Menopause and You: Preventive Care for Women Deborah Streletz, MD Beverly Vaughn, MD Nov. 17, 2011 Dr. Streletz & Dr. Vaughn

2 Preventive Care Between Ages 40 and 50

3 Screening parameters are based on an individual’s risk factors which are variable for each disease process Screening for chronic diseases including hypertension, diabetes and hyperlipidemia Breast Cancer screening PAP testing Immunization recommendations

4 Hypertension Everyone should be screened for hypertension As simple as a blood pressure check at your doctor’s office

5 Diabetes Very important to identify and treat as early as possible Leads to many life-threatening complications including heart disease, kidney failure, blindness, stroke, amputation, increased risk for infection

6 Diabetes: How Do We Screen? Blood testing including fasting blood sugar or a non-fasting blood test called a Hemoglobin A1C or a Glucose challenge test Your doctor can decide which method to use but all blood tests are equally effective ways to test for diabetes

7 Diabetes Everyone starting at age 45 Everyone with one or more of the following risk factors: –BMI greater than 25 (Overweight) –Family history of diabetes – specifically a 1st degree relative –Given birth to a baby weighing greater than 9 pounds –Anyone who has had gestational diabetes –High blood pressure –Certain abnormalities in cholesterol – an HDL (good cholesterol) less than 35 or a triglyceride level greater than 250 –Polycystic ovarian syndrome –High-risk ethnic groups, African-American, Hispanic, Native American, Asian-Pacific Islander

8 Cholesterol Recommended screening starts for everyone at age 45 and should be repeated every 5 years Screening for women at increased risk for heart disease starts as early as age 20. Cholesterol testing requires a fasting blood test.

9 Breast Cancer How do we screen? Mammogram

10 Breast Cancer US Preventive Services Task Force recently changed their recommendations on mammography timing. Current recommendations are: –Biennial mammograms starting at age 50 –Continued screening until age 74 American College of Obstetrics and Gynecology recommendations are: –Mammograms every 1 to 2 years starting at age 40 with yearly mammograms starting at age 50

11 Breast Cancer The time to start your mammography screening needs to be discussed with your doctor based on your specific family history, risk factors, values and beliefs

12 Cervical Cancer Screening The PAP Test The PAP test can now be performed every 2 to 3 years after 3 consecutive negative tests if you DO NOT have a history of a certain type of abnormal PAP in the past (CIN 2 or 3), HIV or another type of disease causing your immune system to be suppressed Your doctor needs to have access to your past PAP test results to make this decision

13 What Does it Look for? Cells collected during the pap smear are examined under a microscope –Pathologist looks for pre-cancerous cells

14 What Does it Look for? It can also look for the presence of the Human Papillomavirus [HPV] –HPV can cause pre-cancerous cervical changes in some individuals

15 Immunizations Recommendations made by the Advisory Committee on Immunization Practices by the CDC

16 Immunizations Tdap – Tetanus booster vaccine which also contains acellular pertussis –Recommended to replace one dose of Td (usual tetanus vaccine) that is given every 10 years –Recommended for everyone but those most at risk for pertussis infection are healthcare workers and those with contact with infants less than 12 months of age –Can be given as an off-label use to those greater than age 65 who have contact with infants

17 Immunizations Pneumovax -23 – vaccine to prevent Pneumococcal pneumonia –New recommendations that include all smokers and individuals with asthma greater than age 19 –Those less than 65 receive 2 doses, separated by 5 years –Those greater than 65 receive one dose

18 Preventive Care Between Ages 50 and 60

19 Preventive Care Between Ages 50 and 60 Continues to include the recommendations previously mentioned PLUS Colorectal Cancer Screening, AKA the Colonoscopy Colonoscopy equivalents include yearly home Fecal Occult blood testing PLUS flexible sigmoidoscopy every 5 years OR Double contrast barium enema every 5 years

20 What Is a Colonoscopy? Procedure to look inside the colon and rectum

21 Colonoscopy: The Preparation Clear liquids the day before procedure A bowel prep like Miralax is then used to further empty the bowel

22 Colonoscopy: The Procedure Light sedative given to help you relax The colonoscope, a thin flexible tube with a camera on the end, is inserted into anus and advanced to the small intestine Procedure lasts 30-60min with about 1-2hr time in recovery room

23 Colonoscopy: What Does it Look for? Colon cancer 1 in 20 lifetime risk Polyps

24 Colonoscopy: Benefits of Screening Finds and removes polyps before they become cancer Catches colon cancer at an earlier stage so that it can be treated more effectively Bottom line: The earlier colon cancer is caught the easier it can be treated

25 Who Needs a Colonoscopy? Everyone age 50 yrs and older And then every 10 yrs after that Note: Colonoscopy may be recommended more frequently depending on risk factors and results

26 Does Anyone Need a Colonoscopy Under Age 50? Yes People with family history of 1st degree relatives with adenomatous polyps and/or colon cancer –Typically starting at 40yo or 10yrs before the youngest case in the family People with a personal history of inflammatory bowel disease (ie. Ulcerative colitis, Crohn's disease)

27 When Can I Stop Getting Colonoscopies? USPSTF says at 75yrs if all screening has been negative and there is no family history of colon cancer American Cancer Society and the American College of Gastroenterology don't set an upper age limit Bottom line – It's a gray area. Talk with your doctor about what's right for you.

28 Preventive Care Between Ages 60 and 70

29 Preventive Care Between Ages 60 and 70 All the prior recommendations PLUS Herpes Zoster Vaccine Osteoporosis Screening with a DEXA scan

30 Immunizations Herpes Zoster vaccine – Zostavax – given to prevent Herpes Zoster (Shingles) infection –One dose at age 60 or greater –Recommended to be given as close to age 60 as possible, less effective if given at a later age –Should be given even if you have already had a shingles outbreak

31 Osteoporosis Screening with a Dexa Scan A special type of X-ray that measures how dense your bones are at specific sites –CENTRAL: hip, spine Preferred –PERIPHERAL: wrist, heel, finger Cheaper Less accurate

32 What Does it Look for? Measures how dense the bones are –Compares your bone density to the bone density of the average Caucasian female

33 What Does it Look for? Measures how dense the bones are –OsteoPENIA: Bone thinning –OsteoPOROSIS: Severe bone thinning leading to bone loss

34 When Should I Have it Done and Why? Over the age of 65 Post-menopausal women between ages 60 and 65 with risk factors: –Ethnicity (Caucasian/Asian) –Family history –Chronic steroid use At least every 2 years ** ● Increased risk of fractures ● Increased risk of pain ● Increased risk of death!

35 Preventive Care at Every Age

36 At Every Age Screening for sexually transmitted infections: –Gonorrhea –Chlamydia –Syphilis –HIV

37 At Every Age Your physician should be discussing other aspects of your health care including –Tobacco use –Sexuality –Fitness and Nutrition –Psychosocial factors including your family and work relationships as well as your stress level –Mood and sleep

38 Time for Questions For a physician referral, call CALL.MLH