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CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI.

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Presentation on theme: "CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI."— Presentation transcript:

1 CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI Chairperson public Awareness committee IMS Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI Chairperson public Awareness committee IMS 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 1

2 Changes in menstrual periods Periods are heavier or lighter than usual More / less frequent More / less frequent Irregular Irregular Regular and then suddenly stops Regular and then suddenly stops Periods are heavier or lighter than usual More / less frequent More / less frequent Irregular Irregular Regular and then suddenly stops Regular and then suddenly stops Medical opinion necessary if : Very heavy or irregular bleeding Very heavy or irregular bleeding Bleeding between periods Bleeding between periods Bleeding after sex Bleeding after sex Bleeding after 12 months of being free from periods Bleeding after 12 months of being free from periods Medical opinion necessary if : Very heavy or irregular bleeding Very heavy or irregular bleeding Bleeding between periods Bleeding between periods Bleeding after sex Bleeding after sex Bleeding after 12 months of being free from periods Bleeding after 12 months of being free from periods 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 2

3 Management – depending on cause Hormonal Therapy Conservative Therapy Hormonal Therapy Conservative Therapy Balloon Therapy LNG IUD Polypectomy Endometrial Ablation Contd.. 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 3

4 Management contd.. Surgery Myomectomy Hysterectomy with Bilateral Salpingo- oophorectomy Hysterectomy 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 4

5 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 5

6 Osteoporosis – the silent disease From 35 yrs onwards you lose bone mass at 0.5 to 1% per yr Around menopause loss is upto 4-5 % per year You also lose muscle mass from 35 years onwards 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 6

7 In perimenopause and menopause you lose bone! Bone turnover at the tissue level Patterns in women Pubertal girls Premenopausal women Post menopausal women change % / yr Formation Resorption Bone loss 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 7

8 Osteoporosis is preventable & treatable One out of two women above 50 will have a life time risk of osteoporotic fracture Each year there are an estimated 5 lac spinal fractures, 300,000 hip fractures, 2 lac broken wrists, and 3 lac fractures of other bones. About 80% of these fractures occur from relatively minor falls or accidents. Each year there are an estimated 5 lac spinal fractures, 300,000 hip fractures, 2 lac broken wrists, and 3 lac fractures of other bones. About 80% of these fractures occur from relatively minor falls or accidents. 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 8

9 Common sites of fractures Most of the times goes unnoticed & undiagnosed 1 st to occur Most debilitating Common Fractures due to osteoporosis WristHip Spine 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 9

10 Poor healing of fractures due to osteoporosis leads to limitation in daily routine Osteoporosis 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 10

11 Spinal complications Reduced height > 1 Weak back muscles Weak back muscles Microfractures of spine Microfractures of spine Dowagers hump Dowagers hump Between 25% and 60% of women over 60 years of age develop spinal compression fractures 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 11

12 Hip fracture Death due to hip fracture is 25% in first year. Those who survive have morbidity and need support for routine activities. 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 12

13 Risk factors for osteoporosis MODIFIABLE: Cigarette smoking or other tobacco use Excessive alcohol intake (>3 oz/day) Excessive alcohol intake (>3 oz/day) Diet low in calcium, vitamin D, or both Diet low in calcium, vitamin D, or both Eating disorder (anorexia nervosa, bulimia) Eating disorder (anorexia nervosa, bulimia) Inactive lifestyle, including extended bed rest Inactive lifestyle, including extended bed rest Use of certain medications eg. diuretics, glucocorticoids Use of certain medications eg. diuretics, glucocorticoids Natural or surgical menopause Natural or surgical menopauseMODIFIABLE: Cigarette smoking or other tobacco use Excessive alcohol intake (>3 oz/day) Excessive alcohol intake (>3 oz/day) Diet low in calcium, vitamin D, or both Diet low in calcium, vitamin D, or both Eating disorder (anorexia nervosa, bulimia) Eating disorder (anorexia nervosa, bulimia) Inactive lifestyle, including extended bed rest Inactive lifestyle, including extended bed rest Use of certain medications eg. diuretics, glucocorticoids Use of certain medications eg. diuretics, glucocorticoids Natural or surgical menopause Natural or surgical menopause NON-MODIFIABLE: Female gender Older age Family history of osteoporosis fractures Race Rheumatoid arthritis Antiepleptic drugs ThinNON-MODIFIABLE: Female gender Older age Family history of osteoporosis fractures Race Rheumatoid arthritis Antiepleptic drugs Thin 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 13

14 Why is osteoporosis a cause for concern? Osteoporosis is asymptomatic It is often known as the silent thief because bone loss occurs without symptoms It is often known as the silent thief because bone loss occurs without symptoms The importance lies in the fact that it greatly increases the risk of fractures The importance lies in the fact that it greatly increases the risk of fractures Osteoporosis is asymptomatic It is often known as the silent thief because bone loss occurs without symptoms It is often known as the silent thief because bone loss occurs without symptoms The importance lies in the fact that it greatly increases the risk of fractures The importance lies in the fact that it greatly increases the risk of fractures The diagnosis is made only after a fracture occurs or when DEXA scan is done 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 14

