Adult Female Health Maintenance

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Table Of Contents
1 Adult Female Health Maintenance
2 Cancer Screening
3 Osteoporosis
4 Cardiovascular disease
5 Domestic Violence
6 Popular Sections

Adult Female Health Maintenance

Cancer Screening

  1. 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.
    1. Annually until have three normal annual PAP smears, then every 3 yrs, but no strong consensus across different expert organizations.
    2. 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.
    3. Most cervical cancer happens in women who haven’t been screened in 5 yrs or who didn’t follow up on an abnormal PAP
    4. HPV vaccine – recommended in kids ages 9 to 26. Does not affect PAP screening intervals.
  2. Mammogram: Most abnormalities found are NOT breast cancer! Every 2 years for women over 50, individual decision for women over 40.
    1. Clinical breast exam – insufficient evidence
    2. Breast self exam – NOT recommended.
  3. BRCA testing
    1. First degree relatives
      1. 2 with breast cancer, w/ one < 50 yrs old
      2. 1 with bilateral breast cancer
    2. First or second degree relatives:
      1. 3 with breast cancer at any age
      2. 2 with ovarian cancer
      3. Anyone with breast and ovarian cancer
      4. Male with breast cancer

Osteoporosis

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

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

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

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