Download - Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Transcript
Page 1: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Women’s HealthWomen’s Health

Bryan E. Mosora D.O.Bryan E. Mosora D.O.

Intern/IM ResidentIntern/IM Resident

Page 2: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Women in your PracticeWomen in your Practice

Special considerations with regards to health Special considerations with regards to health maintenance and preventionmaintenance and prevention

Important to understand cultural issues Important to understand cultural issues Women are not the same as a men!!!Women are not the same as a men!!!

Page 3: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Women in your PracticeWomen in your Practice

Typically more involved with there healthcare Typically more involved with there healthcare then men. This equals more opportunity to then men. This equals more opportunity to play a preventative roleplay a preventative role

Usually will be armed with information from Usually will be armed with information from various sources, i.e. magazines, internet, various sources, i.e. magazines, internet, television.television.

Important role of the physician is to help her Important role of the physician is to help her sort through the garbage and address sort through the garbage and address meaningful issuesmeaningful issues

Page 4: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Issues Issues

Breast cancerBreast cancer Ovarian CancerOvarian Cancer Cervical CancerCervical Cancer Uterine cancerUterine cancer Menopause/HRTMenopause/HRT Heart DiseaseHeart Disease DiabetesDiabetes DepressionDepression

Page 5: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

StatisticsStatistics

213,000 cases of breast cancer per year with 213,000 cases of breast cancer per year with 41,000 deaths.41,000 deaths.

9,700 cases of cervical cancer per year with 9,700 cases of cervical cancer per year with 3,700 deaths3,700 deaths

41,200 cases of uterine cancer per year with 41,200 cases of uterine cancer per year with 7,350 deaths7,350 deaths

20,200 cases of ovarian cancer per year with 20,200 cases of ovarian cancer per year with 15,31015,310

Page 6: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Breast CancerBreast Cancer

Page 7: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Breast CancerBreast Cancer

The most common cancer in women, no matter The most common cancer in women, no matter your race or ethnicity. your race or ethnicity.

The most common cause of death from cancer The most common cause of death from cancer among Hispanic women. among Hispanic women.

The second most common cause of death from The second most common cause of death from cancer among white, black, Asian/Pacific cancer among white, black, Asian/Pacific Islander, and American Indian/Alaska Native Islander, and American Indian/Alaska Native women. women.

Page 8: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Risk FactorsRisk Factors

Research has shown that the following Research has shown that the following conditions increase a woman's chances of conditions increase a woman's chances of getting breast cancer:getting breast cancer:

Personal history of breast cancerPersonal history of breast cancer.. FamilyFamily historyhistory.... Certain breast changes. Certain breast changes. Genetic alterations.Genetic alterations.

5% to 10% of all breast cancer.5% to 10% of all breast cancer.

Page 9: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Warning SignsWarning Signs

New lump in the breast or underarm (armpit). New lump in the breast or underarm (armpit). Thickening or swelling of part of the breast. Thickening or swelling of part of the breast. Irritation or dimpling of breast skin. Irritation or dimpling of breast skin. Redness or flaky skin in the nipple area or the breast. Redness or flaky skin in the nipple area or the breast. Pulling in of the nipple or pain in the nipple area. Pulling in of the nipple or pain in the nipple area. Nipple discharge other than breast milk, including Nipple discharge other than breast milk, including

blood. blood. Any change in the size or the shape of the breast. Any change in the size or the shape of the breast. Pain in any area of the breast. Pain in any area of the breast.

Page 10: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DetectionDetection

Page 11: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Signs of Breast CancerSigns of Breast Cancer

Page 12: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DetectionDetection

Regular self breast exam is nearly as good as Regular self breast exam is nearly as good as mammography in terms of the size of the mammography in terms of the size of the lesion that can be detected.lesion that can be detected.

Second only to regular breast exam by a Second only to regular breast exam by a skilled physicianskilled physician

Page 13: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

The Breast ExamThe Breast Exam

Page 14: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

The Breast ExamThe Breast Exam

Women should undergo breast examination by Women should undergo breast examination by a clinician as part of their normal health a clinician as part of their normal health maintenance program. maintenance program.