15 Clinical evaluation Detailed history and physical examination keeping in mind causes and risk factors Measurement of bone density X-Ray, SXA, DEXA, QCT, QSG Bone turnover markers Markers for bone formation and bone resorption Diagnostic evaluation of osteoporosis 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 15

16 Can be done for mass screening Heel, lower arm,or finger Cant be used to start treatment Better for diabetics 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 16

17 Prevention - starts from childhood Calcium 1500 mg /day Vit d 400-800iu/day Vit d 400-800iu/day Mag. folic acid, Vit C Mag. folic acid, Vit C Exercise specially strength training and aerobic for cardio respiratory endurance Exercise specially strength training and aerobic for cardio respiratory endurance Avoid caffeine, alcohol, smoking, salt Avoid caffeine, alcohol, smoking, salt 15 -30 min of sunshine /day 15 -30 min of sunshine /day Calcium 1500 mg /day Vit d 400-800iu/day Vit d 400-800iu/day Mag. folic acid, Vit C Mag. folic acid, Vit C Exercise specially strength training and aerobic for cardio respiratory endurance Exercise specially strength training and aerobic for cardio respiratory endurance Avoid caffeine, alcohol, smoking, salt Avoid caffeine, alcohol, smoking, salt 15 -30 min of sunshine /day 15 -30 min of sunshine /day 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 17

18 Exercises Aerobics like : Brisk walking Low impact aerobics Lawn mowing Taichi Yoga Aerobics like : Brisk walking Low impact aerobics Lawn mowing Taichi Yoga 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 18

19 Resistance & strength building exercises 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 19

20 In osteoarthritis exercise helps by Decreasing pain Increasing range of movements Decreasing stiffness Increasing strength Cartilage thickness is increased Decreasing pain Increasing range of movements Decreasing stiffness Increasing strength Cartilage thickness is increased 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 20

21 Exercises in osteoarthritis of knee In osteoarthritis one should commit to regular exercise that includes three types of activity: Flexibility (stretching, range-of-motion) exercises Flexibility (stretching, range-of-motion) exercises Isotonic or isometric exercises Isotonic or isometric exercises Strengthening (resistance) exercises Strengthening (resistance) exercises Cardiovascular (aerobic) exercise. Cardiovascular (aerobic) exercise. In osteoarthritis one should commit to regular exercise that includes three types of activity: Flexibility (stretching, range-of-motion) exercises Flexibility (stretching, range-of-motion) exercises Isotonic or isometric exercises Isotonic or isometric exercises Strengthening (resistance) exercises Strengthening (resistance) exercises Cardiovascular (aerobic) exercise. Cardiovascular (aerobic) exercise. This should be incorporated into your daily routine This should be incorporated into your daily routine. 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 21

22 Cancer screening For cancer breastFor cancer breast Cancer cervixCancer cervix Cancer endometriumCancer endometrium Cancer ovariesCancer ovaries Colorectal cancerColorectal cancer For cancer breast, SBE,CBE, Mammography.once in two yrs after 40 and once every year if family historyFor cancer breast, SBE,CBE, Mammography.once in two yrs after 40 and once every year if family history For cancer breastFor cancer breast Cancer cervixCancer cervix Cancer endometriumCancer endometrium Cancer ovariesCancer ovaries Colorectal cancerColorectal cancer For cancer breast, SBE,CBE, Mammography.once in two yrs after 40 and once every year if family historyFor cancer breast, SBE,CBE, Mammography.once in two yrs after 40 and once every year if family history 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 22

23 How to do self breast examination One week after mensesOne week after menses Start from 30 yrs onwardsStart from 30 yrs onwards Once in a monthOnce in a month One week after mensesOne week after menses Start from 30 yrs onwardsStart from 30 yrs onwards Once in a monthOnce in a month SQEEZE NIPPLES FOR ANY DISCHARGE 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 23

24 Pap smear-every 3 years from 30 yrs onwards Definition A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. A Pap smear involves collecting cells from your cervix the lower, narrow end of your uterus.now preferred is liquid cytology and HPV studies Definition A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. A Pap smear involves collecting cells from your cervix the lower, narrow end of your uterus.now preferred is liquid cytology and HPV studies 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 24

25 Transvaginal Ultrasound Every year to assess: Ovaries Endometrial thickness in the uterus Every year to assess: Ovaries Endometrial thickness in the uterus 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 25

