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.

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Medical Screenings for Women

  1. 1. Medical Screenings for Women Andrea Fullerton, MD Elda Perales, MD
  2. 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. 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. 4. Annual Exam Health Care Services <ul><li>Primary & 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 & Gynecology Services </li></ul><ul><ul><li>Obstetric care </li></ul></ul><ul><ul><li>Evaluation and treatment of gynecologic & 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. 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. 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 & C </li></ul></ul>
  7. 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. 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. 9. Various Cancers Caused by HPV Parkin, D.M. (2006)
  10. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 & 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. 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. 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&C </li></ul>
  23. 23. Irregular Vaginal Bleeding Treatments <ul><li>Medical Management </li></ul><ul><ul><li>NSAIDS </li></ul></ul><ul><ul><li>Estrogen & 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. 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. 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. 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. 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. 28. Prolapse and Pessaries
  29. 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. 30. Urinary Incontinence Treatments
  31. 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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