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,dr.Duru shah
3/25/2017

2. Changes in menstrual periods
Periods are heavier or lighter than usual
More / less frequent
Irregular
Regular and then suddenly stops
Medical opinion necessary if :
Very heavy or irregular bleeding
Bleeding between periods
Bleeding after sex
Bleeding after months of being free from periods
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

3. Management – depending on cause
Hormonal Therapy
Conservative Therapy
Balloon Therapy
LNG IUD
Endometrial Ablation
Polypectomy
Contd..
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

4. Management contd.. Surgery Myomectomy Hysterectomy
Hysterectomy with Bilateral Salpingo- oophorectomy
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

5. Balloon therapy
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

8. Osteoporosis is preventable & treatable
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.
One out of two women above 50 will have a life time risk of osteoporotic fracture
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

9. Common sites of fractures Common Fractures due to osteoporosis
Spine
Wrist
Hip
1st to occur
Most debilitating
Most of the times goes unnoticed & undiagnosed
Common Fractures due to osteoporosis
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

10. Osteoporosis
Poor healing of fractures due to osteoporosis leads to limitation in daily routine
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

11. Spinal complications Reduced height > 1” Weak back muscles
Microfractures of spine
Dowager’s hump
Between 25% and 60% of women over 60 years of age develop spinal compression fractures
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

12. Hip fracture
Death due to hip fracture is 25% in first year. Those who survive have morbidity and need support for routine activities.
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

13. Risk factors for osteoporosis
MODIFIABLE:
Cigarette smoking or other tobacco use
Excessive alcohol intake (>3 oz/day)
Diet low in calcium, vitamin D, or both
Eating disorder (anorexia nervosa, bulimia)
Inactive lifestyle, including extended bed rest
Use of certain medications eg. diuretics, glucocorticoids
Natural or surgical menopause
NON-MODIFIABLE:
Female gender
Older age
Family history of osteoporosis fractures
Race
Rheumatoid arthritis
Antiepleptic drugs
Thin
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

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
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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

15. Diagnostic evaluation of osteoporosis
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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

16. QSG Can be done for mass screening Heel, lower arm,or finger
Can’t be used to start treatment
Better for diabetics
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

17. Prevention - starts from childhood
Calcium 1500 mg /day
Vit d iu/day
Mag. folic acid, Vit C
Exercise specially strength training and aerobic for cardio respiratory endurance
Avoid caffeine, alcohol, smoking, salt
min of sunshine /day
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

18. Exercises Aerobics like : Brisk walking Low impact aerobics
Lawn mowing
Taichi
Yoga
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

19. Resistance & strength building exercises
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

20. In osteoarthritis exercise helps by
Decreasing pain
Increasing range of movements
Decreasing stiffness
Increasing strength
Cartilage thickness is increased
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

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
Isotonic or isometric exercises
Strengthening (resistance) exercises
Cardiovascular (aerobic) exercise.
This should be incorporated into your daily routine.
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

22. Cancer screening For cancer breast Cancer cervix Cancer endometrium
Cancer ovaries
Colorectal cancer
For cancer breast, SBE,CBE, Mammography.once in two yrs after 40 and once every year if family history
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

23. How to do self breast examination SQEEZE NIPPLES FOR ANY DISCHARGE
One week after menses
Start from 30 yrs onwards
Once in a month
SQEEZE NIPPLES FOR ANY DISCHARGE
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

25. Transvaginal Ultrasound
Every year to assess:
Ovaries
Endometrial thickness in the uterus
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

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.
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

27. Cardiovascular Disease
Mortality due to
CVD / 1000
Women
Men
Age (years)
Royal College of Gen. Pract., Morbidity Statistics From General Practice, , Third National Survey, 1986, HMSO, London
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

28. Cardiovascular Disease
Incidence of CVD in Women Vs Men ( 2 yr rate / 1000 )
0.5 10 5
1.5 12
7.6 18
3.6 23 34
2.3
1.8
Ratios
AGE
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

29. Life style management
3-step Management of Menopause
This is the basic step of prevention & treatment for quality of life
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

30. Healthy Diet
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

31. What you should do 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.
Dr.Maninder ahuja
3/25/2017

32. Alzheimer’s Disease (AD)
1997 prevalence of Alzheimer’s 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
Contd..
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

33. Alzheimer’s Disease (AD)
you start forgetting what you were going to do.
The rate of Alzheimer’s is 2 – fold higher in women
Only 2% women are aware that HRT could have an impact on Alzheimer’s
Oestrogens Delays brain ageing
May reduce a woman’s risk of AD and slow its progression
Enhances sleep dynamics
Prevents neuronal and vascular injury in the brain from
Oxidative stress
Amyloid – beta protein cytotoxicity
Increases cerebral blood flow
Improves mood quality and minimizes depression
But oestrogens are not being given for prevention of Alzheimer’s
Evans, Milibank Mem Fund Q, 1990; 68 : 267
Kalifert et al, Menopause, 1998; 5 : 197
Leon et al Health Aff, 1998; 17 : 206
Dr.Maninder ahuja
3/25/2017

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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

35. Forms of estrogens Oral Tablets Patches Gels Vaginal creams
Vaginal tablets
Injectables
Sprays
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

36. Premature Menopause When menopause occurs before 40 years of age
Surgically induced
Following cancer treatment
Hormonal treatment is required for conception. Assisted reproductive techniques help
Hormone therapy is useful to delay long term problems
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

37. Doctor’s 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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

38. Traditionally women were exercising!
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

39. Today they are not!
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

40. We offer her Care with her “changing bodies and changing needs” towards a healthier future
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017

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
Dr.Maninder Ahuja,dr.Duru shah
3/25/2017