1. WOMEN’S HEALTH –
BEYOND
REPRODUCTIVE YEARS
- Dr.Gulrukh Hashmi

2. OVERVIEW
 Introduction
 Demographic transition
 Focus on women beyond reproductive years
 Menopause
 Osteporosis
 Cardiovascular diseases
 Mental problems
 Cancers
 Modes of interventions
 Summary

3. CHANGING DEFINITIONS OF WOMEN
HEALTH
 Women’s health typically connotes reproductive
functions
 Increased focus on public programs providing pregnancy
related and/or family planning services.
 Women’s health focus shifted to beyond reproductive
years in 1960s and 70s

4. Health is a state of complete
physical, mental and social well
being and not merely the absence
of disease or infirmity. Women’s
health involves their emotional ,
social and physical well being and
is determined by the social
political and economic context of
their lives as well as by biology.

5. WHY FOCUS ON WOMEN’S
HEALTH BEYOND REPRODUCTIVE
YEARS??

6. Global population of age 60 yrs.
Currently - 580 million
INDIA - 90 million
48.2% - Female in India
55% - Widows
70% - dependent on others
50% - Postmenopausal women
Source:Report on the Status of Elderly in Select States of India, 2011

7. DEMOGRAPHIC TRANSITION
 Life expectancy for women is 67.57 years as against
65.46 years for men.
 Proportion of elderly women is 71/1000 in rural areas as
compared to men 70/1000
 In urban areas proportion of elderly women and men is
71/1000 and 62/1000 respectively.
 Sex ratio is favourable to women only in age group of 65
years and above

9. TOTAL FERTILITY (AVERAGE NUMBER OF CHILDREN PER
WOMAN)BY MAJOR REGION, 1970–2005

10. Decreased
fertility rates
Increased life
expectancy
Increase in
aging
population

11. TEN LEADING CAUSES OF DEATH
20-59YRS >60 YRS

13. PERCENTAGE DEATHS BY CAUSE IN
WHO REGIONS

14. Health events in post reproductive life
 Ageing involves slowing down of the system
The key event that occurs in women is
MENOPAUSE
Marks the end of women’s reproductive life
Occurs between the 45-55years
Nearly 1/3rd of the women’s life is spent after
menopause.

15. •Menstrual irregularities
•Hot flushes
•Palpitation
•Muscle And Joint Pain
•Low Backache
•Vaginal Dryness
•Urinary incontinence
•Urinary Frequency
•Fatigue
•Mood Swings
•Depression
•Sleeping Problems
•Memory Lapse
•Decreased Libido
•Weight Gain
•Dryness Of Skin
•Hair Loss
Short term problems

16. LONG TERM PROBLEMS
 Osteoporosis
 Heart Disease
 Depression
Of Menopause
Of Ageing
• Arthritis
• Cancers
• Diabetes
• Hypertension
• Problems of Hearing, vision

17. OSTEOPOROSIS
 Osteoporosis is common problem
 Prevalence is 52% in urban areas
and 76% in rural areas.
 Falls account for 87% of all fractures for
elderly women
 About one-fifth of hip fracture patients require
long-term nursing home care
 10% remain functionally dependent for daily
living care.
Normal bone
Osteoporotic
bone

18. CARDIOVASCULAR DISEASES
 Stroke is the most common cause of death leading to
21.7% deaths.
 Ischemic heart diseases leads to 19.8% deaths.
 No protective action of estrogen
 The chance of having a stroke more than doubles for
each decade of a woman's life after age of 55.
 Decreased heart capacity, decreased pumping capacity

19. THE RISK FACTORS FOR HEART DISEASE

20. MENTAL HEALTH
 An estimated 20% suffer depression
at some point during the menopause.
 Mood swings, irritability, tearfulness, anxiety,
and feelings of despair in the years leading to
menopause.
 These symptoms occur in conjunction with
vasomotor instability as a result of declining
ovarian function.

21. INCIDENCE OF MOST COMMON CANCERS
AMONG FEMALES

22. CANCERS
 Occurs before the age of 60 years but most of the deaths
(68%) occur at older ages.
 Breast cancer is a hormonally influenced disease
 Age at menarche, age at first and last pregnancy, and age
at menopause and family history of breast cancer are
associated with an increased risk.
 Breast cancer accounts for 572,100 cases of breast
cancer each year in the world, of which 40 percent occur
in developing countries.

