CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women...
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Transcript of CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women...
“CHANGING CARE WITH CHANGING BODIES AND
CHANGING NEEDS !
“CHANGING CARE WITH CHANGING BODIES AND
CHANGING NEEDS !
- A health awareness module for women
- A health awareness module for women
Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSIChairperson public Awareness committee IMS
Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSIChairperson public Awareness committee IMS
04/10/23Dr.Maninder Ahuja,dr.Duru shah
1
Changes in menstrual periods
Changes in menstrual periods• Periods are Periods are
heavier or heavier or lighter lighter than usual than usual• More / less More / less frequent frequent• IrregularIrregular• Regular and Regular and then suddenly then suddenly stops stops
• Periods are Periods are heavier or heavier or lighter lighter than usual than usual• More / less More / less frequent frequent• IrregularIrregular• Regular and Regular and then suddenly then suddenly stops stops
Medical opinion Medical opinion necessary if :necessary if :
• Very heavy or Very heavy or irregular irregular bleedingbleeding• Bleeding Bleeding between between periods periods• Bleeding after Bleeding after sexsex• Bleeding after Bleeding after 12 12 months of being months of being free from free from periodsperiods
Medical opinion Medical opinion necessary if :necessary if :
• Very heavy or Very heavy or irregular irregular bleedingbleeding• Bleeding Bleeding between between periods periods• Bleeding after Bleeding after sexsex• Bleeding after Bleeding after 12 12 months of being months of being free from free from periodsperiods
04/10/23Dr.Maninder Ahuja,dr.Duru shah2
Management – depending on cause
Management – depending on cause
• Hormonal Therapy
• Conservative Therapy
• Hormonal Therapy
• Conservative Therapy
Balloon TherapyBalloon Therapy
LNG IUDLNG IUD
PolypectomyPolypectomy
Endometrial AblationEndometrial Ablation
Contd..Contd..04/10/23Dr.Maninder Ahuja,dr.Duru shah
3
Management contd..Management contd..
Surgery Surgery
MyomectomyMyomectomy
Hysterectomy with Bilateral Salpingo- oophorectomy
Hysterectomy with Bilateral Salpingo- oophorectomy
HysterectomyHysterectomy
04/10/23Dr.Maninder Ahuja,dr.Duru shah4
04/10/23Dr.Maninder Ahuja,dr.Duru shah 5
Osteoporosis – the silent disease
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 yearYou also lose muscle mass from 35 years onwards
04/10/23Dr.Maninder Ahuja,dr.Duru shah6
In perimenopause and menopause you lose bone!
In perimenopause and menopause you lose bone!
-2
-1
0
1
2
3
4
5
6
7
8
Bone turnover at the tissue levelBone turnover at the tissue level
Patterns in women
Pubertal girls
Premenopausal women
Post menopausal women
ch
an
ge %
/ y
r
ch
an
ge %
/ y
r
Formation
Resorption
Bone loss
04/10/23Dr.Maninder Ahuja,dr.Duru shah7
Osteoporosis is preventable & treatable
Osteoporosis is preventable & treatable
One out of two women above 50 will One out of two women above 50 will have a life time risk of osteoporotic have a life time risk of osteoporotic
fracturefracture
One out of two women above 50 will One out of two women above 50 will have a life time risk of osteoporotic have a life time risk of osteoporotic
fracturefracture
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.
04/10/23Dr.Maninder Ahuja,dr.Duru shah8
Common sites of fracturesCommon sites of fractures
Most of the times goes unnoticed & undiagnosed
11stst to occur to occur Most Most debilitatingdebilitating
Common Common Fractures due to Fractures due to
osteoporosisosteoporosis
Wrist
Hip Spine
04/10/23Dr.Maninder Ahuja,dr.Duru shah9
Poor healing of Poor healing of fractures due fractures due
to osteoporosis to osteoporosis leads to leads to
limitation in limitation in daily routinedaily routine
Poor healing of Poor healing of fractures due fractures due
to osteoporosis to osteoporosis leads to leads to
limitation in limitation in daily routinedaily routine
OsteoporosisOsteoporosis
04/10/23Dr.Maninder Ahuja,dr.Duru shah10
Spinal complications
• Reduced height > 1”Reduced height > 1”• Weak back musclesWeak back muscles• Microfractures of spineMicrofractures of spine• Dowager’s humpDowager’s hump
Between 25% and 60% of women over 60 years of age develop spinal compression fractures
Between 25% and 60% of women over 60 years of age develop spinal compression fractures
04/10/23Dr.Maninder Ahuja,dr.Duru shah11
Hip fractureHip fracture
Death due to hip fracture is 25% in first year. Those who survive have morbidity and need support for routine activities.
