Health Maintenance in women American family physician, Vol. 87, No. 1, pp. 30

1. Health Maintenance in womenAmerican family physician, Vol. 87, No. 1, pp. 30 Marie Stoddard

2. What is the Health Maintenance Exam? An exam that provides doctors to spend FOCUSED time with patients to discuss disease prevention and health promotion Advised to be performed ANNUALLY

3. Health Maintenance in Women • Doctors must be able to select services that BEST promote the health in ASYMPTOMATIC women • In order to come to the best conclusion about what services the patient needs, questions regarding the following categories are important: • History • Family Planning • STD’s • Coronary Heart Disease • Stroke Prevention • Cancer Screening • Osteoporosis Screening • Immunizations

4. History • History: In addition to asking about the patient’s medical, social, and family history, it is important to also inquire about: • Tobacco, Alcohol, and Illicit Drug Use (be sure to provide cessation interventions) • Depression • Intimate partner violence

5. Family Planning • Premenopausal women should be asked about their reproductive plans • Provide contraceptives to those who do not want to conceive • Provide those who are planning OR capable of pregnancy a folic acid supplement • Reduces the risk of neural tube defects

6. STD’s • High-risk sexually active adults: • Multiple sexual partners • Have or have had an STD within the past year, • Currently in a non-monogamous relationship • It is advised that these patients receive an intensive behavioral counseling lasting more than 30 minutes in one session focused on abstinence, condom use, sexual practice changes, and vaccinations • Also, there is a need to screen these patients annually for chlamydia, gonorrhea and syphilis

7. Coronary Heart Disease • Leading cause of death in U.S. women • Targeted screening for CHD risk factors is important • Current risk factors include: • Overweight and obesity • Hypertension • Dyslipidemia • Type 2 Diabetes • It is advised that doctors consider a selective rather than routine counseling, depending on the aforementioned risk factors

8. Stroke Prevention • Women ages 55-79 recommended to take 75mg aspirin/day in order to lower the risk for an ischemic stroke • This benefit outweighs the risk for GI hemorrhage

9. Cancer Screening • Cancer is the 2nd leading cause of death in the U.S. • Early screening leads to early diagnosis and the greatest chance at survival • The following cancers should be screened for: • Cervical cancer- Pap Test for those 21yrs and older; screening should be end at 65 yrs or post total hysterectomy • Breast cancer-Screening should begin at 40 without a specific discontinuation age • Colorectal cancer- Recommended for women between the ages of 50-75 years old • Ovarian cancer- the routine screening is not recommended because it does not reduce ovarian cancer mortality

10. Osteoporosis Screening • Osteoporosis affects 35 million women older than 50 yrs (expected to increase to 41million by 2020 • Screening guidelines: • Screen women 65 years of age • Screen woman younger than 65 years with fracture risk ≥ than that of a 65 year old woman

11. Immunizations • Immunizations should be given to all adults unless its contradicted in an individual patient