The Adult Female Health Maintenance is part of the Family Medicine section provides High Yield information for the USMLE, COMLEX, Medical School, Residency, and in the future career as a Physician. Prepare and Learn Ahead! Educating, Preparing, and Proving high-yield content, quizzes, and medical resources to students who are interested in the medical field.
Adult Female Health Maintenance
- PAP smears: Have decreased cervical cancer rates! Start at age 21 or within 3 years of the onset of sexual activity. Stop at age 65 unless risk factors – new partner, recent abnormal PAPs, etc.
- Annually until have three normal annual PAP smears, then every 3 yrs, but no strong consensus across different expert organizations.
- Can be discontinued following hysterectomy for benign indication if cervix is gone, too. But continue if cervical dysplasia was present and/or if cervix remains.
- Most cervical cancer happens in women who haven’t been screened in 5 yrs or who didn’t follow up on an abnormal PAP
- HPV vaccine – recommended in kids ages 9 to 26. Does not affect PAP screening intervals.
- Mammogram: Most abnormalities found are NOT breast cancer! Every 2 years for women over 50, individual decision for women over 40.
- Clinical breast exam – insufficient evidence
- Breast self exam – NOT recommended.
- BRCA testing
- First degree relatives
- 2 with breast cancer, w/ one < 50 yrs old
- 1 with bilateral breast cancer
- First or second degree relatives:
- 3 with breast cancer at any age
- 2 with ovarian cancer
- Anyone with breast and ovarian cancer
- Male with breast cancer
- First degree relatives
Osteoporosis: HALF of all post menopausal women will have an osteoporosis related fracture! Risk increases w/ age, smoking, weight, white/asian, family history, sedentary life, low calcium intake.
- In men: risk factors include prolonged corticosteroids, diseases that alter hormone levels (chronic kidney, lung), undiagnosed low testosterone levels
- Screening: DEXA scan is best for predicting hip fracture. Screen women over 65, or 60 if risk factors
- Osteoporosis = T score < -2.5, osteopenia if -2.5 < T score < -1.0.
- Prevention: All women over 50 should take 1200 mg calcium and 400-800 mg Vitamin D Use supplements if diet isn’t enough. Do exercises.
Cardiovascular disease: number 1 killer of women in the US. Screening rec’s are similar as to those for men.
- Blood pressure: all women over 18 yrs
- Lipids: all women over 45
- Hormone replacement is NOT recommended for prevention of chronic conditions – increased rates of adverse CV outcomes, whether estrogen solo or estrogen + progesterone.
Domestic violence: USPSTF found insufficient evidence to recommend for or against screening or that screening affects outcomes, but other groups recommend screening
- Risk factors: Young age, low income, pregnant, mental illness, alcohol or substance use, separated or divorced, childhood abuse
- Reporting is mandatory in some states