26 Pap smear procedure Avoid intercourse, douching or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a Pap smear, as these may wash away or obscure abnormal cells. Try not to schedule a Pap smear during your menstrual period. Although the test can be done, it's best to avoid this time of your cycle, if possible. Avoid intercourse, douching or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a Pap smear, as these may wash away or obscure abnormal cells. Try not to schedule a Pap smear during your menstrual period. Although the test can be done, it's best to avoid this time of your cycle, if possible. 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 26

27 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 27 Age (years) Women Men Royal College of Gen. Pract., Morbidity Statistics From General Practice, 1981-82, Third National Survey, 1986, HMSO, London Mortality due to CVD / 1000 Mortality due to CVD / 1000

28 Incidence of CVD in Women Vs Men ( 2 yr rate / 1000 ) 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 0.5 10 5 1.5 12 7.65 18 3.6 10 23 18 34 2.3 1.8 Ratios AGE 28

29 Life style management This is the basic step of prevention & treatment for quality of life 3-step Management of Menopause 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 29

30 Healthy Diet 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 30

31 Get your lipid profile done Keep your weight under control Keep your waist hip ratio to 0.8 or absolute waist to < 85 cms Keep exercising regularly minimum of 30 min/day of brisk walk for 5 days/week 2-3 day of resistance or weight training If Lipid profile abnormal then statins or antihypertnsive drugs if blood pressure is high. 1/15/2014 Dr.Maninder ahuja

32 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 1997 prevalence of Alzheimers was estimated to be 4 million Prevalence expected to quadruple in the next 50 years to 1 in every 45 Americans 1997 prevalence of Alzheimers was estimated to be 4 million Prevalence expected to quadruple in the next 50 years to 1 in every 45 Americans Evans, Milibank Mem Fund Q, 1990; 68 : 267 Kalifert et al, Menopause, 1998; 5 : 197 Leon et al Health Aff, 1998; 17 : 206 Evans, Milibank Mem Fund Q, 1990; 68 : 267 Kalifert et al, Menopause, 1998; 5 : 197 Leon et al Health Aff, 1998; 17 : 206 Contd.. 32

33 Evans, Milibank Mem Fund Q, 1990; 68 : 267 Kalifert et al, Menopause, 1998; 5 : 197 Leon et al Health Aff, 1998; 17 : 206 Evans, Milibank Mem Fund Q, 1990; 68 : 267 Kalifert et al, Menopause, 1998; 5 : 197 Leon et al Health Aff, 1998; 17 : 206 you start forgetting what you were going to do. The rate of Alzheimers is 2 – 3 fold higher in women Only 2% women are aware that HRT could have an impact on Alzheimers Only 2% women are aware that HRT could have an impact on Alzheimers you start forgetting what you were going to do. The rate of Alzheimers is 2 – 3 fold higher in women Only 2% women are aware that HRT could have an impact on Alzheimers Only 2% women are aware that HRT could have an impact on Alzheimers 1/15/2014 33 Dr.Maninder ahuja

34 Indications for Hormonal Therapy Women who suffer from severe symptoms Not for prevention of heart disease, or chronic diseases Window of opportunity if started early Women who suffer from severe symptoms Not for prevention of heart disease, or chronic diseases Window of opportunity if started early 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 34

35 Forms of estrogens Oral Tablets Patches Gels Vaginal creams Vaginal tablets Injectables Sprays Oral Tablets Patches Gels Vaginal creams Vaginal tablets Injectables Sprays 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 35

36 Premature Menopause When menopause occurs before 40 years of ageWhen menopause occurs before 40 years of age Surgically inducedSurgically induced Following cancer treatmentFollowing cancer treatment Hormonal treatment is required for conception. Assisted reproductive techniques helpHormonal treatment is required for conception. Assisted reproductive techniques help Hormone therapy is useful to delay long term problemsHormone therapy is useful to delay long term problems 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 36

37 Doctors visit involves Counseling – answering all your queries related to menopause Basic health check up Routine gynecology check up Cancer screening Prevention & treatment of menopausal issues Counseling – answering all your queries related to menopause Basic health check up Routine gynecology check up Cancer screening Prevention & treatment of menopausal issues 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 37

38 Traditionally women were exercising! 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 38

39 Today they are not! 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 39

40 We offer her Care with her changing bodies and changing needs towards a healthier future 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 40

41 Acknowledgements Past President IMS … Dr Duru Shah Advisors … Dr Meeta Singh Dr Rashmi Shah Dr Jyoti Shah Coordinators … All members of Geriatric Gynecology Committee of FOGSI All chapter secretaties of IMS and members of IMS Who would propagate this further Past President IMS … Dr Duru Shah Advisors … Dr Meeta Singh Dr Rashmi Shah Dr Jyoti Shah Coordinators … All members of Geriatric Gynecology Committee of FOGSI All chapter secretaties of IMS and members of IMS Who would propagate this further 1/15/2014 Dr.Maninder Ahuja,dr.Duru shah 41


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