1. 3/4/2013
Just between women What is happening to my body?
A candid talk by women for women Changes from 16 to 60
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Providence Medical Group Jennifer Scalici D.O.
Feb. 28 OB/GYN
Providence Medical Group
What are some major concerns? Teenage years
• Many women use their OBGYN as their • From menarche or the onset of menstrual
primary care provider. If you fall into this cycles a woman’s body is beginning to fine
category, there are some preventative health tune itself and cycles may be irregular until
screenings that you should request from your
screenings that you should request from your the late teens.
provider. • Many girls complain of acne related to their
cycles
• Some young women experience mood swings
• Our goal is to treat the whole woman, all and irritability related to their menstrual
through her reproductive years and beyond. cycles
Things to consider in your teens,
Relationship safety
or for your teen child
• HPV Vaccination, Gardasil • In the teen years is the time to start
– Reduces risk of HPV infection that can lead to discussions about relationship violence and
genital warts or cancer of the cervix, vagina, vulva sexual assault.
or rectum.
• Encourage open dialogue between you and
Encourage open dialogue between you and
– HPV has been implicated in head and neck cancer your teenager
in men
• Enforce the idea that “NO” means “NO” under
every circumstance
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2. 3/4/2013
The “BIG 21” In your 20’s
• Most current guidelines recommend • For many women this is the decade of life where
they start a family
beginning cervical cancer screening (also
• Health care centers around promoting healthy
known as ‘PAP SMEAR’ at age 21. lifestyles
• Why age 21?
Why age 21? • Optimize the health of your pregnancy by
Optimize the health of your pregnancy by
receiving pre‐conception counseling
• Paps every other year if normal – Disease screening
• HPV vaccine still considered through age 26. – Genetic counseling
– Weight loss
– Smoking cessation, avoidance of alcohol
– Medication screening
General health in your 20s Begin to build your bones
• STD screening should be a part of your annual • The 20s’s are a great decade to build an
exam if you are sexually active insurance policy against osteoporosis
• Many STD’s have no symptoms but can impair – Weight bearing exercise
fertility in the future.
fertility in the future – Adequate calcium intake
Adequate calcium intake
• Avoidance of tobacco, drugs, alcohol
• Dermatology exams if frequent user of
tanning beds, these should continue into the
30s and beyond.
In your 30s Pap Smears in your 30s and beyond
• Some women continue childbearing into their • Pap smears every 3‐5 years if your pap is
30s normal and your HPV test is negative.
• Some may begin childbearing after age 35, • If your HPV test is positive, you should
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also known as advanced maternal age. continue annual pap tests
continue annual pap tests
– Increased risk for pregnancy complications in this
age group • If your HPV test is positive for more than 2
• Gestational diabetes years you will undergo additional testing to
• Pregnancy induced hypertension ensure the pap isn’t missing abnormal cells
• Preeclampsia
• Genetic disorders and chromosomal abnormalities
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3. 3/4/2013
Oh my darn period… “Just take it out!!”
• In many women their menstrual cycles become • Even now when hysterectomy is necessary
heavier and more painful after childbearing and
in their 30s. there are much less invasive means
• Many women seek out treatment options for – Laparoscopic assisted vaginal
their heavy cycles.
their heavy cycles – Laparoscopic supracervical
Laparoscopic supracervical
• Hysterectomy which was once the ‘mainstay’ – Total laparoscopic
treatment is now our treatment of last resort.
– Less invasive treatments requested by patients – Robotic assisted (DaVinci)
• Endometrial ablation
• Hormone manipulation, lower doses less risk
– IUD, Pill, Ring, patch
Not tonight dear…. In your 40s
• Low libido seen often in the 30s • Due to advances in reproductive technologies
– Hormone more women are becoming mothers in their
– Depression 40s.
– Fatigue • Menses can become heavy and irregular
Menses can become heavy and irregular
– LIFE!!! • Risk of breast cancer begins to increase
– Baseline mammogram recommended at age 40 in
absence of family history
Peri‐menopause No trampoline for me, thank you!
There can be up to a ten year period leading • Many women in their 40s begin to experience
up to menopause. Menopause is defined as 12 symptoms of stress urinary incontinence.
months with no menstrual bleeding. • This is leakage of urine with cough, sneeze,
Frequent complaints of hot flashes, night
Frequent complaints of hot flashes, night trampolines or Zumba.
trampolines or Zumba
sweats, irritability, mood swings, vaginal dryness,
• There are many treatments available for this
decreased libido.
condition.
Increase in menstrual flow should be
evaluated to rule out endometrial cancer, especially • Pelvic floor physical therapy treatments can
in the obese often help avoid the need for surgical repair
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4. 3/4/2013
Life in the bedroom In your 50s
• Many women enter menopause in their 50s
• Decreased libido, same situation as women in • Many women have increasing bothersome
their 30s symptoms of menopause
–V i ld
Vaginal dryness with coital discomfort
ith it l di f t • T
Treatments for menopause symptoms can be
f b
• Increased libido discussed with your physician
– Kids older – Hormone replacement
– Fewer responsibilities – Bioidentical hormones
– Non‐hormonal treatments
Ovarian cancer warning signs
• Most ovarian cancer diagnoses are in women • Decreased risk with:
over age 55 – Oral contraceptive pills
• Vague symptoms lasting for 2‐3 weeks straight – Tubal ligation
p y p y
should be reported to your physician – Normal weight
Normal weight
– Dr. Barbara Goff, UW Medical Cancer Care Alliance
– Having children
• Bloating
• Abdominal pain • No screening tests for ovarian cancer
• Pelvic pain – CA‐125 used to guide therapy, not diagnostic
• Difficulty urinating
• Early satiety
Other preventative screenings In your 60s and beyond
• If no PCP, blood tests for diabetes, thyroid disease Most screenings should continue.
and elevated cholesterol
• Mammograms Paps may stop at age 65 if they have been normal for 10 years
prior.
• DEXA scanning for bone mineral density to detect
changes leading to osteoporosis
changes leading to osteoporosis Sexual activity can continue as long as both partners desire.
– Age 65, post menopause, no risk factors Vaginal hormone replacement, low risk, great benefits
– Under age 65 if post‐menopause with risk factor
• Screening colonoscopy at age 50 Any postmenopausal bleeding should be reported to your
– If normal findings, every 10 year interval physician
– If abnormal, every 5 years
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5. 3/4/2013
Sleep disturbances
• In the senior years, sleep is harder to come by,
harder to fall asleep, harder to stay asleep,
lighter sleep, and daytime fatigue
• Behavior modification
Behavior modification
• Sleep hygiene can help
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