Preventive health for Women

Preventive health for Women

All women should opt for a well woman check, even if they are not really facing any medical problem. In a well woman check, the gynecologist includes

• Health screening
• Risk screening
  • Depression screening
  • Domestic violence
  • Substance Abuse
• Vaccinations
• Cancer screening
• STD testing
• Weight control
• Birth control
• Preconception counseling
• Menstrual issues

Rubella vaccination

• All girls should receive the vaccine before planning pregnancy
• Should avoid becoming pregnant until one month (28 days) after receiving the MMR vaccine and, ideally, not until your immunity is confirmed by a blood test.(CDC)

T dap Vaccine

• This is given to pregnant women in the third trimester to give immunity to both the mother and child against Diphtheria, tetanus and whooping cough
• If Tdap is not administered during pregnancy, Tdap should be administered immediately postpartum.
• Vaccination of family members is also done to protect the newborn (cocooning)

Influenza vaccination

• Routine influenza vaccination is recommended for all above 6 months of age during influenza season (October - March)
• It is given to pregnant women after the first trimester

HPV Vaccine -It is a vaccine against cervical cancer and warts

• The target age for vaccination is 11–12 years for girls and boys.
• before age 15 years receive 2 doses of HPV vaccine 6 months apart
• Bivalent, quadrivalent, and 9-valent vaccines are recommended for females aged 9–26 years and quadrivalent and 9-valent vaccines are recommended for males aged 9–26 years.
• 9valent Human Papillomavirus Vaccine is recommended by ACIP. It has been licensed by the FDA in Dec 2014, but not available in India yet.
• High efficacy for prevention of greater than or equal to CIN 2, VIN 2 or 3, and VAIN 2 or 3 due to HPV 31, 33, 45, 52, 58.
• Antibody titer against HPV 6, 11, 16, and 18 was not reduced

Prevention of cervical cancer

Cervical cancer is the second most common cancer in women in India. It is the most preventable cancer as it has a very slow progress and has a vaccine against it.To prevent it, one should

• Stop smoking
• Barrier contraception-always use Protection(condoms)
• HPV Vaccination
  • 9-45years
  • 3 doses over 6 months
  • 2 doses if less than 15years
  • Avoid in pregnancy
• Regular Pap smear-It is a routine test done by a gynecologist in the OPD. It is not painful and is a very effective test in early diagnosis of cervical cancer.

Screening for cervical cancer-Pap smear test. Young women should also visit the gynecologist for regular screening.

• Less than 21 years age
  • Pap test-no need
  • STD testing yearly if sexually active
• Age 21-29
  • Pap smear 3yearly if sexually active
  • Pap smear 3yearly if sexually active
• Above 30
  • Pap smear 3yearly
  • Co-testing HPV 5yrs if want to lengthen the screening interval
• Annual pap testing if :
  • High risk for cervical cancer(HIV infection, organ transplant, or long-term steroid use)
  • Positive High risk HPV, high grade cervical dysplasia CIN 2, 3 or CIS
  • Hysterectomy for pre malignant condition or malignancy
• Screening for Breast cancer-This is done by Self breast examination and of the armpit area, monthly after periods by women themselves after the age of 20.
• Breast examination by a gynecologist may be done every 3 years in the age 20-35 and then annually after 35.
• But the most important tool for Breast cancer screening is mammography.It is a specialised X-ray of the breast, to be done after 40years of age.
  • The American college ACOG recommends
    • Mammography screening should be offered annually to women beginning at age 40.
  • American Academy of Family Physicians (AAFP)
    • Age less than 50 individualize considering patient’s context and risk factors.
    • Ages 50 and 74- biennial screening.
  • The Royal college, UK and NHS
    • targets women between 50 and 70 years, who are offered routine screening every three years.
    • Women aged 70 may be screened on request.
• Ovarian cancer-It is a rare cancer, but is mostly diagnosed at a late stage.
  • Its incidence is between 5.4 and 8.0 per 100,000 population
  • Who’s at high risk
    • BRCA1 or 2 positivity
    • First degree relative with ovarian cancer
  • There is no screening except annual pelvic examination
  • Annual ca125 blood test
  • Ultrasound every 2 years
• Lung cancer
  • It is the most common cancer worldwide.The screening depends on risk factors, especially smoking.
  • If a person has a 30 pack year smoking history and hasn’t quit within 15 years of turning 50, low dose CT scan annually is recommended until 15 years of cessation
  • Life expectancy 10 years less than non smokers
  • 90% deaths preventable if quit by 40
  • Smokeless tobacco can also cause cancer
• Colon cancer
  • Third most common cancer in men and women
  • Screening in persons at average risk should begin at 50 years
  • Options for screening
    • high-sensitivity fecal occult blood testing annually
    • flexible sigmoidoscopy every five years with high-sensitivity fecal occult blood testing every three years
    • colonoscopy every 10 years
• Bone health
  • BMD test should be done if,
    • Age more than 65
    • Broke a bone before 50
    • Menopausal with risk factors
    • Positive family history
    • Premature menopause
    • Infrequent periods
  • Osteoporosis happens in women, especially after menopause.It could be more severe if the woman has
    • Exercise induced loss of periods
    • Low BMI
    • Medical issues( thyroid, prolactin, malabsorption, arthritis)
    • Medication(steroids, antiepileptics, heparin)
    • Immobility
    • Alcohol, smoking
    • Low calcium , vitamin D
  • Prevention of Osteoporosis
    • Lifestyle modifications- reduction in smoking, alcohol, physical inactivity, and steroid intake .
    • Weight bearing and muscle strengthening exercises-
    • 30 minutes of regular exercises at least 4 days a week is recommended.
    • Dietary calcium supplementation for women < 50 yrs is 1000mg/day and for women > 50 yrs is 1200 mg/day.
    • Vit. D supplementation for women < 50 yrs is 400-800IU/day and for> 50 yrs is 800-1000IU/day
• Heart disease : This is the most common reason for demise in women after menopause.It needs to be evaluated in preventive health checks with a TMT and an echocardiography
• Annual health check
  • Physical examination
  • Weight (BMI)
  • Blood pressure
• Labs
  • Cholesterol
  • Triglycerides
  • Diabetes screen
• Prevention
  • Diet
  • Exercise
  • Quit smoking
  • Cholesterol lowering medication
• Get regular, intentional physical activity.
• At least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
• Reduce your lifetime weight gain by limiting your calories and getting regular physical activity.
• Avoid or limit your alcohol intake.

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