This should be done every two to three years This should be done every two to three years from age 20 to 40, and annually after the age from age 20 to 40, and annually after the age of 40. of 40.

Page 15: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Breast cancerBreast cancer

Over 50 years:Over 50 years: All women over the age of 50 All women over the age of 50 years should have annual mammography years should have annual mammography examinations.examinations.

40-50:40-50: The National Cancer Institute The National Cancer Institute recommends that these women get a recommends that these women get a mammogram every 1-2 years. mammogram every 1-2 years.

Under 40 years:Under 40 years: Most women under the age Most women under the age of 40 years do not need annual mammogramsof 40 years do not need annual mammograms

Page 16: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

PrognosisPrognosis STAGE 0. In Situ ("in place") disease in which the cancerous cells are STAGE 0. In Situ ("in place") disease in which the cancerous cells are

in their original location within normal breast tissue. STAGE I. in their original location within normal breast tissue. STAGE I. Tumor less than 2 cm in diameter with no spread beyond the breast Tumor less than 2 cm in diameter with no spread beyond the breast

STAGE IIA. Tumor 2 to 5 cm in size without spread to axillary STAGE IIA. Tumor 2 to 5 cm in size without spread to axillary (armpit) lymph nodes (armpit) lymph nodes

STAGE IIB. Tumor greater than 5 cm in size without spread to STAGE IIB. Tumor greater than 5 cm in size without spread to axillary lymph nodes axillary lymph nodes

STAGE IIIA. Tumor smaller than 5 cm in size with spread to axillary STAGE IIIA. Tumor smaller than 5 cm in size with spread to axillary lymph nodes which are attached to each other or to other structures, lymph nodes which are attached to each other or to other structures,

STAGE IIIB. The tumor has penetrated outside the breast to the skin STAGE IIIB. The tumor has penetrated outside the breast to the skin of the breast or of the chest wall or has spread to lymph nodes inside of the breast or of the chest wall or has spread to lymph nodes inside the chest wall along the sternum the chest wall along the sternum

STAGE IV. A tumor of any size with spread beyond the region of the STAGE IV. A tumor of any size with spread beyond the region of the breast and chest wall, such as to liver, bone, or lungsbreast and chest wall, such as to liver, bone, or lungs

Page 17: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

PrognosisPrognosis

The clinical stage of breast cancer is the best indicator The clinical stage of breast cancer is the best indicator for prognosis (probable outcome).for prognosis (probable outcome).

Five-year survival rates for individuals with breast Five-year survival rates for individuals with breast cancer who receive appropriate treatment are cancer who receive appropriate treatment are approximately:approximately:

95% for stage 0 95% for stage 0 88% for stage I 88% for stage I 66% for stage II 66% for stage II 36% for stage III 36% for stage III 7% for stage IV 7% for stage IV

Page 18: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Ovarian CancerOvarian Cancer

Ovarian cancer is the fifth leading cause of Ovarian cancer is the fifth leading cause of cancer death in women cancer death in women

The leading cause of death from gynecological The leading cause of death from gynecological malignancies.malignancies.

The second most commonly diagnosed The second most commonly diagnosed gynecologic malignancy gynecologic malignancy

Page 19: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.
Page 20: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.
Page 21: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Ovarian CancerOvarian Cancer

The risk for developing ovarian cancer appears The risk for developing ovarian cancer appears to be affected by several factors:to be affected by several factors: Early age of first pregnancyEarly age of first pregnancy MultiparityMultiparity Later age of final pregnancyLater age of final pregnancy Tubal LigationTubal Ligation

Page 22: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

SymptomsSymptoms digestive symptoms, bloating, distention or cramping digestive symptoms, bloating, distention or cramping abdominal or low-back discomfort abdominal or low-back discomfort pelvic pressure or frequent urination pelvic pressure or frequent urination unexplained changes in bowel habits unexplained changes in bowel habits nausea or vomiting nausea or vomiting pain or swelling in the abdomen pain or swelling in the abdomen loss of appetite (loss of appetite (anorexiaanorexia) ) unexplained weight gain or loss unexplained weight gain or loss pain during intercourse pain during intercourse vaginal bleeding in post-menopausal women vaginal bleeding in post-menopausal women