Death due to hip fracture is 25% in first year. Those who survive have morbidity and need support for routine activities.
04/10/23Dr.Maninder Ahuja,dr.Duru shah12
Risk factors for osteoporosisRisk factors for osteoporosisMODIFIABLE:MODIFIABLE:
• Cigarette smoking or Cigarette smoking or other tobacco use other tobacco use• Excessive alcohol intake Excessive alcohol intake (>3 oz/day) (>3 oz/day)• Diet low in calcium, Diet low in calcium, vitamin D, or both vitamin D, or both• Eating disorder (anorexia Eating disorder (anorexia nervosa, bulimia) nervosa, bulimia)• Inactive lifestyle, including Inactive lifestyle, including extended bed rest extended bed rest• Use of certain Use of certain medications eg. diuretics, medications eg. diuretics, glucocorticoids glucocorticoids• Natural or surgical menopauseNatural or surgical menopause
MODIFIABLE:MODIFIABLE:• Cigarette smoking or Cigarette smoking or other tobacco use other tobacco use• Excessive alcohol intake Excessive alcohol intake (>3 oz/day) (>3 oz/day)• Diet low in calcium, Diet low in calcium, vitamin D, or both vitamin D, or both• Eating disorder (anorexia Eating disorder (anorexia nervosa, bulimia) nervosa, bulimia)• Inactive lifestyle, including Inactive lifestyle, including extended bed rest extended bed rest• Use of certain Use of certain medications eg. diuretics, medications eg. diuretics, glucocorticoids glucocorticoids• Natural or surgical menopauseNatural or surgical menopause
NON-MODIFIABLE:NON-MODIFIABLE:
• Female gender• Older age• Family history of osteoporosis fractures• Race•Rheumatoid arthritis•Antiepleptic drugs•Thin
NON-MODIFIABLE:NON-MODIFIABLE:
• Female gender• Older age• Family history of osteoporosis fractures• Race•Rheumatoid arthritis•Antiepleptic drugs•Thin
04/10/23Dr.Maninder Ahuja,dr.Duru shah13
Why is osteoporosis a cause for concern?
Why is osteoporosis a cause for concern?
• Osteoporosis is asymptomaticOsteoporosis is asymptomatic
• It is often known as “the silent It is often known as “the silent thief” thief” because bone loss occurs without because bone loss occurs without symptoms symptoms
• The importance lies in the fact that The importance lies in the fact that it it greatly increases the risk of greatly increases the risk of fractures fractures
• Osteoporosis is asymptomaticOsteoporosis is asymptomatic
• It is often known as “the silent It is often known as “the silent thief” thief” because bone loss occurs without because bone loss occurs without symptoms symptoms
• The importance lies in the fact that The importance lies in the fact that it it greatly increases the risk of greatly increases the risk of fractures fractures
The diagnosis is made only The diagnosis is made only after a fracture occurs or when after a fracture occurs or when DEXA scan DEXA scan is doneis done 04/10/23Dr.Maninder Ahuja,dr.Duru shah
14
Clinical evaluation Detailed history and physical examinationkeeping 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
Diagnostic evaluation of osteoporosis
04/10/23Dr.Maninder Ahuja,dr.Duru shah15
Can be done for mass screening Heel, lower arm,or finger Can’t be used to start treatment Better for diabetics
