Women's health

The field of women's health is concerned with health issues and aging changesrelating to postpubescent females. During adolescence (ages 12-20), a youngwoman's body begins to change as puberty sets in and menstrual cycles begin.At the same time, teenage girls also have changing nutritional needs and susceptibility to diseases.

Teenage girls need more calories and nutrients than at any other time in their lives as their body mass will almost double. Bone development and calcium requirements really peak during these years; in fact, how much calcium a girlgets now will establish the lifelong pattern for how healthy her bones become. Yet this dramatic increase in food requirements comes at a time when many girls develop irregular eating habits. Concerned as their bodies begin to change and become more mature, many teenagers start to diet. A few girls take dieting too far and develop eating disorders.

As young girls start to make their own food choices, many stop drinking milkand switch to soda (which further depletes calcium). Girls who don't drink milk should at least eat three daily servings of calcium-rich food (low-fat yogurt, cheese, cottage cheese and ice cream, salmon with bones).

The onset of adolescence may carry with it an emotional impact to health thatcould give rise to eating disorders, unprotected sex, and substance abuse. It is not uncommon for some young women to experience a drop in self-esteem due to peer pressures and the biological changes they are experiencing.

In addition, teenage girls are vulnerable to a range of other serious problems as well, including AIDS, drug addiction, early pregnancy, violence, tobacco, alcohol, and overexposure to the sun.

A girl should have her first Pap smear once she becomes sexually active or when she turns 18--whichever comes first. A Pap smear is a simple, painless test in which the doctor obtains some cells from the cervix during a pelvic exam. The cells are sent to a lab, which examines them for any abnormalities. This cancer screening test is the most effective ever devised for the early detection of cancer. In fact, since the Pap exam began after World War II, deathsfrom uterine cervical cancer have dropped 70% in the United States. It's clear that Pap smears save lives, since 80% of women who die from cervical cancer haven't had a Pap smear in the past five years.

Many doctors recommend that a girl get her first pelvic exam by age 18 (or when she becomes sexually active, if that's sooner). There are a number of different specialists who have special training in the health and disease of a woman's reproductive organs, including pediatricians, gynecologists, family doctors, and nurse practitioners. Teenage girls who decide to go to doctor's office may need to involve an adult for insurance purposes. However, girls who can't involve their parents may visit a health clinic which has fully-trainedstaffs to care for teenagers (usually at a lower cost).

To be really helpful, a physical should include at least some of the following:

  • blood glucose check: This blood test screens for diabetes or hypoglycemia
  • Blood pressure check: This basic test almost every doctor willdo for every visit
  • Breast exam: an annual manual exam is an essential screen for breast cancer
  • Complete blood count (CBC): This test screens for anemia and measures blood components
  • Immunizations: at leastsome of these vaccinations should be discussed depending on age
  • Pap smear: usually done as part of an annual pelvic exam
  • Skin-cancer check: This visual inspection of your entire body checks for skin cancer should bedone at least every three years (or more if there is a family history of skin cancer or many moles)
  • TB test: This test checks for exposure to tuberculosis and should be done every year for people at high risk, or as suggested by the doctor
  • Urinalysis: Screens for urinary tract infections and kidney disorders, in addition to other diseases (such as diabetes)

Young Adulthood (20-39)

As a young woman enters adulthood, she must begin to integrate different liferoles. Health issues now tend to reflect career and marital decisions, as well as the special health needs associated with pregnancy and childbirth. Themultiple roles that many women assume leave her particularly susceptible to chronic fatigue syndrome and depression. This is also the time when women aremost susceptible to immune system disorders such as lupus and rheumatoid arthritis. They also may be at risk for diabetes and other chronic conditions dueto persistent lack of exercise and poor diet. Finally, a woman may fall victim to domestic violence at this time of her life. Additional health concernsfor adult women include weight gain, breast cancer, ovarian cancer, and skincancer.

Young women in their 20s and 30s have a range of new health concerns to consider with each new decade. While cancer is still relatively unlikely in the second and third decade, infectious diseases, sexually transmitted diseases, and issues of birth control, pregnancy and infertility move into prominence. Many women don't realize that as they enter their mid-to late 30s, the symptomsthey may suspect to be Premenstrual Syndrome (PMS) may actually be the onsetof early menopause.

As a woman enters her 20s, her body is producing estrogen, progesterone and androgen at peak levels in preparation for pregnancy, adding both fat and muscle. Metabolism rate is high, so most women can get away with the occasional cheeseburger. Most young women have strong bones and good flexibility and should begin regular exercise now. Skin is young and healthy, with plenty of collagen and elastin to keep it looking strong and flexible. Women this age should try to avoid skin-damaging habits like smoking and drinking, and start nowwith a routine of good cleansing, moisturizing and sunscreen so there is lessto worry about with wrinkles and skin cancer later on.