23. CANCERS
 Out of the 572,100 new cases each year worldwide, it
accounts for between 1 and 3 percent of all deaths in
developing countries and 3 to 5 percent in developed
countries
 Cancer of the cervix accounts for 500,000 new cancer
cases each year worldwide.
 About 80 percent of these occur in the developing
countries, accounting for 200,000 deaths annually
 Develops slowly and readily detectable

24. OTHER HEALTH PROBLEMS
 Diabetes
 Prevalence is 3.8% in rural areas and 11.8% in urban areas
 Urinary incontinence
 affects 31.5% of women.
 Poor vision
 46.8% of women affected
 Hearing difficulties
 19% women have difficulty in hearing

26. HEALTH PROMOTION
 Increasing awareness of health issues
 Exercise
 Healthy diet
 Smoking and alcohol cessation

27. HORMONE REPLACEMENT THERAPY
 The use of estrogens can relieve the menopausal
symptoms.
 Hot flashes , sweats and other complaints disappear or
improve within a few days of starting estrogens therapy.
The administration of estrogen without progestogen
increases the risk of endometrial cancer and breast cancer.
 Cyclical therapy with 10 days progestogen per month ,
can reduces the incidence of cancer.

28. IMMUNIZATION
oVaccination to prevent cervical cancer
3 dose schedule
Given to women and girls age 11-26 years
o Influenza – every year age 65-80
(optional age 50-64)
 Pneumonia – once at age 65
 Tetanus toxoid – every 10 years
 Zoster (Shingles) – once at age 60

29. EARLY DIAGNOSIS AND TREATMENT
 Early detection usually means a better
outcome and less invasive treatment
 Regular check-ups should include dental, vision and
hearing checks
 Screening tests

30. SCREENING TESTS
 Self breast examination
 Mammogram
 Examination by physician
 Pap smear tests
 Bone mineral density
 Lipid screening

31. DISABILITY LIMITATION AND
REHABILITATION
 Most common disabilities are locomotor and vision.
 46.8% women suffer from poor vision
 Free operation facilities for cataract surgeries
 Nearly 19% women had difficulty in hearing but only
3.6% of women use hearing aids.
 Proper dentures.

32. LIFE CYCLE APPROACH TO WOMEN’S
HEALTH
 Anticipates and meets women’s health needs
from infancy through old age
 Emphasizes health-seeking behavior and
appropriate services to meet women’s health
needs throughout their lives

33. HEALTH AND NUTRITIONAL PROBLEMS
.
•Women and girls have
special health needs
throughout their lives.
•Health systems should
recognize and address
women’s health problems
throughout the life cycle

34. SPECIFIC ACTIONS
 For post-reproductive age women:
 Encourage women to continue seeking health care
throughout their menopausal and post-menopausal
years
 Provide screening and accessible treatment for breast
and gynecological cancers.

35. SUMMARY
 Health and social status of women beyond reproductive
years highlight greater emphasis on involvement of
health care activities
 Awareness generation regarding healthy lifestyle should
be done
 Information on common health problems and facilities
available should be provided.
 Policies need to be more gender sensitive and should
focus on women’s needs.

36.  Geriatric medicine should be given more focus and
recognition.
 Encourage more research regarding the health and social
issues in relation to women beyond reproductive age
group.
 Health strategies has to be country specific as there are
variations in diseases.

37. REFERENCES
 Park’s text book of “preventive & social medicine” 22nd
edition
 WHO AFMC textbook of community medicine. 2nd Edition
 Sunder Lal Textbook of community medicine 3rd edition
 Flavia Bustreo, Felicia Marie,Knaul Afsan Bhadelia.
Women’s health beyond reproduction: meeting the
challenges. Bulletin of the World Health
Organization 2012;90:478-478A. doi:
10.2471/BLT.12.103549
 Barfield WD, Warner L. Preventing chronic disease in women
of reproductive age:opportunities for health promotion and
preventive services. Prev Chronic Dis
2012;9:110281.DOIhttp://dx.doi.org/10.5888/pcd9.110281

38. REFERENCES
 Gender, health and ageing. Department of
gender and women’s health.WHO
 Dr. Indira Jai Prakash. Health Concerns of older
Women in India
 Carol S. Weisman. Changing definitions of
women’s health: implications for health Care and
Policy.. Maternal and child health journal, Vol 1,
No 3, 1997.183-189
 Susan U Raymond,Henry M Greenberg, Stephen R
Leeder. Beyond reproduction: Women’s health in
today’s developing world. International Journal of
Epidemiology 2005;34:1144–1148

39.  Experts suggest ways of coping with menopausal
effects. Times of India available on
http://articles.timesofindia.indiatimes.com/2013-
02-23/allahabad/37256673_1_menopausal-
symptoms-aruna-gaur-anjula-sahai
 Mary Eming Young. Health Problems and
Policies for Older Women: An Emerging Issue in
Developing Countries. HRO Working Papers
World Bank, May 1994

40. THANK YOU