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“ CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS !

“ CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS !. - A health awareness module for women. Dr.Maninder Ahuja Geriatric Gynaecology Committee of FOGSI Chairperson public Awareness committee IMS. Changes in menstrual periods. Periods are heavier or lighter than usual

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“ CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS !

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  1. “CHANGING CARE WITH CHANGING BODIES AND CHANGING NEEDS ! - A health awareness module for women Dr.ManinderAhuja Geriatric Gynaecology Committee of FOGSI Chairperson public Awareness committee IMS Dr.Maninder Ahuja,dr.Duru shah

  2. Changes in menstrual periods • Periods are heavier or lighter than usual • More / less frequent • Irregular • Regular and then suddenly stops Medical opinion necessary if : • Very heavy or irregular bleeding • Bleeding between periods • Bleeding after sex • Bleeding after 12 months of being free from periods Dr.Maninder Ahuja,dr.Duru shah

  3. Management – depending on cause Balloon Therapy • Hormonal Therapy • Conservative Therapy LNG IUD Endometrial Ablation Polypectomy Contd.. Dr.Maninder Ahuja,dr.Duru shah

  4. Management contd.. Myomectomy Surgery Hysterectomy Hysterectomy with Bilateral Salpingo- oophorectomy Dr.Maninder Ahuja,dr.Duru shah

  5. Balloon therapy Dr.Maninder Ahuja,dr.Duru shah

  6. 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 year You also lose muscle mass from 35 years onwards Dr.Maninder Ahuja,dr.Duru shah

  7. Bone turnover at the tissue level Formation Patterns in women Resorption Bone loss  change % / yr Pubertal girls Premenopausal women Post menopausal women In perimenopause and menopause you lose bone! Dr.Maninder Ahuja,dr.Duru shah

  8. Osteoporosis is preventable & treatable • 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. One out of two women above 50 will have a life time risk of osteoporotic fracture Dr.Maninder Ahuja,dr.Duru shah

  9. Common sites of fractures Spine Wrist Hip 1st to occur Most debilitating Most of the times goes unnoticed & undiagnosed Common Fractures due to osteoporosis Dr.Maninder Ahuja,dr.Duru shah

  10. Osteoporosis Poor healing of fractures due to osteoporosis leads to limitation in daily routine Dr.Maninder Ahuja,dr.Duru shah

  11. Spinal complications • Reduced height > 1” • Weak back muscles • Microfractures of spine • Dowager’s hump Between 25% and 60% of women over 60 years of age develop spinal compression fractures Dr.Maninder Ahuja,dr.Duru shah

  12. Hip fracture Death due to hip fracture is 25% in first year. Those who survive have morbidity and need support for routine activities. Dr.Maninder Ahuja,dr.Duru shah

  13. Risk factors for osteoporosis • MODIFIABLE: • Cigarette smoking or other tobacco use • Excessive alcohol intake (>3 oz/day) • Diet low in calcium, vitamin D, or both • Eating disorder (anorexia nervosa, bulimia) • Inactive lifestyle, including extended bed rest • Use of certain medications eg. diuretics, glucocorticoids • Natural or surgical menopause • NON-MODIFIABLE: • Female gender • Older age • Family history of osteoporosis fractures • Race • Rheumatoid arthritis • Antiepleptic drugs • Thin Dr.Maninder Ahuja,dr.Duru shah

  14. Why is osteoporosis a cause for concern? • Osteoporosis is asymptomatic • It is often known as “the silent thief” because bone loss occurs without symptoms • The importance lies in the fact that it greatly increases the risk of fractures The diagnosis is made only after a fracture occurs or when DEXA scan is done Dr.Maninder Ahuja,dr.Duru shah

  15. Diagnostic evaluation of osteoporosis Dr.Maninder Ahuja,dr.Duru shah

  16. QSG • Can be done for mass screening • Heel, lower arm,or finger • Can’t be used to start treatment • Better for diabetics Dr.Maninder Ahuja,dr.Duru shah