04/10/23Dr.Maninder Ahuja,dr.Duru shah 16
Prevention - starts from childhood
Prevention - starts from childhood
• Calcium 1500 mg /dayCalcium 1500 mg /day• Vit d 400-800iu/dayVit d 400-800iu/day• Mag. folic acid, Vit CMag. folic acid, Vit C• Exercise specially strength Exercise specially strength training and aerobic for training and aerobic for cardio respiratory cardio respiratory endurance endurance• Avoid caffeine, alcohol, Avoid caffeine, alcohol, smoking, salt smoking, salt• 15 -30 min of sunshine /day15 -30 min of sunshine /day
• Calcium 1500 mg /dayCalcium 1500 mg /day• Vit d 400-800iu/dayVit d 400-800iu/day• Mag. folic acid, Vit CMag. folic acid, Vit C• Exercise specially strength Exercise specially strength training and aerobic for training and aerobic for cardio respiratory cardio respiratory endurance endurance• Avoid caffeine, alcohol, Avoid caffeine, alcohol, smoking, salt smoking, salt• 15 -30 min of sunshine /day15 -30 min of sunshine /day
04/10/23Dr.Maninder Ahuja,dr.Duru shah17
Exercises Exercises
Aerobics like :
• Brisk walking
• Low impact aerobics
• Lawn mowing
• Taichi
• Yoga
Aerobics like :
• Brisk walking
• Low impact aerobics
• Lawn mowing
• Taichi
• Yoga
04/10/23Dr.Maninder Ahuja,dr.Duru shah18
Resistance & strength building exercises
Resistance & strength building exercises
04/10/23Dr.Maninder Ahuja,dr.Duru shah19
In osteoarthritis exercise helps by
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
04/10/23Dr.Maninder Ahuja,dr.Duru shah20
Cancer screeningCancer screening•For cancer breastFor cancer breast
•Cancer cervix Cancer cervix
•Cancer endometriumCancer endometrium
•Cancer ovariesCancer ovaries
•Colorectal cancerColorectal cancer
•For cancer breast, For cancer breast, SBE,CBE, SBE,CBE, Mammography.once in Mammography.once in two yrs after 40 and two yrs after 40 and once every year if once every year if family historyfamily history
•For cancer breastFor cancer breast
•Cancer cervix Cancer cervix
•Cancer endometriumCancer endometrium
•Cancer ovariesCancer ovaries
•Colorectal cancerColorectal cancer
•For cancer breast, For cancer breast, SBE,CBE, SBE,CBE, Mammography.once in Mammography.once in two yrs after 40 and two yrs after 40 and once every year if once every year if family historyfamily history
04/10/23Dr.Maninder Ahuja,dr.Duru shah22
How to do self breast examination
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 SQEEZE NIPPLES FOR NIPPLES FOR
ANY ANY DISCHARGEDISCHARGE
04/10/23Dr.Maninder Ahuja,dr.Duru shah23
Pap smear-every 3 years from 30 yrs onwards
Pap smear-every 3 years from 30 yrs onwards
DefinitionA 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
DefinitionA 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
04/10/23Dr.Maninder Ahuja,dr.Duru shah24
Transvaginal UltrasoundTransvaginal Ultrasound
Every year to assess:
• Ovaries
• Endometrial thickness in
the uterus
Every year to assess:
• Ovaries
• Endometrial thickness in
the uterus 04/10/23Dr.Maninder Ahuja,dr.Duru shah
25
Pap smear procedurePap 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.
