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Women’s health – beyond reproductive years

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Women’s health – beyond reproductive years

  1. 1. WOMEN’S HEALTH – BEYOND REPRODUCTIVE YEARS - Dr.Gulrukh Hashmi
  2. 2. OVERVIEW  Introduction  Demographic transition  Focus on women beyond reproductive years  Menopause  Osteporosis  Cardiovascular diseases  Mental problems  Cancers  Modes of interventions  Summary
  3. 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. 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. 5. WHY FOCUS ON WOMEN’S HEALTH BEYOND REPRODUCTIVE YEARS??
  6. 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. 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
  8. 8. TOTAL FERTILITY (AVERAGE NUMBER OF CHILDREN PER WOMAN)BY MAJOR REGION, 1970–2005
  9. 9. Decreased fertility rates Increased life expectancy Increase in aging population
  10. 10. TEN LEADING CAUSES OF DEATH 20-59YRS >60 YRS
  11. 11. PERCENTAGE DEATHS BY CAUSE IN WHO REGIONS
  12. 12. 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.
  13. 13. •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
  14. 14. LONG TERM PROBLEMS  Osteoporosis  Heart Disease  Depression Of Menopause Of Ageing • Arthritis • Cancers • Diabetes • Hypertension • Problems of Hearing, vision
  15. 15. 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
  16. 16. 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
  17. 17. THE RISK FACTORS FOR HEART DISEASE
  18. 18. 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.
  19. 19. INCIDENCE OF MOST COMMON CANCERS AMONG FEMALES
  20. 20. 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.
  21. 21. 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
  22. 22. 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
  23. 23. HEALTH PROMOTION  Increasing awareness of health issues  Exercise  Healthy diet  Smoking and alcohol cessation
  24. 24. 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.
  25. 25. 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
  26. 26. 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
  27. 27. SCREENING TESTS  Self breast examination  Mammogram  Examination by physician  Pap smear tests  Bone mineral density  Lipid screening
  28. 28. 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.
  29. 29. 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
  30. 30. 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
  31. 31. 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.
  32. 32. 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.
  33. 33.  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.
  34. 34. 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
  35. 35. 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
  36. 36.  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
  37. 37. THANK YOU

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