  17. Prevention - starts from childhood • Calcium 1500 mg /day • Vit d 400-800iu/day • Mag. folic acid, Vit C • Exercise specially strength training and aerobic for cardio respiratory endurance • Avoid caffeine, alcohol, smoking, salt • 15 -30 min of sunshine /day Dr.Maninder Ahuja,dr.Duru shah

  18. Exercises • Aerobics like : • Brisk walking • Low impact aerobics • Lawn mowing • Taichi • Yoga Dr.Maninder Ahuja,dr.Duru shah

  19. Resistance & strength building exercises Dr.Maninder Ahuja,dr.Duru shah

  20. In osteoarthritis exercise helps by • Decreasing pain • Increasing range of movements • Decreasing stiffness • Increasing strength • Cartilage thickness is increased Dr.Maninder Ahuja,dr.Duru shah

  21. Cancer screening • For cancer breast • Cancer cervix • Cancer endometrium • Cancer ovaries • Colorectal cancer • For cancer breast, SBE,CBE, Mammography.once in two yrs after 40 and once every year if family history Dr.Maninder Ahuja,dr.Duru shah

  22. How to do self breast examination • One week after menses • Start from 30 yrs onwards • Once in a month SQEEZE NIPPLES FOR ANY DISCHARGE Dr.Maninder Ahuja,dr.Duru shah

  23. Pap smear-every 3 years from 30 yrs onwards Definition A 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 Dr.Maninder Ahuja,dr.Duru shah

  24. Transvaginal Ultrasound • Every year to assess: • Ovaries • Endometrial thickness in the uterus Dr.Maninder Ahuja,dr.Duru shah

  25. Pap smear procedure Avoid 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. Dr.Maninder Ahuja,dr.Duru shah

  26. Cardiovascular Disease Mortality due to CVD / 1000 Women Men Age (years) Royal College of Gen. Pract., Morbidity Statistics From General Practice, 1981-82, Third National Survey, 1986, HMSO, London Dr.Maninder Ahuja,dr.Duru shah

  27. 34 1.8 23 18 18 2.3 Ratios 12 3.6 10 10 5 7.6 5 1.5 0.5 AGE Cardiovascular Disease Incidence of CVD in Women Vs Men ( 2 yr rate / 1000 ) Dr.Maninder Ahuja,dr.Duru shah

  28. Life style management 3-step Management of Menopause This is the basic step of prevention & treatment for quality of life Dr.Maninder Ahuja,dr.Duru shah

  29. Healthy Diet Dr.Maninder Ahuja,dr.Duru shah

  30. What you should do • 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. Dr.Maninder ahuja

  31. Alzheimer’s Disease (AD) • 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 : 267 Kalifert et al, Menopause, 1998; 5 : 197 Leon et al Health Aff, 1998; 17 : 206 Contd.. Dr.Maninder Ahuja,dr.Duru shah

  32. Alzheimer’s Disease (AD) • you start forgetting what you were going to do. • The rate of Alzheimer’s is 2 – 3 fold higher in women • Only 2% women are aware that HRT could have an impact on Alzheimer’s Evans, MilibankMem Fund Q, 1990; 68 : 267 Kalifert et al, Menopause, 1998; 5 : 197 Leon et al Health Aff, 1998; 17 : 206 Dr.Maninder ahuja

  33. 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 Dr.Maninder Ahuja,dr.Duru shah

  34. Forms of estrogens • Oral Tablets • Patches • Gels • Vaginal creams • Vaginal tablets • Injectables • Sprays Dr.Maninder Ahuja,dr.Duru shah

  35. Premature Menopause • When menopause occurs before 40 years of age • Surgically induced • Following cancer treatment • Hormonal treatment isrequired for conception. Assisted reproductive techniques help • Hormone therapy is useful to delay long term problems Dr.Maninder Ahuja,dr.Duru shah

  36. 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 Dr.Maninder Ahuja,dr.Duru shah

  37. Traditionally women were exercising! Dr.Maninder Ahuja,dr.Duru shah

  38. Today they are not! Dr.Maninder Ahuja,dr.Duru shah

  39. We offer her Care with her “changing bodies and changing needs” towards a healthier future Dr.Maninder Ahuja,dr.Duru shah

  40. 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 further Dr.Maninder Ahuja,dr.Duru shah

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