“CHANGING CARE WITH CHANGING BODIES AND

CHANGING NEEDS !

- A health awareness module for women

Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSIChairperson public Awareness committee IMS

04/22/23Dr.Maninder Ahuja,dr.Duru shah

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Changes in menstrual periods• Periods are Periods are

heavier or heavier or lighter lighter than usual than usual• More / less More / less frequent frequent• IrregularIrregular• Regular and Regular and then suddenly then suddenly stops stops

Medical opinion Medical opinion necessary if :necessary if :

• Very heavy or Very heavy or irregular irregular bleedingbleeding• Bleeding Bleeding between between periods periods• Bleeding after Bleeding after sexsex• Bleeding after Bleeding after 12 12 months of being months of being free from free from periodsperiods

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Management – depending on cause

• Hormonal Therapy • Conservative Therapy

Balloon TherapyLNG IUD

Polypectomy

Endometrial Ablation

Contd..Contd..04/22/23Dr.Maninder Ahuja,dr.Duru shah

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Management contd..

Surgery Myomectomy

Hysterectomy with Bilateral Salpingo- oophorectomy

Hysterectomy

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Osteoporosis – the silent disease

From 35 yrs onwards you lose bone mass at 0.5 to 1% per yr

Around menopause loss is upto 4-5 % per yearYou also lose muscle mass from 35 years onwards

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In perimenopause and menopause you lose bone!

-2-1012345678

Bone turnover at the tissue level

Patterns in women

Pubertal girls

Premenopausal women

Post menopausal women

ch

ange

% /

yr

Formation

Resorption

Bone loss

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Osteoporosis is preventable & treatable

One out of two women above 50 will One out of two women above 50 will have a life time risk of osteoporotic have a life time risk of osteoporotic

fracturefracture

Each year there are an estimated • 5 lac spinal fractures, • 300,000 hip fractures, • 2 lac broken wrists, and • 3 lac fractures of other bones.  • About 80% of these fractures occur from relatively minor falls or accidents.

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Common sites of fractures

Most of the times goes unnoticed & undiagnosed

11stst to occur to occur Most Most debilitatingdebilitating

Common Common Fractures due to Fractures due to

osteoporosisosteoporosis

Wrist

Hip Spine

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Poor healing of Poor healing of fractures due fractures due

to osteoporosis to osteoporosis leads to leads to

limitation in limitation in daily routinedaily routine

Osteoporosis

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Spinal complications• Reduced height > 1”Reduced height > 1”• Weak back musclesWeak back muscles• Microfractures of spineMicrofractures of spine• Dowager’s humpDowager’s hump

Between 25% and 60% of women over 60 years of age develop spinal compression fractures

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Hip fracture

Death due to hip fracture is 25% in first year. Those who survive have morbidity and need support for routine activities.

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Risk factors for osteoporosisMODIFIABLE:MODIFIABLE:

• Cigarette smoking or Cigarette smoking or other tobacco use other tobacco use• Excessive alcohol intake Excessive alcohol intake (>3 oz/day) (>3 oz/day)• Diet low in calcium, Diet low in calcium, vitamin D, or both vitamin D, or both• Eating disorder (anorexia Eating disorder (anorexia nervosa, bulimia) nervosa, bulimia)• Inactive lifestyle, including Inactive lifestyle, including extended bed rest extended bed rest• Use of certain Use of certain medications eg. diuretics, medications eg. diuretics, glucocorticoids glucocorticoids• Natural or surgical menopauseNatural or surgical menopause

NON-MODIFIABLE:NON-MODIFIABLE:• Female gender• Older age• Family history of osteoporosis fractures• Race•Rheumatoid arthritis•Antiepleptic drugs•Thin

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Why is osteoporosis a cause for concern?

• Osteoporosis is asymptomaticOsteoporosis is asymptomatic• It is often known as “the silent It is often known as “the silent thief” thief” because bone loss occurs without because bone loss occurs without symptoms symptoms• The importance lies in the fact that The importance lies in the fact that it it greatly increases the risk of greatly increases the risk of fractures fractures The diagnosis is made only The diagnosis is made only

after a fracture occurs or when after a fracture occurs or when DEXA scan DEXA scan is doneis done 04/22/23Dr.Maninder Ahuja,dr.Duru shah

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Clinical evaluation Detailed history and physical examinationkeeping in mind causes and risk factors

Measurement of bone density

X-Ray, SXA, DEXA, QCT, QSG

Bone turnover markers

Markers for bone formation and bone resorption

Diagnostic evaluation of osteoporosis

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Can be done for mass screening Heel, lower arm,or finger Can’t be used to start treatment Better for diabetics

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Prevention - starts from childhood

• Calcium 1500 mg /dayCalcium 1500 mg /day• Vit d 400-800iu/dayVit d 400-800iu/day• Mag. folic acid, Vit CMag. folic acid, Vit C• Exercise specially strength Exercise specially strength training and aerobic for training and aerobic for cardio respiratory cardio respiratory endurance endurance• Avoid caffeine, alcohol, Avoid caffeine, alcohol, smoking, salt smoking, salt• 15 -30 min of sunshine /day15 -30 min of sunshine /day

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Exercises Aerobics like :• Brisk walking• Low impact aerobics• Lawn mowing• Taichi• Yoga

