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Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
Medical Screenings for Women
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Medical Screenings for Women

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Dr. Andrea Fullerton and Dr. Elda Perales presented to the Via Christi Women's Connection November luncheon.

Dr. Andrea Fullerton and Dr. Elda Perales presented to the Via Christi Women's Connection November luncheon.

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  • 1. Medical Screenings for Women Andrea Fullerton, MD Elda Perales, MD
  • 2. Objectives <ul><li>Discuss types of physicians who provide annual examinations </li></ul><ul><li>Better understand available screening tests for women </li></ul><ul><li>Review common health concerns by age categories </li></ul>
  • 3. Who should I see for my annual visit? <ul><li>Family medicine physician </li></ul><ul><li>Internal medicine physician </li></ul><ul><li>Obstetrician-gynecologist </li></ul><ul><li>Team approach </li></ul>
  • 4. Annual Exam Health Care Services <ul><li>Primary &amp; Preventive Services </li></ul><ul><ul><li>Age-specific routine assessment </li></ul></ul><ul><ul><li>Health status evaluation and counseling </li></ul></ul><ul><ul><ul><li>Fitness, nutrition, exercise </li></ul></ul></ul><ul><ul><li>Routine detection and prevention of disease </li></ul></ul><ul><ul><ul><li>Cardiovascular disorders, diabetes, cancer, smoking, emotional health </li></ul></ul></ul><ul><ul><li>Family planning </li></ul></ul><ul><ul><li>Preconception care </li></ul></ul><ul><ul><li>Menopausal management </li></ul></ul><ul><li>Obstetrics &amp; Gynecology Services </li></ul><ul><ul><li>Obstetric care </li></ul></ul><ul><ul><li>Evaluation and treatment of gynecologic &amp; breast conditions </li></ul></ul><ul><ul><li>Evaluation and treatment of incontinence </li></ul></ul><ul><ul><li>Evaluation and treatment of endocrine dysfunction and infertility </li></ul></ul>
  • 5. Periodic Assessments 13-18 years <ul><li>Annual Screening </li></ul><ul><ul><li>General physical health </li></ul></ul><ul><ul><ul><li>Hypertension </li></ul></ul></ul><ul><ul><ul><li>Cholesterol screening for those at high risk </li></ul></ul></ul><ul><ul><li>Psychological health </li></ul></ul><ul><ul><ul><li>Eating disorders, depression, other </li></ul></ul></ul><ul><ul><li>Tobacco use, alcohol and drug use/abuse </li></ul></ul><ul><ul><li>Sexual activity </li></ul></ul><ul><ul><li>Abuse – physical, emotional, sexual </li></ul></ul><ul><ul><li>School performance </li></ul></ul>
  • 6. Examinations <ul><li>Pelvic exam </li></ul><ul><ul><li>Only if abnormal bleeding, abnormal discharge or pelvic pain </li></ul></ul><ul><li>Examination of breasts and external genitalia for pubertal development </li></ul><ul><li>Discuss menstrual history </li></ul><ul><li>If sexually active STD screening offered </li></ul><ul><ul><li>Screened annually for chlamydia, gonorrhea, HIV </li></ul></ul><ul><ul><li>If indicated trichomonas, syphilis, hepatitis B &amp; C </li></ul></ul>
  • 7. Immunizations <ul><li>Tetanus-diptheria-pertussis (Tdap) booster </li></ul><ul><ul><li>Once between ages 11 and 16 </li></ul></ul><ul><ul><li>Then every 10 years </li></ul></ul><ul><li>Hepatitis B vaccine </li></ul><ul><ul><li>For those not previously immunized </li></ul></ul><ul><li>Meningococcal conjugate vaccine </li></ul><ul><ul><li>Once after age 11 </li></ul></ul><ul><li>Human papillomavirus vaccine </li></ul><ul><ul><li>Gardasil </li></ul></ul><ul><ul><li>Cervarix </li></ul></ul><ul><li>Other vaccines for high risk groups </li></ul>
