Cholesterol screening every 5 years
• Start at 45 if no risk factors
• Exercise

10
EXERCISE

• Inadequate physical activity has been recognized
  as an independent risk factor for premature
  development of coronary heart disease.
• It has been estimated that approximately 12 of
  all mortality in the US is related to the lack of
  regular physical activity
• Physical inactivity is associated with at least a
  twofold increase in the risk for coronary events

11
EXERCISE

• Potential Benefits of exercise
• Improved Lipid Profile decreased triglyceride,
  increased HDL (good cholesterol)
• Reduction of Blood Pressure can lower BP by as
  much as 5-15 mmHg
• Treatment and possible prevention of Type 2
  Diabetes
• Reduction in Inflammation C-reactive protein
  plays an important role in atherosclerosis/CHD

12
EXERCISE

• Appropriate physical activity consists of 30-60
  minutes of exercise four to six times per week.
• End points indicating an adequate degree of
  exercise include
• Breathlessness
• Fatigue
• Sweating
• Achievement of goal heart rate is not necessary

13
EXERCISE

• The Health Professionals Follow up Study
  evaluated how the type of physical activity
  correlated with reduction in CHD risk
• Running for one hour or more per week RR 0.58
• Lifting weights for 30 min or more per week RR
  0.77
• Rowing for one hour or more per week RR 0.82
• Brisk walking for 30 minutes or more per day RR
  0.82

14
Health in our 50s

• Colorectal Cancer screening colonoscopy every 10
  years, or sigmoidoscopy every 5 years, or yearly
  stool blood testing.
• Start earlier if family history of colon cancer
• Hearing Test every 3 years beginning at age 50
  per the American Speech-Language-Hearing
  Association
• Hormone Replacement

15
HORMONE REPLACEMENT AND CARDIOVASCULAR RISK

• Initially, HRT was thought to be
  cardio-protective, but the results of the WHI
  (Womens Health Initiative) study told us
  otherwise
• For the combination Estrogen/Progesterone arm of
  study
• Rate of CHD (AMI or death due to CHD) increased
  by 24 (39 vs 33 events per 10,000 person years).
• There was an increase in risk for stroke and
  venous thromboembolism

16
HRT

• Other findings
• Risk of breast cancer was increased
• Risk of fracture was decreased
• Risk of colon cancer was decreased

17
HRT

• The unopposed Estrogen arm showed
• an increase risk of stroke and venous
  thromboembolic events, but did not show an
  increased incidence of CHD over an average
  follow-up of 6.8 years
• Reduction of fracture risk
• No effect on breast cancer
• No effect on colon cancer

18
HRT

• Current recommendations based upon WHI trial
• Estrogen/Progesterone therapy should not be
  prescribed for primary prevention of CHD.
• Estrogen/Progesterone therapy should be
  discontinued if an acute CHD event occurs, and
  should not be resumed as a secondary prevention
  strategy.
• Unopposed estrogen should not be prescribed for
  primary prevention because no reduction in CHD
  risk was observed.
• Estrogen or Estrogen/Progesterone therapy should
  be reserved for women with moderate to severe
  menopausal symptoms. The lowest estrogen dose
  that relieves symptoms should be used for the
  shortest duration possible.

19
Health in our 60s and beyond

• Osteoporosis
• Maintaining mobility/Exercise

20
Health in our 60s and beyond

• Osteoporosis
• Bone mineral density testing Every 2-3 years,
  starting at age 65, or earlier if risk factors.
• Risk factors
• Personal or family Hx of fracture
• Asian, Caucasian, Hispanic background
• Smoking
• Alcoholism
• Glucocorticoid/steroid therapy for 3 months
• Estrogen deficiency at an early age (before 45yo)
• Certain medications and medical conditions

21
OSTEOPORISIS

• Approximately 13-18 of women over the age of 50
  have Osteoporosis, and the number increases with
  age.
• The presence of osteoporosis was associated with
  a four-fold increase in fracture rate according
  to the largest study of postmenopausal
  osteoporosis to date.

22
OSTEOPOROSIS

• Non-pharmacologic therapy
• Calcium postmenopausal 1200-1500mg/day
• Vitamin D 400-800 IU/day
• Exercise at least 30 minutes/3-4times per week
  of weight bearing exercise
• Stop smoking

23
OSTEOPOROSIS

• Drug therapy
• Selective Estrogen Receptor Modulator
• Bisphosphonate
• Estrogen (not recommended as first line)
• Calcitonin
• Monitoring response to therapy
• Repeat bone density testing in 2 years
• Newer urine tests to evaluate the response to
  therapy available.

24
In Conclusion

• Maintaining Health is a way of life
• Remember, Heart disease is Multifactorial
• Talk to your doctor, ask questions

25
HPV
26
HPV vaccine

• In June 2006, the Advisory Committee on
  Immunization Practices voted to recommend the
  first vaccine developed to prevent Cervical
  Cancer and other diseases in females caused by
  certain types of genital Human Papillomavirus
  (HPV).
• The vaccine protects against 4 HPV types, which
  together cause 70 of cervical cancers and 90 of
  genital warts

27
HPV Vaccine

• The vaccine is approved for females 9-26 years of
  age.
• Given through a series of 3 shots over a six
  month period.
• Retail price is 120 per dose
• Ideally, females should get the vaccine before
  they become sexually active
• Not recommended for pregnant women
• We do not know if the vaccine is effective in
  males
• Studies are on-going