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Resistance & strength building exercises

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In osteoarthritis exercise helps by

• Decreasing pain• Increasing range of movements• Decreasing stiffness• Increasing strength• Cartilage thickness is increased 04/22/23Dr.Maninder Ahuja,dr.Duru shah

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Cancer screening•For cancer breastFor cancer breast•Cancer cervix Cancer cervix •Cancer endometriumCancer endometrium•Cancer ovariesCancer ovaries•Colorectal cancerColorectal cancer•For cancer breast, For cancer breast, SBE,CBE, SBE,CBE, Mammography.once in Mammography.once in two yrs after 40 and two yrs after 40 and once every year if once every year if family historyfamily history

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How to do self breast examination•One week after mensesOne week after menses

•Start from 30 yrs onwardsStart from 30 yrs onwards•Once in a monthOnce in a month

SQEEZE SQEEZE NIPPLES FOR NIPPLES FOR

ANY ANY DISCHARGEDISCHARGE

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Pap smear-every 3 years from 30 yrs onwards

DefinitionA Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. A Pap smear involves collecting cells from your cervix — the lower, narrow end of your uterus.now preferred is liquid cytology and HPV studies

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Transvaginal Ultrasound

Every year to assess:• Ovaries• Endometrial thickness in

the uterus 04/22/23Dr.Maninder Ahuja,dr.Duru shah

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Pap smear procedureAvoid intercourse, douching or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a Pap smear, as these may wash away or obscure abnormal cells. Try not to schedule a Pap smear during your menstrual period. Although the test can be done, it's best to avoid this time of your cycle, if possible.

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0

2

4

6

8

10

10 20 30 40 50 60 70 75 +Age (years)

WomenMen

Royal College of Gen. Pract., Morbidity Statistics From General Practice, 1981-82, Third National Survey, 1986, HMSO, London

Mortality due to CVD / 1000

Incidence of CVD in Women Vs Men ( 2 yr rate / 1000 )

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0

5

10

15

20

25

30

35

40

35 - 44 45 - 54 55 - 64 65 - 74 75 - 84

FemaleMale

0.5

105

1.5

12

7.6 5

18

3.6 10

23

18

34

2.3

1.8

Ratios

AGE

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Life style management

This is the This is the basic step of basic step of prevention prevention

& treatment & treatment for quality for quality

of life of life

3-step Management of Menopause

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Healthy Diet

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Get your lipid profile done Keep your weight under control Keep your waist hip ratio to 0.8 or

absolute waist to < 85 cms Keep exercising regularly minimum of

30 min/day of brisk walk for 5 days/week

2-3 day of resistance or weight training If Lipid profile abnormal then statins or

antihypertnsive drugs if blood pressure is high.

04/22/23Dr.Maninder ahuja

04/22/23Dr.Maninder Ahuja,dr.Duru shah

•1997 prevalence of Alzheimer’s was estimated to be 4 million

•Prevalence expected to quadruple in the next 50 years to 1 in every 45 Americans

Evans, Milibank Mem Fund Q, 1990; 68 : 267Kalifert et al, Menopause, 1998; 5 : 197Leon et al Health Aff, 1998; 17 : 206 Contd..

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Evans, Milibank Mem Fund Q, 1990; 68 : 267Kalifert et al, Menopause, 1998; 5 : 197Leon et al Health Aff, 1998; 17 : 206

• you start forgetting what you were going to do.• The rate of The rate of Alzheimer’s is 2 – 3 Alzheimer’s is 2 – 3 fold higher in women fold higher in women• Only 2% women Only 2% women are aware that HRT are aware that HRT could have an could have an impact on Alzheimer’s impact on Alzheimer’s

04/22/23 33Dr.Maninder ahuja

Indications for Hormonal Therapy

•Women who suffer from severe symptoms

•Not for prevention of heart disease , or chronic diseases

•Window of opportunity if started early

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Forms of estrogens

•Oral Tablets•Patches•Gels•Vaginal creams•Vaginal tablets•Injectables•Sprays

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Premature Menopause• When menopause When menopause

occurs before 40 years occurs before 40 years of ageof age

• Surgically induced Surgically induced • Following cancer Following cancer

treatmenttreatment• Hormonal treatment isHormonal treatment is

required for conception. required for conception. Assisted reproductive Assisted reproductive techniques helptechniques help

• Hormone therapy is Hormone therapy is useful to delay long useful to delay long term problems term problems

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Doctor’s visit involves

• Counseling – answering all your queries related to menopause• Basic health check up• Routine gynecology check up • Cancer screening • Prevention & treatment of menopausal issues

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Traditionally women were exercising!

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Today they are not!

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We offer her Care with

her “changing bodies and changing needs”

towards a healthier

future04/22/23Dr.Maninder Ahuja,dr.Duru shah40

Acknowledgements Past President IMS … Dr Duru Shah

•Advisors … Dr Meeta Singh Dr Rashmi Shah Dr Jyoti Shah•Coordinators … All members of

“Geriatric Gynecology Committee of FOGSI”

•All chapter secretaties of IMS and members of IMS

•Who would propagate this further04/22/23Dr.Maninder Ahuja,dr.Duru shah

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