  • 8. HPV Vaccines <ul><li>Gardasil protects against: </li></ul><ul><ul><li>Cervical cancer </li></ul></ul><ul><ul><li>Vulvar cancer </li></ul></ul><ul><ul><li>Genital warts </li></ul></ul><ul><li>Cervarix protects against: </li></ul><ul><ul><li>Cervical cancer </li></ul></ul><ul><ul><li>Vulvar cancer </li></ul></ul>Approved for 9-26 year olds, Ideal period 11-12 year olds
  • 9. Various Cancers Caused by HPV Parkin, D.M. (2006)
  • 10. Human Papillomavirus Vaccine (HPV) <ul><li>Reduces need for biopsies </li></ul><ul><li>Reduces invasive </li></ul><ul><li>procedures associated with </li></ul><ul><li>follow-up from abnormal </li></ul><ul><li>pap tests </li></ul><ul><li>FDA and CDC concede </li></ul><ul><li>HPV vaccine is safe and </li></ul><ul><li>effective </li></ul><ul><ul><li>Benefits continue to outweigh risks </li></ul></ul><ul><li>ACOG endorses </li></ul><ul><li>recommendation </li></ul>
  • 11. Periodic Screenings 19-39 Years <ul><li>History and physical examination </li></ul><ul><li>Breast examination </li></ul><ul><li>Pap smear (age 21) and pelvic examination </li></ul><ul><li>Discuss family planning and fertility issues </li></ul><ul><li>Discuss sexually transmitted disease screening and testing </li></ul>
  • 12. Pap Smears <ul><li>Dramatically decreased incidence </li></ul><ul><li>of cervical cancer </li></ul><ul><li>Start at age 21 </li></ul><ul><li>Every 1-2 years for ages 21-29 </li></ul><ul><li>Every 1-3 years for ages 30-plus </li></ul><ul><li>Discontinue between age 65-70 and if low risk </li></ul><ul><li>Discontinue after hysterectomy (for benign reason and if no prior high risk abnormal paps) </li></ul><ul><li>Still need pelvic examination at annual visit </li></ul>
  • 13. Preconception Counseling <ul><li>Education regarding </li></ul><ul><li>pregnancy expectations, </li></ul><ul><li>risks and care </li></ul><ul><li>Provide optimum </li></ul><ul><li>pregnancy outcome </li></ul><ul><ul><li>Review medications, medical problems, nutrition, exercise, substance use, immunizations, genetics </li></ul></ul>
  • 14. Sexually Transmitted Diseases Screenings <ul><li>Gonorrhea and Chlamydia </li></ul><ul><ul><li>Test with a swab sample from cervix or urethra, examination </li></ul></ul><ul><ul><li>Treat with antibiotics </li></ul></ul><ul><ul><li>Treat to prevent pelvic inflammatory disease (PID) </li></ul></ul><ul><li>Human Papillomavirus </li></ul><ul><ul><li>Can lead to genital warts, cancers </li></ul></ul><ul><ul><li>Vaccination available </li></ul></ul><ul><li>Syphilis </li></ul><ul><ul><li>Blood test and examination </li></ul></ul>
  • 15. STD Screenings <ul><li>Genital herpes </li></ul><ul><ul><li>Examination and possible blood test </li></ul></ul><ul><ul><li>Patient history </li></ul></ul><ul><li>Human Immunodeficiency Virus (HIV) </li></ul><ul><ul><li>Blood test </li></ul></ul><ul><li>Trichomonas </li></ul><ul><ul><li>Examination and vaginal swab </li></ul></ul><ul><li>Hepatitis B and C </li></ul><ul><ul><li>Blood test </li></ul></ul>
  • 16. Periodic Assessments 40-64 Years <ul><li>Pap smears continue as previously described </li></ul><ul><li>Mammography </li></ul><ul><ul><li>Yearly beginning at age 40 (ACOG) </li></ul></ul><ul><li>Lipid profile assessment </li></ul><ul><ul><li>Every 5 yrs beginning at age 45 </li></ul></ul><ul><li>Colonoscopy </li></ul><ul><ul><li>Starting at age 50 and every 10 yrs </li></ul></ul><ul><li>Diabetic assessment </li></ul><ul><ul><li>At 45 and every 3 yrs </li></ul></ul><ul><li>Thyroid check </li></ul><ul><ul><li>At age 50 and every 5 yrs </li></ul></ul>
