Fundamentals of Women's Health

Men and women have many of the same health issues, but their symptoms may be completely different. For example, heart attacks in women may be "silent" (without the chest pain that often heralds a heart attack in a man). Some medical problems are more common in women than in men (depression, obesity, osteoarthritis), other conditions such as menopause and pregnancy are unique to women. Lifestyle factors, especially smoking, affect a woman's chance of developing diseases such as lung cancer that were previously thought to be more likely in men.

Health care for women includes the entire spectrum of a woman's life, not just pregnancy and childbirth. Medical problems can affect women and men differently. Some serious medical issues, such as cardiac disease and heart attack, may be overlooked because symptoms in many women are not clear-cut. Many research studies in the past did not include women participants; therefore, conclusions from those studies may not be valid for making health care decisions about women. At each stage of a woman's life, there are important preventive health care steps to follow in order to provide early detection of medical problems, or to prevent them entirely. Simple steps include healthy eating, regular exercise, and medical checkups. It is important to be informed about women's health issues and discuss them thoroughly with your doctor.

STD's & Birth Control

Sexually transmitted diseases (STDs) are infections that you can get from having sex with someone who has the infection. Many people are aware of the most prominent STD: HIV. However, many other STDs affect millions of men and women each year. Many of these STDs initially cause no symptoms, especially in women. Symptoms, when they do develop, may be confused with those of other diseases that are not transmitted through sexual contact. STDs can still be transmitted person to person even if they do not show symptoms. Also, health problems caused by STDs tend to be more severe for women than for men.
The causes of STDs are bacteria, parasites and viruses. There are more than 20 types of STDs, including Chlamydia, Gonorrhea, Herpes Simplex, HIV/AIDS, HPV, Syphilis, and Trichomoniasis. If you have an STD caused by bacteria or parasites, your health care provider can treat it with antibiotics or other medicines. If you have an STD caused by a virus, there is no cure. Sometimes medicines can keep the disease under control. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STDs.
Male latex condoms can reduce your risk of getting an STD if used correctly. Female condoms aren't as effective as male condoms, but should be used when a man won't use a male condom. However, condoms aren't 100% safe and can't protect you from coming in contact with some sores such as those that can occur with herpes, or warts which can be caused by HPV infection. It was once thought that spermicides with nonoxynol-9 could help prevent STDs much like they help prevent pregnancy, by damaging the organisms that cause the diseases. New research has shown that nonoxynol-9 can irritate a woman's vagina and cervix, actually increasing the risk of STD infection.
A typical U.S. woman is fertile about 40 years — half of her expected life span. If you choose not to have children at any point during that time, it's important that you select a birth control method that you find comfortable and appealing to your lifestyle. Given all the options available, you may find choosing a birth control method confusing. You can make it a little easier by considering your lifestyle, goals and health status.

Birth Control or contraceptive effectiveness is measured by how many women become pregnant using a particular birth control method in the first year of use. Thus, if 100 women use a method that has a 12 percent first-year failure rate, then sometime during the first year of use, 12 of the women should become pregnant. The most effective methods in typical use are those that do not depend upon regular user action.
Surgical sterilization, Depo-Provera, implants, and intrauterine devices (IUDs) all have first-year failure rates of less than one percent for perfect use. Sterilization, implants, and IUDs also have typical failure rates under one percent. The typical failure rate of Depo-Provera is disagreed upon, with figures ranging from less than one percent up to three percent.Other methods may be highly effective if used consistently and correctly, but can have typical use first-year failure rates that are considerably higher due to incorrect or ineffective usage by the user.
Hormonal contraceptive pills, patches or rings, fertility awareness methods, and the lactational amenorrhea method (LAM), if used strictly, have first-year (or for LAM, first-6-month) failure rates of less than 1%. In one survey, typical use first-year failure rates of hormonal contraceptive pills (and by extrapolation, patches or rings) were as high as five percent per year. Fertility awareness methods as a whole have typical use first-year failure rates as high as 25 percent per year; however, as stated above, perfect use of these methods reduces the first-year failure rate to less than 1%.
Condoms and cervical barriers such as the diaphragm have similar typical use first-year failure rates (14 and 20 percent, respectively), but perfect usage of the condom is more effective (three percent first-year failure vs six percent) and condoms have the additional feature of helping to prevent the spread of sexually transmitted diseases such as the HIV virus. The withdrawal method, if used consistently and correctly, has a first-year failure rate of four percent. Due to the difficulty of consistently using withdrawal correctly, it has a typical use first-year failure rate of 19 percent, and is not recommended by some medical professionals.
Your choice of birth control should depend on several factors. These include your health, frequency of sexual activity, number of sexual partners and desire to have children in the future. Your health care provider can help you select the best form of birth control for you.

Diet & Fitness

Healthy eating and physical activity go hand in hand. Together, they help you maintain a healthy weight and lower your risk of some diseases and conditions. Following a healthy eating plan doesn't mean that you can't indulge every now and then. If what you eat is generally low in fat (especially saturated and trans fat) and sugars and you are getting enough vitamins and minerals, you may indulge in a rich dessert or serving of fried food every once in a while. If, on the other hand, you eat a lot of high-calorie foods, you are likely to get all the calories you need quickly without getting enough vital nutrients.