As women move into their 30s, estrogen and progesterone levels begin to fall,which means women are gradually less and less fertile. This doesn't mean they can't get pregnant, however. Indeed, the number of first-time moms in their30s has more than tripled since 1975. Metabolism begins to slow down in the30s, as the percentage of lean muscle tissue in the body decreases and fat increases. Women will need to be sure to start exercising now as it will becomeeasier to put on weight--even a gain of five to 10 pounds can mean a significant increase of health problems. While women in their 30s are still young, they may start to see some wrinkles around the eyes and mouth as the rate of facial skin-cell renewal starts to slow down. Exfoliating may help here.

Women this age should be sure to eat a healthy, balanced diet and avoid fad diets. After age 30, women's bones begin to lose calcium, and one in four American women will develop osteoporosis in her lifetime. To avoid this, women should take at least 1500 mg. calcium a day to prevent hip and spine fractures;vitamin D to help bones absorb calcium and maintain bone density, and vitamin C to help absorb calcium and iron to maintain tissues, bones and teeth (andhelp prevent cataracts).

A woman's family doctor provides comprehensive medical care for everyone in the family, treating all problems and making referrals to specialists as necessary. Some specialists are qualified to treat particular health concerns of women, including internist (a specialist in the diagnosis and treatment of adult diseases, especially those related to the internal organs); reproductive endocrinologist (an endocrinologist who specializes in problems involving reproductive hormones); specialist in hormone replacement therapy.

Women in their 20s and 30s should have a number of tests, including:

  • Breast Exam: Yearly (usually at the same time as the Pap smear and pelvic exam)
  • Pelvic exam: Every other year
  • Sexually transmitted diseasescheck: Every year
  • Mammogram: a "baseline" mammogram sometime betweenage 30 and 35 (those with a family history of breast cancer should have a first mammogram at age 30 and then another mammogram every year or two thereafter as a doctor recommends)
  • Pap smear: Smear every other year beginning with onset of sexual activity
  • Blood work: Every five years
  • Cholesterol: Every five years after age 35 (more often if level is above 200)
  • Physical: Every one to three years
  • Breast self-exam: Everymonth
  • Blood pressure: Blood pressure should be checked every other year after age 30
  • Electrocardiogram: A baseline ECG should be done in the 30s followed by another at age 45 to check the health of the heart
  • Stool screening: Check for fecal occult blood every other year

Vaccines for your 20s-30s

While most vaccinations are given to young children, certain vaccines are still important during the 20s and 30s. The first vaccine against Lyme disease (LYMErix) has recently been approved by the FDA; a second vaccine (ImuLyme) isstill awaiting FDA approval. Both vaccines are designed to kill the disease-causing spirochete within the tick before it can enter the blood. The vaccinerequires three injections over a 12-month period to build immunity. It has not yet been determined whether additional booster shots will be needed in subsequent years. Women reasonably at risk for Lyme disease (or who live in an area where the disease is common) should talk to a doctor about having this vaccination. These vaccines can't be used to treat actual symptoms of Lyme disease, and they aren't effective against other tick-borne diseases (such as ehrlichiosis, babesiosis and Rocky Mountain spotted fever).

Historically, the flu shot was recommended for older patients or those with chronic conditions, but new research shows that younger people are also at risk for complications from influenza, and should be sure to get a yearly flu shot. Each year scientists at the World Health Organization and the Centers forDisease Control predict which strains of the flu should be in that year's flu shot; if they're correct, the shot is up to 90% effective.

Women should continue to get a tetanus shot every 10 years to protect againsttetanus, a life-threatening central nervous system disease contracted when bacteria invades an open wound.

Mature Years (40 to 64)

What were once considered the "middle ages" are now rapidly becoming the bestyears of a woman's life, as she settles into her career and her life. Nevertheless, these years also can be stressful as women in their 40s and 50s become sandwiched between raising a family and caring for aging parents. The pressures involved in juggling obligations of daughter, wife, mother and career can be overwhelming, and can lead to stress-related disorders such as depression, high blood pressure, and heart disease. Now's the time to be sure to get enough rest, exercise and eat a good diet--and be sure to keep up with a social support network.

One of the biggest changes that occur during these years is the onset of menopause. The beginning of menopause symptoms (called the perimenopause) may occur as early as the late 30s or early 40s in some women, and last for a few months to five years or more. At menopause, a woman must contend with associated changes in her cardiovascular system, bones, and central nervous system.

In anticipating menopause, a woman may experience a sense of urgency in making life decisions, such as bearing a child or making retirement plans. She mayalso have to make decisions about undergoing hormone replacement therapy totreat menopausal symptoms, and about managing risks associated with estrogendeficiency such as heart disease and osteoporosis. Besides heart disease, diabetes, colon cancer, skin cancer, and cataracts and glaucoma, women between the ages of 45 and 65 must also be concerned with their susceptibility to breast cancer and ovarian cancer.

According to the National Institutes of Health, exercise is the most effective anti-aging pill ever discovered. Women facing menopause may find that exercise is the single best thing they can do to boost your physical and emotionalhealth. According to a 1997 Iowa study, women who exercised had a 30% lowerdeath rate than those who didn't. Among other things, exercise can regulate cholesterol, control weight, strengthen bones, lower cancer risk, ease depression, and ease unpleasant symptoms of menopause.

