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Know what makes a women a well woman

Here we discuss the important points around women healthcare and wellness.

John_martin123
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Know what makes a women a well woman

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  1. “Women Wellness”

  2. Content • Fibroids • PCOD and other menstrual problems • Endometriosis • Obesity • WDPV • Breast cancer • Cervical cancer and cervical cancer vaccines

  3. FIBROIDS • Fibroids are growths/lumps in the womb • Fibroids are Benign growth (99%) • Localised overgrowth of myometrium • Estrogen and Progesterone dependent growth • 20-50% of women of reproductive age group will have fibroids • Symptoms can be varied • May need to be removed if causing problems

  4. FIBROIDS

  5. FIBROIDS • Symptoms-Heavy and prolonged M/C • Intermenstrual bleeding • Pelvic pain • Frequent urination • Lump lower abdomen • Low backache • Pain during intercourse

  6. DIAGNOSIS • USG • HSG • MRI • HYSTEROSCOPY

  7. TREATMENT FOR FIBROIDS • Medical • Anti-fibrinolytics-tranexamic acid • Oral pills/ progesterones • GnRH agonists • Ulipristal acetate(SPRM) • Mifepristone • Surgical • Myomectomy • Hysterectomy • Myolysis • MRFUS • UAE

  8. FIBROIDS

  9. PCOD • Metabolic and Endocrine abnormality • Increased levels of male hormones Testosterone • Oligo/Anovulation • Insulin Resistance /hyper-insulinemia • Multiple micro-cyst formation on outer surface of ovary diagnosed by USG(2-8 mm ) ,>12 cyst in each ovary • Clinical features-Irregular menses, infertility, obesity, Hirsutism and increased risk of DM , HTN and Endometrial carcinoma in later life

  10. TREATMENT • For regular periods-Contraceptive pills, Antiandrogen and Insulin sensitizer • For cosmetic purpose- Cyproterone acetate, Spironolactone, Laser treatment, shaving, and electrolysis • For infertility-Ovulation inducing drugs

  11. Endometriosis • Definition- Where abnormal growth of Endometrial cells outside uterus on ovaries, bowel and rarely on lungs, • Etiology - Unknown • Retrograde menstruation • Clinical features-Infertility, Painful menstruation Dyspaerunea, • Painful bowel movements

  12. Endometriosis

  13. Endometrioisis

  14. Endometriosis Treatment: For pain-Analgesics/OCP/progesterone Menstrual irregularity-OCP ,Progesterone For infertility- Lap ovarian cystectomy Assisted conception such as- IUI,IVF,ICSI

  15. Menstrual Problems • Heavy bleeding- Bleeding with clots or associated with weakness and disrupting • social life Causes: Anovulation/fibroids/polyps/adenomyosis • Investigations: CBC, Thyroid profile, coagulation panel USG to rule out Fibroids/Polyps/PCOD/Endometriosis/ Adenomyosis

  16. Obesity BMI (body mass index)-Weight in kg/height in meter square Normal BMI-20-25 Overweight >25 Obese >30

  17. Obesity

  18. Problem of obesity Obstetric Problem: • Infertility • Early pregnancy loss • Recurrent pregnancy Loss • Gestational Diabetes • High BP in pregnancy Gynecological Problem: • Irregular menses/PCOD/endometrial cancer

  19. WDPV White discharge per vagina Causes: • Physiological • Ovulation • PID-STD and Non STD • Pelvic infections- Candidiasis ,Bacterial vaginosis

  20. WPDV Investigations: Pap smear ,High vaginal Swab and culture Ultrasonography Treatment-based on the cause: Antibiotics/ personal hygiene/antifungals

  21. Introduction-breast cancer • Breast cancer is the most common cancers in females in world 2nd commonest cancer in India • Accounts for 25-31% of cancers of urban India • In USA; 2.6 millions in 2016 • In US 1 in 8 women suffers from breast cancer • In India;less than 1 millions cases recorded every year • Occuring in younger age groups recently(30-50 years)

  22. Risk factors • Modifiable-BMI ,age of childbirth , duration of breast feeding ,alcohol ,diet , number of children • Non modifiable-age , gender , relatives with breast cancer , age of menarche and menopause

  23. Sign and Symptom

  24. Signs and symptoms • Lump in the breast • Thick breast skin • Discharge from nipple • Bleeding • Less common-lung problems or fractures because of spread

  25. Diagnosis • Triple assessment- • Breast self-examination/examination by doctor • Radiology- Ultrasound, mammography • Pathology-tissue sampling by FNAC/biopsy

  26. Screening(ACS) • 40-44 yrs-can opt for annual mammogram • 45 -Yearly screening Screening • Genetic screening-5% females with breast • Cancer carry BRCA 1 or BRCA 2 mutation • Those who are BRCA 1 or 2 positive have a 50 % lifetime risk of breast cancer

  27. Cancer spread • Through lymph nodes • Blood • Both • Spread is most commonly to- liver,lungs,brain,bone and skin `

  28. Breast examination • Self examination- • Recommended monthly from age of 30 years • Position- standing with hands on hips and arms elevated, lying down position • Best time to do- after periods

  29. Breast examination

  30. Ultrasound/mammography features • Features of cancer: • Irregular margins • Hypoechoic masses (darker than rest of image) • Calcification(calcium deposits) • Increased blood supply

  31. Role of MRI • Indications: • Dense breasts • Breast implants • Previous breast surgery • Recurrent lesions

  32. Biopsy • Sample of tissue for examination under microscope • Types- tru cut/incision/excision biopsy • Excision biopsy done under anaesthesia in OT • Best way to diagnose cancer when there is suspicion on ultrasound/mammography

  33. Cervical cancer • Global burden with 80% cases in developing countries • Easily accessible for visualisation • Long latent phase • HPV is one of the most common cause • Low risk-HPV 6,11 ,intermediate-33,35 • High risk-16,18 etc

  34. Risk Factors for Cervical Cancer • Early age at first Intercourse • Multiple sexual Partners • Multi-parity • Poor Hygiene • Low socio-economic group • Smoking • Human Papilloma Virus Infection • STD – Syphilis ,Gonorrhoea

  35. Cervical cancer-symptoms • Intermenstrual bleeding or Spotting per vagina • Post coital bleeding • Foul smelling Discharge per vagina • Bleeding in between regular periods • Pain in lower abdomen • Later stages-difficulty in passing urine ,constipation

  36. Cervical cancer-signs • Abnormal Pap smear • Unhealthy looking cervix • Growth on cervix –cauliflower like mass • Cervix –very friable bleeds to touch

  37. Screening • Pap smear- smear of cervix to be visualised under microscope to rule out cervical cancer • HPV test • Recommended from age of 21 -50 years every 3 yearly and thereafter yearly • Suspicious smears are referred for colposcopy • Cervical Biopsy

  38. Pap smear

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