Regular aerobic physical activity increases your fitness level and capacity for exercise. It also plays a role in both primary and secondary prevention of cardiovascular disease.
Regular physical activity can help control blood lipid abnormalities, diabetes and obesity. Aerobic physical activity can also help reduce blood pressure. The results of pooled studies show that people who modify their behavior and start regular physical activity after heart attack have better rates of survival and better quality of life. Healthy people — as well as many patients with cardiovascular disease — can improve their fitness and exercise performance with training.
For health benefits to the heart, lungs and circulation, perform any moderate-to-vigorous-intensity aerobic activity for at least 30 minutes on most days of the week at 50–85 percent of your maximum heart rate. You can accumulate 30 minutes in 10 or 15 minute sessions. What's important is to include physical activity as part of a regular routine. The training effects of such activities are most apparent at exercise intensities that exceed 50 percent of a person's exercise capacity (maximum heart rate). If you're physically active regularly for longer periods or at greater intensity, you're likely to benefit more. But don't overdo it. Too much exercise can give you sore muscles and increase the risk of injury. Even moderate-intensity activities, when performed daily, can have some long-term health benefits.

Sreening & Prevention

Screening tests are a basic part of prevention medicine. All screening tests are commonly available through your doctor, and some may be available elsewhere. Take an active role and discuss screening tests with your doctor early in life.
For more information, see the General Screenings and Immunizations Guidelines for Women (National Women's Health Information Center) Also available in Spanish

Osteoporosis is a condition with progressive loss of bone density leading to bone fractures. When estrogen levels drop after menopause, bone loss accelerates. Thus osteoporosis is most common among postmenopausal women. DEXA bone density scanning can detect osteoporosis before fractures occur, predict the risk of future bone fractures, and although still controversial, some doctors use bone density to monitor effects of osteoporosis treatments. Even though there is no formal recommendation, bone density measurements should be considered for all postmenopausal women, especially for persons at higher than normal risk of developing osteoporosis.
Breast cancer is the most common cancer among women in the United States. Approximately 1 in 9 women who live to age 65 will develop breast cancer, although many will not do so until after age 65. All women over age 20 should perform breast self- examination monthly, preferably at about the same time in their menstrual cycle, and all women over age 40 should have breast examinations by their doctors every year.
High Blood Pressure (Hypertension) About one-sixth of all Americans have high blood pressure, and the incidence of this disease increases with age. Consequently, the proportion among adults is higher, and it is even higher among seniors. African-Americans are more likely than others to have high blood pressure. High blood pressure can cause arterial disease (atherosclerosis) that can lead to heart attack, congestive heart failure, stroke and kidney failure.
How often blood pressure should be checked depends on how severely elevated the blood pressure is, and also depends on the number of other heart attack and stroke risk factors. Adults with most recent normal blood pressure of systolic <130 and diastolic <85 should be checked at least every other year.

Cervical cancer is the third most common gynecologic cancer. Scientists believe that cancer of the cervix is developed from abnormal precancerous (before-cancer) cells on the surface of the cervix. These abnormal cells transform into cervix cancer over a number of years. After turning cancerous, these cancer cells can invade or spread to other parts of the body. A Pap test is a simple, quick office test in which a sample of cells from a woman's cervix is collected by aspiration or swabbing and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for precancerous (before-cancer) or cancer cells. Women should have yearly Pap tests as part of a manual pelvic examination beginning at age 18. Because the risk of cervix cancer increases sharply in the first few years after sexual activity beings, some physicians begin screening women as soon as they become sexually active, but not before.

Elevated LDL cholesterol or low HDL cholesterol increases the risk of developing atherosclerosis ("hardening of arteries"). Atherosclerosis can begin to develop in adolescence and progress without any symptoms for many years. It leads to heart attack and stroke later in life. Hyperlipidemia is a common and treatable cause of atherosclerosis. Atherosclerosis is the most common cause of death in both men and women in developed countries. The goal is to diagnose and retard or reverse atherosclerosis while it is still in a silent early state. Screening is done by a Blood lipid panel that includes Total cholesterol, LDL cholesterol, HDL cholesterol, and cholesterol Triglyceride. All adults over 20 should have a lipid panel every 5 years, and more frequently as medically indicated.

Adult Onset Diabetes Mellitus is a condition characterized by elevated blood sugar levels ("hyperglycemia") due to impaired utilization of insulin, decreased production of insulin, or both. Diabetes is the seventh leading cause of death in the United States. An estimated 18% of all Americans over 65 have diabetes. Over ten million Americans have been diagnosed with diabetes and at least half as many more are thought to have diabetes that is undiagnosed. Many more have a condition that precedes diabetes, called "impaired glucose tolerance," characterized by sluggish metabolism of sugar (glucose) to a lesser degree than is present in those with diabetes.
Tests for diabetes mellitus include Fasting blood sugar (blood sugar test after at least 8 hours without calories), normal level less than 126 mg/dl and 2 hour postprandial blood sugar (blood sugar test 2 hours after a meal), normal level less than 140mg/dl. Healthy subjects over 45 years should have fasting blood glucose level checked every 3 years.