04/10/23Dr.Maninder Ahuja,dr.Duru shah26
04/10/23Dr.Maninder Ahuja,dr.Duru shah 27
0
2
4
6
8
10
10 20 30 40 50 60 70 75 +Age (years)Age (years)
WomenWomenMen Men
Royal College of Gen. Pract., Morbidity Statistics From General Practice, 1981-82, Third National Survey, 1986, HMSO, London
Royal College of Gen. Pract., Morbidity Statistics From General Practice, 1981-82, Third National Survey, 1986, HMSO, London
Mortality due to CVD / 1000Mortality due to CVD / 1000
Incidence of CVD in Women Vs Men ( 2 yr rate / 1000 )
04/10/23Dr.Maninder Ahuja,dr.Duru shah
0
5
10
15
20
25
30
35
40
35 - 44 45 - 54 55 - 64 65 - 74 75 - 84
Female
Male
0.5
10
5
1.5
12
7.6 5
18
3.6 10
23
18
34
2.3
1.8
Ratios Ratios
AGE
28
Life style managementLife style management
This is the This is the basic step of basic step of prevention prevention
& treatment & treatment for quality for quality
of life of life
3-step Management of Menopause
04/10/23Dr.Maninder Ahuja,dr.Duru shah29
Healthy DietHealthy Diet
04/10/23Dr.Maninder Ahuja,dr.Duru shah30
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.
04/10/23Dr.Maninder ahuja
04/10/23Dr.Maninder Ahuja,dr.Duru shah
•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
•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 : 267Kalifert et al, Menopause, 1998; 5 : 197Leon et al Health Aff, 1998; 17 : 206
Evans, Milibank Mem Fund Q, 1990; 68 : 267Kalifert et al, Menopause, 1998; 5 : 197Leon et al Health Aff, 1998; 17 : 206
Contd..32
Evans, Milibank Mem Fund Q, 1990; 68 : 267Kalifert et al, Menopause, 1998; 5 : 197Leon et al Health Aff, 1998; 17 : 206
Evans, Milibank Mem Fund Q, 1990; 68 : 267Kalifert et al, Menopause, 1998; 5 : 197Leon et al Health Aff, 1998; 17 : 206
• you start forgetting what you were going to do.
• The rate of The rate of Alzheimer’s is 2 – 3 Alzheimer’s is 2 – 3 fold higher in women fold higher in women
• Only 2% women Only 2% women are aware that HRT are aware that HRT could have an could have an impact on Alzheimer’s impact on Alzheimer’s
• you start forgetting what you were going to do.
• The rate of The rate of Alzheimer’s is 2 – 3 Alzheimer’s is 2 – 3 fold higher in women fold higher in women
• Only 2% women Only 2% women are aware that HRT are aware that HRT could have an could have an impact on Alzheimer’s impact on Alzheimer’s
04/10/23 33Dr.Maninder ahuja
Indications for Hormonal Therapy
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
04/10/23Dr.Maninder Ahuja,dr.Duru shah34
Forms of estrogensForms of estrogens
•Oral Tablets•Patches•Gels•Vaginal creams•Vaginal tablets•Injectables•Sprays
•Oral Tablets•Patches•Gels•Vaginal creams•Vaginal tablets•Injectables•Sprays
04/10/23Dr.Maninder Ahuja,dr.Duru shah35
Premature MenopausePremature Menopause• When menopause When menopause
occurs before 40 years occurs before 40 years of ageof age
• Surgically induced Surgically induced • Following cancer Following cancer
treatmenttreatment• Hormonal treatment isHormonal treatment is
required for conception. required for conception. Assisted reproductive Assisted reproductive techniques helptechniques help
• Hormone therapy is Hormone therapy is useful to delay long useful to delay long term problems term problems
04/10/23Dr.Maninder Ahuja,dr.Duru shah36
Doctor’s visit involvesDoctor’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
• Counseling – answering all your queries related to menopause
• Basic health check up
• Routine gynecology check up
• Cancer screening
• Prevention & treatment of menopausal issues
04/10/23Dr.Maninder Ahuja,dr.Duru shah37
Traditionally women were exercising!
Traditionally women were exercising!
04/10/23Dr.Maninder Ahuja,dr.Duru shah38
Today they are not!Today they are not!
04/10/23Dr.Maninder Ahuja,dr.Duru shah39
We offer her Care with
her “changing bodies and changing needs”
towards a healthier
future
We offer her Care with
her “changing bodies and changing needs”
towards a healthier
future04/10/23Dr.Maninder Ahuja,dr.Duru shah
40
AcknowledgementsAcknowledgements
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 further04/10/23Dr.Maninder Ahuja,dr.Duru shah
41