  • 17. Perimenopausal Transition <ul><li>Ovaries begin to produce less </li></ul><ul><li>estrogen </li></ul><ul><li>Not enough estrogen to </li></ul><ul><li>thicken uterine lining – </li></ul><ul><li>menstruation stops </li></ul><ul><li>Ovulation Stops </li></ul><ul><li>Average age of onset is 46 </li></ul><ul><li>Average age of menopause is 51 </li></ul><ul><li>After menopause, estrogen </li></ul><ul><li>continues to be made by </li></ul><ul><li>other glands, body fat </li></ul>
  • 18. Perimenopausal Transition <ul><li>Natural event </li></ul><ul><li>Factors affecting timing of menopause: </li></ul><ul><ul><li>Genetics </li></ul></ul><ul><ul><li>Ethnicity </li></ul></ul><ul><ul><ul><li>Black and Hispanic women undergo menopause 1-2 yrs before Caucasian women </li></ul></ul></ul><ul><ul><li>Smoking </li></ul></ul>
  • 19. Common Symptoms <ul><li>Hot flashes </li></ul><ul><ul><li>75-85% of perimenopausal women get them </li></ul></ul><ul><ul><li>Most common symptom </li></ul></ul><ul><li>Sleep disturbance </li></ul><ul><ul><li>REM (rapid eye movement) sleep affected </li></ul></ul><ul><li>Vaginal and urinary changes </li></ul><ul><ul><li>Tissue less flexible </li></ul></ul>
  • 20. Management of Symptoms <ul><li>Lifestyle modifications </li></ul><ul><ul><li>Healthy diet, calcium, vitamin D, exercise, sleep schedule, layer clothing </li></ul></ul><ul><ul><li>Limit caffeine, alcohol, fatty foods. Stop smoking. </li></ul></ul><ul><li>Over-the-counter supplements </li></ul><ul><ul><li>Soy, isoflavones, St. John’s wort, black cohosh, evening primrose </li></ul></ul><ul><ul><li>Not regulated by FDA </li></ul></ul><ul><ul><li>May affect other medications &amp; surgery </li></ul></ul><ul><li>Other prescriptions </li></ul><ul><ul><li>Gabapentin and SSRIs (selective serotonin reuptake inhibitors) reduce hot flashes, other symptoms </li></ul></ul>
  • 21. Hormone Therapy <ul><li>Estrogen supplementation to replace the estrogen your body no longer makes </li></ul><ul><ul><li>Comes in various forms </li></ul></ul><ul><ul><li>Lowest effective dose recommended (short-term use of HRT, 3 to 5 years, is the most effective) </li></ul></ul><ul><li>Potential risks: </li></ul><ul><ul><li>Causes lining of uterus to grow </li></ul></ul><ul><ul><li>Spotty bleeding </li></ul></ul><ul><ul><li>Increased risk of breast cancer </li></ul></ul><ul><ul><li>Heart attack </li></ul></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Blood clots </li></ul></ul>
  • 22. Irregular vaginal bleeding <ul><li>Abnormal bleeding can be a sign of other problems </li></ul><ul><li>Often evaluated with in office endometrial biopsy or outpatient hysteroscopy with D&amp;C </li></ul>
  • 23. Irregular Vaginal Bleeding Treatments <ul><li>Medical Management </li></ul><ul><ul><li>NSAIDS </li></ul></ul><ul><ul><li>Estrogen &amp; progestins </li></ul></ul><ul><li>Surgical Management </li></ul><ul><ul><li>Endometrial ablation </li></ul></ul><ul><ul><li>Uterine artery embolization </li></ul></ul><ul><ul><li>Hysterectomy </li></ul></ul>