Page 23: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DiagnosisDiagnosis

a complete medical history to assess all the a complete medical history to assess all the risk factors risk factors

a thorough bi-manual pelvic examination a thorough bi-manual pelvic examination CA-125 assay CA-125 assay one or more various imaging procedures one or more various imaging procedures a lower GI series, or a lower GI series, or barium enemabarium enema diagnostic laparoscopy diagnostic laparoscopy

Page 24: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

PrognosisPrognosis

Stage I: Cancer is confined to one or both ovaries. Stage I: Cancer is confined to one or both ovaries. Stage II: Cancer is found in one or both ovaries Stage II: Cancer is found in one or both ovaries

and/or has spread to the uterus, fallopian tubes, and/or and/or has spread to the uterus, fallopian tubes, and/or other body parts within the pelvic cavity. other body parts within the pelvic cavity.

Stage III: Cancer is found in one or both ovaries and Stage III: Cancer is found in one or both ovaries and has spread to lymph nodes or other body parts within has spread to lymph nodes or other body parts within the cavitythe cavity

Stage IV: Cancer is found in one or both ovaries and Stage IV: Cancer is found in one or both ovaries and has spread to other organs such as the liver or lung. has spread to other organs such as the liver or lung.

Page 25: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

PrognosisPrognosis

Stage I cancer 95% survival rate at 5 years Stage I cancer 95% survival rate at 5 years post diagnosispost diagnosis

Stages III and IV may have a survival rate of Stages III and IV may have a survival rate of 17-30% at five years post-diagnosis. 17-30% at five years post-diagnosis.

Page 26: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Cervical CancerCervical Cancer

Worldwide, it is the second-most common Worldwide, it is the second-most common cancer of women. cancer of women.

Human papilloma virus (HPV) infection is Human papilloma virus (HPV) infection is responsible for >90% of the cases of cervical responsible for >90% of the cases of cervical cancer cancer

An effective vaccine for the two most common An effective vaccine for the two most common strains of HPV has recently been licensed strains of HPV has recently been licensed

Page 27: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Genital warts (HPV)Genital warts (HPV)

Page 28: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Normal CervixNormal Cervix

Page 29: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.
Page 30: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Cervical CancerCervical Cancer

Page 31: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DiagnosisDiagnosis

The early stages of cervical cancer may be The early stages of cervical cancer may be completely asymptomaticcompletely asymptomatic

Vaginal bleeding, contact bleeding or (rarely) Vaginal bleeding, contact bleeding or (rarely) a vaginal mass may indicate the presence of a vaginal mass may indicate the presence of malignancy malignancy

In advanced disease, metastases may be In advanced disease, metastases may be present in the abdomen, lungs, or elsewhere. present in the abdomen, lungs, or elsewhere.

Page 32: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DiagnosisDiagnosis

Diagnosis is made by doing a biopsy of the Diagnosis is made by doing a biopsy of the cervix.cervix.

Often involves colposcopy, or a magnified Often involves colposcopy, or a magnified visual inspection of the cervix aided by using visual inspection of the cervix aided by using an acetic acid (e.g. vinegar) solution to an acetic acid (e.g. vinegar) solution to highlight abnormal cells on the surface of the highlight abnormal cells on the surface of the cervix.cervix.

A Pap smear is insufficient for the diagnosis. A Pap smear is insufficient for the diagnosis.

Page 33: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

ColposcopyColposcopy

Page 34: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

TreatmentTreatment

Prevention may be the best treatmentPrevention may be the best treatment Merck has developed a vaccine against four Merck has developed a vaccine against four

strains of HPV, called Gardasil.strains of HPV, called Gardasil. Targeted at girls and women of age 9 to 26.Targeted at girls and women of age 9 to 26. Vaccine only works if given before infection Vaccine only works if given before infection

occurs. occurs. They are targeting girls before they begin They are targeting girls before they begin

having sex.having sex.

