Healthy What every woman should know about her health
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Immunizations you need and when you need them Below are recommended immunization guidelines. Ask your doctor about your risk factors and specific needs. He or she will consider your health, occupation and lifestyle to determine the vaccinations you need. For example, healthcare workers or people traveling to certain countries may need specific immunizations. Your doctor may recommend a particular shot if you can’t remember or can’t find proof you’ve already been immunized. Immunization
Ages 20–29
u Influenza (“flu”) vaccine
Ask your doctor. Get vaccinated if you’re pregnant or plan to be, have a chronic disease, are a healthcare worker or live or work with those at high risk of flu.
Every year
u Pneumococcal (“pneumonia”)
Ask your doctor. You should be vaccinated if you have a chronic disease.
Once, at age 65
u Tetanus-diphtheria booster vaccine
Every 10 years
u Meningococcal (“meningitis”)
College students
u Human papillomavirus
Once, up to age 26
vaccine
Ages 30–39
Ages 40–49
Ages 50+
vaccine
(“cervical cancer”) vaccine
u Herpes zoster (“shingles”) vaccine u Hepatitis A and hepatitis B vaccines
Once, at age 60 Ask your doctor about your risk factors.
Sources: Centers for Disease Control and Prevention, Womenshealth.gov
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BONE HEALTH Osteoporosis Osteoporosis is a disease that makes bones weaker over time. Eventually, the bones become fragile and break easily. Eighty percent of people with osteoporosis are women.
•M edicine. Some medicines can slow or stop bone
loss, boost bone strength and lower fracture risk.
•G ood nutrition. You need calcium and vitamin D to
keep your bones strong.
•A ctivity. Besides helping you maintain a healthy
weight, exercise can help build bone.
• F all prevention. A fall can easily lead to a fracture.
You need to take certain steps to prevent falls. This may include walking with a cane or avoiding certain floor surfaces because they’re slippery.
Signs and symptoms
Osteoporosis is a “silent” disease because it has no symptoms. In fact, many women don’t know they have the disease until they break a bone. Any little bump or fall can lead to a break. The most common places to fracture a bone are the wrist, spine and hip. People with spine fractures usually have a loss of height and a stooped posture.
Self-care and prevention
•G et your calcium and vitamin D. Adults ages 18 and
Causes and risk factors
Your bones can become fragile if you:
• are postmenopausal • are female • are thin and small-boned • are Caucasian or Asian • have a family history of osteoporosis or fractures • have an abnormal absence of menstrual periods • have low estrogen levels • are anorexic • don’t get enough vitamin D and calcium • t ake certain medications, such as antiseizure
medications and glucocorticoids
• are inactive • smoke • drink excessively
Diagnosis
A bone mineral density test can help your doctor tell whether you have osteoporosis. You should have a bone density test if you’re over 65. If you have any of the risk factors listed, talk with your doctor about being screened before you’re 65.
Treatment
The goal of treating osteoporosis is to lower the risk of a fracture. Treatment can include:
•
•
•
• •
older need 1,000–1,200 mg of calcium a day. You can get calcium from low-fat dairy products, dark-green leafy vegetables, tofu and nuts. You can also find it in foods with calcium added, such as orange juice and cereals. Adults need 400–800 IU of vitamin D a day, depending on their age. The vitamin is made in the skin when exposed to sun. Fish is the best food source of vitamin D. If you can’t get enough calcium or vitamin D naturally, you may need a supplement. B e active. Weight-bearing exercises, like walking, dancing, jogging and lifting weights, make bones stronger. Ask your doctor what’s best for you. D on’t smoke. Smoking can lower estrogen levels — a risk factor for osteoporosis. Smoking can also make it hard for your body to absorb calcium. D on’t drink a lot of alcohol. Alcohol may damage bones. Drinking a lot can also lead to bad eating habits and a higher risk of falling. Women shouldn’t have more than one drink a day. A sk your doctor about your medicines. They could be causing osteoporosis. K eep paths clear. Stop a fall by keeping your house clutter-free. Wear shoes with good traction. Install plenty of lighting so you can see well.
Stay strong Osteoporosis will cause up to half of all women and 25 percent of men older than 50 to break a bone.
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REPRODUCTIVE HEALTH Reproductive cancers Cervical, uterine and ovarian cancers are treatable if found early. Unfortunately, these cancers don’t always have symptoms in the early stages. Signs and symptoms Cervical cancer
The cervix is the lower part of the uterus. An abnormal Pap test may be the first sign something’s wrong. As the cancer grows, you may have: • v aginal bleeding after intercourse, between periods or after menopause •w atery, bloody vaginal discharge that may be heavy and smell bad •p ain in the pelvis or painful intercourse Uterine cancer
Uterine cancer usually occurs after menopause. The most common form of uterine cancer starts in the uterus lining. This is sometimes called endometrial cancer. Possible symptoms include: • unusual vaginal bleeding or discharge • problems urinating • pelvic pain • painful intercourse Ovarian cancer
Ovarian cancer usually affects women over age 50. However, younger women can have it, too. Ovarian cancer can cause: • bloating • abdominal or pelvic pain • feeling full after eating only a small amount • frequent or urgent urination • a heavy feeling in the pelvis • vaginal bleeding • weight gain or loss • unexplained back pain that gets worse • gas, nausea, vomiting or loss of appetite
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Risk factors
Cervical cancer • human papillomavirus (HPV) • multiple sexual partners • having sexual intercourse before age 18 • sexually transmitted infections • a weak immune system • cigarette smoking Uterine cancer • s tarting menstruation before age 12 • a history of infertility or never giving birth •o besity •u se of tamoxifen, a breast cancer medication •u se of menopausal hormone therapy •o varian disorders such as polycystic ovary • • • • •
syndrome a high-fat diet d iabetes a family history of uterine or colorectal cancer a personal history of breast or ovarian cancer p rior radiation therapy to the pelvic area
Ovarian cancer •b eing postmenopausal •o besity •n ot having children • i nfertility •u sing the fertility medication Clomid for more than
a year without getting pregnant
• t aking the endometriosis medication danazol • t aking menopausal hormone therapy • a family history of ovarian, breast or colorectal
cancer
•o varian cysts after menopause
Diagnosis
Imaging tests can help find cancer. These include ultrasounds or computed tomography (CT) scans. Blood tests may also be done. Some cancers have specific tests. For example, cervical cancer may be found with a Pap test.