  • 24. Periodic Assessments 65+ years <ul><li>History (medical, surgical, family, social) </li></ul><ul><li>Physical Examination </li></ul><ul><li>Pelvic examination </li></ul><ul><ul><li>Discuss if pap discontinuation is appropriate </li></ul></ul><ul><li>Breast cancer screening </li></ul><ul><ul><li>Discuss mammogram </li></ul></ul><ul><li>Colorectal cancer screening </li></ul><ul><ul><li>Discuss colonoscopy, flexible sigmoidoscopy, barium enema testing </li></ul></ul>
  • 25. Periodic Assessments 65+ years <ul><li>Osteoporosis screening </li></ul><ul><ul><li>Discuss DEXA scan </li></ul></ul><ul><li>Laboratory testing </li></ul><ul><ul><li>Cholesterol screening, diabetic screening, thyroid screening </li></ul></ul><ul><li>Immunizations </li></ul><ul><ul><li>Influenza yearly </li></ul></ul><ul><ul><li>Tdap every 10 years </li></ul></ul><ul><ul><li>Pneumococcal vaccine (first vaccine or possible repeat dose) </li></ul></ul><ul><ul><li>Zoster vaccine (age 60 and above, maybe age 50) </li></ul></ul>
  • 26. Bone Density Screening <ul><li>DEXA scan </li></ul><ul><ul><li>Start at age 65 </li></ul></ul><ul><ul><li>Or postmenopausal with risk factors: low BMI, smoker, family history, caucasian </li></ul></ul><ul><ul><li>Frequency : no more than every 2 years </li></ul></ul><ul><ul><li>Treatment : Depends on extent of bone loss </li></ul></ul><ul><ul><li>Preventative steps : </li></ul></ul><ul><ul><li>Weight-bearing exercise, healthy diet, discontinue smoking, reduce fall risk </li></ul></ul>
  • 27. Pelvic Organ Prolapse <ul><li>Most common reason for hysterectomy over age 55 </li></ul><ul><li>Not every patient will need treatment </li></ul><ul><li>Treatment </li></ul><ul><ul><li>Life-style modification </li></ul></ul><ul><ul><ul><li>Control cough, constipation, weight </li></ul></ul></ul><ul><ul><ul><li>Kegel exercises, pelvic floor physical therapy </li></ul></ul></ul><ul><ul><li>Pessary use </li></ul></ul><ul><ul><ul><li>Can be fitted in the office </li></ul></ul></ul><ul><ul><ul><li>Several different types/ shapes </li></ul></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><ul><li>Hysterectomy often with another procedure </li></ul></ul></ul><ul><ul><ul><li>Procedure to add support </li></ul></ul></ul>
  • 28. Prolapse and Pessaries
  • 29. Urinary Incontinence <ul><li>Can occur at earlier ages </li></ul><ul><li>Evaluated with examination, history, voiding diary, urine sample, occasionally more </li></ul><ul><li>complex testing is needed </li></ul><ul><li>Often managed by a gynecologist, urologist, or uro-gynecologist </li></ul><ul><li>Treatment options: </li></ul><ul><ul><li>Behavioral modifications : Weight loss, reduce caffeine, manage fluids, reduce physical exertion, stop smoking, relieve constipation, bladder training, pelvic muscle physical therapy </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Pessaries </li></ul></ul><ul><ul><li>Surgical Management : suspensions and slings, bulking agent injections, neurologic stimulation therapy </li></ul></ul>
  • 30. Urinary Incontinence Treatments
  • 31. Conclusion <ul><li>Screenings are important to your health </li></ul><ul><li>Your health needs change as you age </li></ul><ul><li>Health care is often a team approach: </li></ul><ul><ul><li>Family medicine physician </li></ul></ul><ul><ul><li>Internal medicine physician </li></ul></ul><ul><ul><li>Obstetrician-gynecologist </li></ul></ul><ul><ul><li>Specialists as directed </li></ul></ul><ul><ul><li>YOU </li></ul></ul><ul><li>See your doctor annually </li></ul><ul><li>Be honest with your doctor </li></ul>

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