Page 35: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Uterine CancerUterine Cancer

Uterine cancer is the most common cancer of Uterine cancer is the most common cancer of the female reproductive systemthe female reproductive system

There are two different types of uterine cancer:There are two different types of uterine cancer: endometrial cancer endometrial cancer uterine sarcoma (less common)uterine sarcoma (less common)

Page 36: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Endometrial CancerEndometrial Cancer

Page 37: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Risk FactorsRisk Factors Obesity Obesity Use of Tamoxifen Use of Tamoxifen Use of unopposed estrogen Use of unopposed estrogen Hypertension (high blood pressure) Hypertension (high blood pressure) Polycystic ovarian syndrome and/or skipping menstrual Polycystic ovarian syndrome and/or skipping menstrual

periods for months at a time periods for months at a time Family history of endometrial, ovarian or colon cancer Family history of endometrial, ovarian or colon cancer Never having had children Never having had children Menopause at a late age Menopause at a late age Endometrial hyperplasia (excessive build up of the uterine Endometrial hyperplasia (excessive build up of the uterine

lining) lining) DiabetesDiabetes

Page 38: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Signs and SymptomsSigns and Symptoms

Bleeding after menopause (experienced by Bleeding after menopause (experienced by over 90% of endometrial cancer patients) over 90% of endometrial cancer patients)

Change in bowel or bladder habits and/or pain Change in bowel or bladder habits and/or pain during intercourse during intercourse

A thickened endometrial lining (which can be A thickened endometrial lining (which can be seen on an ultrasound of the uterus)seen on an ultrasound of the uterus)

Page 39: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

PrognosisPrognosis

The American Cancer Society estimates that 41,200 The American Cancer Society estimates that 41,200 women will be diagnosed with uterine cancer in women will be diagnosed with uterine cancer in 2006, and of those 7,350 will die. 2006, and of those 7,350 will die.

A woman’s chance of developing this cancer through A woman’s chance of developing this cancer through out her life time is about 1 in 38. out her life time is about 1 in 38.

This cancer is 40% more prominently found in white This cancer is 40% more prominently found in white women.women.

On average the five-year survival rate is at 84%, and On average the five-year survival rate is at 84%, and this percentage increases if the cancer is detected in this percentage increases if the cancer is detected in early stages. early stages.

Page 40: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Menopause/HRTMenopause/HRT

Menopause occurs as the ovaries stop Menopause occurs as the ovaries stop producing estrogen, causing the reproductive producing estrogen, causing the reproductive system to gradually shut down. system to gradually shut down.

Technically, Technically, menopausemenopause refers to the cessation refers to the cessation of mensesof menses

The average onset of menopause is 50.5 years The average onset of menopause is 50.5 years

Page 41: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

MenopauseMenopause

Page 42: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Sign and SymptomsSign and Symptoms

The clinical features of menopause are caused The clinical features of menopause are caused by the lessening in the amount of estrogen in by the lessening in the amount of estrogen in the woman's body.the woman's body. hot flashes, hot flushes, including night sweats hot flashes, hot flushes, including night sweats sleep disturbances sleep disturbances

Page 43: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.
Page 44: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Sign and SymptomsSign and Symptoms

Urogenital atrophyUrogenital atrophy dyspareuniadyspareunia itching itching dryness dryness bleeding bleeding urinary frequency urinary frequency urinary urgency urinary urgency urinary incontinenceurinary incontinence

Page 45: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Sign and SymptomsSign and Symptoms

SkeletalSkeletal osteoporosisosteoporosis joint, muscle pain joint, muscle pain back pain back pain

Skin, soft tissueSkin, soft tissue breast atrophy breast atrophy skin thinning skin thinning decreased elasticity decreased elasticity

Page 46: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Sign and SymptomsSign and Symptoms

PsychologicalPsychological mood disturbance mood disturbance irritability irritability fatiguefatigue decreased libido decreased libido memory loss memory loss

Page 47: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Treatment OptionsTreatment Options While menopause is a natural stage of life, some While menopause is a natural stage of life, some

symptoms may be alleviated through medical symptoms may be alleviated through medical treatments. treatments.