Treatment
Treatment depends on the type of cancer. Surgery, chemotherapy, radiation and hormone therapy are common options.
Prevention
Cervical cancer •P rotect yourself against HPV. Delay when you first
have sex. Have fewer sexual partners. Use condoms every time you have sex. •A sk your doctor about the vaccine Gardasil. It can protect against the most dangerous forms of HPV. Gardasil is most effective if given before a girl has sex for the first time. • Get routine Pap tests. • Don’t smoke. Uterine cancer •A sk your doctor about other treatments if you’re
• • • • •
taking any medicines that could increase your risk for uterine cancer. A sk your doctor about the pros and cons of birth control pills, which can lower uterine cancer risk. Maintain a healthy weight. Get any problems with your uterus treated. Get your diabetes under control. Eat a diet low in fat.
• Exercise daily. •T alk with your doctor if uterine cancer runs in your
family.
Ovarian cancer • Maintain a healthy weight. •A sk your doctor about other treatments if you’re
taking any medicines that could increase your risk for ovarian cancer. •A sk your doctor about the pros and cons of birth control pills, which can lower ovarian cancer risk. •T alk with your doctor if ovarian cancer runs in your family.
Pap test facts • A Pap test can detect abnormalities of the cervix that can lead to cervical cancer. • Experts recommend that women get tested at least every three years after they begin having sexual intercourse, but no later than age 21. • Women ages 70 and older who’ve had three normal tests in a row and no abnormal results in the last 10 years may decide to stop getting tested. • Even if you’ve been vaccinated against HPV, you should still get regular Pap tests.
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Appendix B
15 tips to prepare for pregnancy You can increase your chances of a safe pregnancy and a healthy newborn by taking these 15 precautions.
1
Reach a healthy weight before conceiving.
2
Exercise before and during pregnancy. If
3
Schedule a gynecological exam. Your doctors
Obese women are more prone to gestational diabetes and preeclampsia (dangerously high blood pressure), and women with those conditions tend to have complicated deliveries. you’re fit, your heart can more easily meet the demands of pregnancy and pump a steady flow of blood to the fetus. Strong muscles can support pregnancy weight and reduce the risk of injuries. will look for potential problems which can be treated or controlled before you conceive.
Take prenatal vitamins for at least two months before conception (and throughout the first trimester). The folic acid
4
in prenatal vitamins may decrease the risk of fetal brain and nervous-system abnormalities, while the extra iron can prevent anemia.
watch what you eat The most critical time for nutrition is during the first eight weeks of gestation — when many women aren’t aware of their pregnancies.
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5
Get a blood test. If your blood is Rh negative
6
Test for rubella antibodies. If you haven’t
7
Consider genetic counseling. If you’re
and your baby is Rh positive, your body will produce antibodies that destroy Rh positive red blood cells. In first pregnancies, the antibodies are too few in number to cause alarm. But in later pregnancies, Rh antibodies can cause fetal anemia, organ damage or death. If you’re Rh negative, an injection of Rh immune globulin in your first pregnancy will prevent future production of Rh antibodies. developed antibodies against rubella, get vaccinated. In that case, wait at least three months before conceiving. Rubella can cause birth defects. concerned about a family history of stillbirths or mental disabilities, consider genetic counseling. Likewise, if you have a family history of inherited diseases such as cystic fibrosis, or if you and your spouse have similar ethnic origins, you may want to find out if you’re carriers of specific genetic diseases.
8
If you use oral contraceptives, switch to another
form of birth control for at least a month before conceiving. Although fetal problems are rarely associated with birth control pills, some hormones are known to cause fetal damage.
9
Review your medications with your doctor. Accutane, antiseizure medications,
chemotherapy and other medications can harm your growing fetus. Over-the-counter medications can also be unsafe.
10
Revamp your diet. Eat at least five servings a
day of fruits and vegetables to provide folic acid, beta-carotene, vitamin C and other nutrients. Eat lean beef and fortified cereals to boost your iron reserves, and include four nonfat dairy servings daily.
11
If you smoke, quit. Smoking increases the
12
Give up alcohol. It can cause brain dysfunction
13
Don’t do drugs. They can cause fetal
14
Take care of X-rays and dental work before you conceive. Modern dental X-ray techniques
risk of fetal-growth retardation, miscarriages, prematurity and stillbirth. and facial and skeletal malformations.
abnormalities, prematurity and growth retardation.
offer adequate protection from harmful radiation, and local anesthetics are not believed to be dangerous during pregnancy. But why take a chance?
15
Avoid overheating. Exercising at too high
an intensity or taking hot baths, saunas and whirlpools can raise your core body temperature. That, in turn, may cause congenital defects.
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