Women in this age bracket need breast and rectal exams every year. Other important tests include:

  • Sigmoidoscopy: This procedure to inspect the last12 inches of the large intestine should be done about every four years afterage 50
  • Mammogram: Every one or two years after age 35 for women witha family history of breast cancer; every year for all women over age 50
  • Stool screening: Check for fecal occult blood every three years until age50; after 50, get an annual exam (have the test every year after age 40 if there are predisposing factors or a family history for rectal/colon cancer)
  • Electrocardiogram: An ECG at age 45 to check the health of your heart
  • Pap smear: yearly (even after menopause or hysterectomy)
  • Bloodwork: Every five years (including a cholesterol check)
  • Physical: Every one to three years
  • Bone density baseline: Menopausal women shouldconsider a baseline if considering or taking hormone replacement or corticosteroids, or there is a fractured vertebrae
  • eye exam: Every five yearsuntil age 50; after this, every four years (including glaucoma screen)

Unfortunately, 80% of the 20 million American women with osteoporosis have noidea they have the disease. There are several kinds of brief tests to measure your bone density. The two most common are the dual-energy X-ray (DEXA) absorptiometry and the dual-photon absorptiometry. The machines measure currentbone mineral content at hip, spine or wrist (the most common sites of fractures by osteoporosis) as the woman lies fully clothed on a table as the scannerpasses above, emitting only very slight radiation. The DEXA can help show whether a woman is losing, maintaining or building bone mass. The bone densityis compared with another woman of similar age and size, and also with the estimated peak bone density of a healthy young adult woman. Generally, the loweryour bone density, the higher your risk for a fracture.

Bone density also can be checked with an ultrasound of the heel; it's much faster and less expensive than densitometry, and is radiation free. Alternatively, a CAT scan or a single-photon densitometry can both evaluate bones in thewrist. A lab test can also check the amount of calcium in the urine.

Not all insurance companies pay for these tests, which range from inexpensiveto very expensive. (For example, the dual photon test can cost from $50 to $250, depending on where in the country the test is done).

Women in this age group should continue to get appropriate vaccinations in order to continue protection against some illnesses. These include the flu shot, Lyme disease shot, and tetanus booster. (Two out of three people over age 50 lack adequate immunity to tetanus, according to researchers at the University of Florida.) In addition, a one-time pneumococcal (pneumonia) vaccine to prevent infection with Streptococcus pneumoniae may be recommended if the woman has a chronic illness or a weakened immune system. The shot is also recommended among some Alaska Native and American Indian populations. One shot provides permanent immunity.

Postmenopause Years (65 and older)

In the postmenopausal phase of life (ages 65 and up), a woman's health largely depends on freedom from conditions that can largely be controlled through continued good nutrition and exercise, which include heart disease, osteoporosis, and cancer.

For women in their 60s, the balance between female hormones (estrogens) and male hormones (androgens) shifts. As a result:

  • hair on your head may thin
  • body hair may get darker or thicker
  • hairs may appear on your face or chin
  • sexual interest may wane.

Because women statistically outlive men, many postmenopausal women experiencebereavement due to the loss of their spouses. At the same time, many women become burdened by the accumulation of chronic ailments which may make them dependent upon more than one medical specialist. Ailments that postmenopausal woman frequently experience include osteoarthritis, loss of hearing orvision;accidental falls; influenza and pneumonia; gastrointestinal ailments; inability to adapt to heat and cold; incontinence; and thyroid problems.

The weight gain during your 40s and 50s may slow, but if a woman is already carrying too much weight in the abdomen, she runs the risk of high blood pressure, heart disease and diabetes. Exercise (especially weight training) can help prevent all three of these conditions, while building strength and muscletone.

As a woman approaches her 70s, she may lose her appetite as her metabolism slows down. Be sure to keep taking a multivitamin and calcium supplement to combat loss of muscle strength and bone density. Keep moderately active to stayflexible and strong. The skin also begins to change as cells in the top layerbecome irregular. Precancerous lesions and pigment changes ("liver spots") may begin to appear, with skin getting thinner and wrinklier.

In addition to yearly rectal and breast exams, stool screening, urinalysis, and mammograms, diagnostic tests that are important at this age include:

  • Thyroid tests: measure the level of thyroid stimulating hormone (TSH), andcheck for tumors or thyroid malfunction
  • Hearing tests: A yearly hearing exam
  • Eye tests: Every four years
  • Pap smear: Every year, even after menopause or hysterectomy (some experts say women over 65 who have had no abnormal Pap smears may schedule an exam every three years)
  • Sigmoidoscopy: This procedure to inspect the last 12 inches of the large intestine should be done about every four years
  • Blood work: Every five years(including a cholesterol check)
  • Physical: Every one to three years

As women age, it's crucial that they maintain their social support network and stay busy and involved with life. Studies are clear that memory stays sharpwhen an older person is surrounded by an enriched environment. Spending timewith family, friends--even pets--will keep women healthier and help stave off depression. Women who do get sick (even chronically ill) or suffer life crises, but who have social support will have a better chance of surviving.

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