Most notably, Hormone Replacement Therapy Most notably, Hormone Replacement Therapy (HRT), has been used to reduce osteoporosis.(HRT), has been used to reduce osteoporosis.

A large, randomized, controlled trial (the Women's A large, randomized, controlled trial (the Women's Health Initiative) found that women undergoing HRT Health Initiative) found that women undergoing HRT had an increased risk of:had an increased risk of: Alzheimer's diseaseAlzheimer's disease Breast cancerBreast cancer Heart disease Heart disease StrokeStroke

Page 48: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Heart DiseaseHeart Disease

Heart disease isn't just a man's disease.Heart disease isn't just a man's disease. Heart attack, stroke and other cardiovascular Heart attack, stroke and other cardiovascular

diseases are devastating to women, too. diseases are devastating to women, too. Coronary heart disease, is the leading cause of Coronary heart disease, is the leading cause of

death for American women. death for American women. Nearly twice as many women in the United Nearly twice as many women in the United

States die of heart disease and stroke as from States die of heart disease and stroke as from all forms of cancer, including breast cancer. all forms of cancer, including breast cancer.

Page 49: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Heart DiseaseHeart Disease

Page 50: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Heart DiseaseHeart Disease

Page 51: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Heart Disease Risk FactorsHeart Disease Risk Factors Increasing age — As women grow older, their risk of Increasing age — As women grow older, their risk of

heart disease and stroke begins to rise and keeps heart disease and stroke begins to rise and keeps rising with age. rising with age.

Heredity (family history) — Both women and men Heredity (family history) — Both women and men are more likely to develop heart disease or stroke if are more likely to develop heart disease or stroke if their close blood relatives have had them. their close blood relatives have had them.

Race is also a factor. Race is also a factor. Black women have a greater risk of heart disease and Black women have a greater risk of heart disease and

stroke than white women. stroke than white women. Previous heart attack Previous heart attack

Women who've had a heart attack are at higher risk of Women who've had a heart attack are at higher risk of having a second heart attack. having a second heart attack.

Page 52: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Risk FactorsRisk Factors Tobacco smoke Tobacco smoke High blood cholesterol High blood cholesterol 

Research has shown that low levels of HDL cholesterol Research has shown that low levels of HDL cholesterol seem to be a stronger risk factor for women than for men. seem to be a stronger risk factor for women than for men.

High blood pressure High blood pressure  Physical inactivityPhysical inactivity Obesity and overweightObesity and overweight Diabetes mellitusDiabetes mellitus

Compared to women without diabetes, women with Compared to women without diabetes, women with diabetes have from diabetes have from two to six timestwo to six times the risk of heart the risk of heart disease and heart attack disease and heart attack

Page 53: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Diabetes mellitusDiabetes mellitus

About 10 million American women have About 10 million American women have diabetesdiabetes

3 million of them don’t even know it 3 million of them don’t even know it Diabetes increases a woman’s risk of Diabetes increases a woman’s risk of

developing heart disease 3- to 7-fold, developing heart disease 3- to 7-fold, compared with 2- to 3-fold in men compared with 2- to 3-fold in men

Women with diabetes are 2 to 5 times more Women with diabetes are 2 to 5 times more likely to die of heart disease than women likely to die of heart disease than women without diabetes without diabetes

Page 54: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DiabetesDiabetes

Page 55: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Diabetes in PregnancyDiabetes in Pregnancy

Nearly all pregnant women should be tested for Nearly all pregnant women should be tested for gestational diabetes during the 24th to 28th weeks of gestational diabetes during the 24th to 28th weeks of pregnancy. pregnancy.

Gestational diabetes occurs in about 4% of Gestational diabetes occurs in about 4% of pregnancies pregnancies

Causes macrosomia which can lead to:Causes macrosomia which can lead to: shoulder injuries during birth, shoulder injuries during birth, breathing problems, breathing problems, higher risk of developing obesity and type 2 diabetes later higher risk of developing obesity and type 2 diabetes later

in life.in life.

Page 56: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Diabetes in PregnancyDiabetes in Pregnancy

Page 57: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DepressionDepression

Women experience Women experience depression twice as often depression twice as often as men as men

Women with depression Women with depression more frequently more frequently experience guilt, anxiety, experience guilt, anxiety, increased appetite and increased appetite and sleep, weight gain and sleep, weight gain and comorbid eating comorbid eating disorders. disorders.

Page 58: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Risk FactorsRisk Factors Family history of mood disordersFamily history of mood disorders Personal past history of mood disorders Loss of a Personal past history of mood disorders Loss of a

parent before the age of 10 yearsparent before the age of 10 years Childhood history of physical or sexual abuseChildhood history of physical or sexual abuse Use of an oral contraceptive, especially one with a Use of an oral contraceptive, especially one with a

high progesterone contenthigh progesterone content Use of gonadotropin stimulants as part of infertility Use of gonadotropin stimulants as part of infertility

treatmenttreatment Persistent psychosocial stressors (e.g., loss of job)Persistent psychosocial stressors (e.g., loss of job) Loss of social support system or the threat of such a Loss of social support system or the threat of such a

lossloss

Page 59: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DiagnosisDiagnosis

Psychological SymptomsPsychological Symptoms Depressed moodDepressed mood Reduction of interest and/or pleasure in activities, Reduction of interest and/or pleasure in activities,

including sexincluding sex Feelings of guilt, hopelessness and worthlessness Feelings of guilt, hopelessness and worthlessness Suicidal thoughts (recurrent)Suicidal thoughts (recurrent)

Page 60: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

DiagnosisDiagnosis

Physical SymptomsPhysical Symptoms Sleep disturbance (insomnia or hypersomnia)Sleep disturbance (insomnia or hypersomnia) Appetite/weight changesAppetite/weight changes Attention/concentration difficultiesAttention/concentration difficulties Decreased energy or unexplained fatigue Decreased energy or unexplained fatigue Psychomotor disturbancesPsychomotor disturbances

Page 61: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Treatment StrategiesTreatment Strategies

Identify any relationship between depression Identify any relationship between depression and menstruation, pregnancy, the perinatal and menstruation, pregnancy, the perinatal period or the perimenopausal period.period or the perimenopausal period.

A possible relationship between depression A possible relationship between depression and medications such as birth control pills or and medications such as birth control pills or agents used in hormone replacement therapy agents used in hormone replacement therapy must also be explored.must also be explored.

If there is a link to any treatable cause of If there is a link to any treatable cause of depression, it should be addressed first. depression, it should be addressed first.

Page 62: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Treatment ConsiderationsTreatment Considerations Absorption of antidepressants may be enhanced in Absorption of antidepressants may be enhanced in

women because they secrete less gastric acid than women because they secrete less gastric acid than men. men.

In addition, gastrointestinal transit time may be In addition, gastrointestinal transit time may be slower in women, especially during high slower in women, especially during high progesterone phases of the reproductive cycle, thus progesterone phases of the reproductive cycle, thus enhancing the absorption of antidepressant enhancing the absorption of antidepressant medications. medications.

Another difference is the higher ratio of body fat to Another difference is the higher ratio of body fat to muscle in women; muscle in women; this ratio becomes even greater with age and increases the this ratio becomes even greater with age and increases the

volume of distribution for many drugs. volume of distribution for many drugs.

Page 63: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

Treatment ConsiderationsTreatment Considerations

Because of these biologic differences, Because of these biologic differences, antidepressant plasma concentrations may be antidepressant plasma concentrations may be higher in women. higher in women.

Thus, female patients with depression may Thus, female patients with depression may require lower dosages of antidepressants than require lower dosages of antidepressants than their male counterparts. their male counterparts.

Also, women frequently experience sexual Also, women frequently experience sexual side effects, they generally do not report these side effects, they generally do not report these effects unless specifically asked. effects unless specifically asked.

Page 64: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

SummarySummary

Women have many issues that of course Women have many issues that of course require special attention.require special attention.

Important not to forget about the similar Important not to forget about the similar disease processes that could affect them as disease processes that could affect them as equally as their male counterparts.equally as their male counterparts.

And finally……..My favorite woman!!!And finally……..My favorite woman!!!

Page 65: Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

We Are Outta Here!We Are Outta Here!