A guide to women’s health and wellness through the years. We know we are supposed to go to the doctor and get our screening tests done on schedule. But it can all be so intimidating and confusing. How do we know our doctors are as thorough as they are supposed to be in our exams? What can we do to help ourselves at an appointment? What tests should we take? Why? When? How can we best be prepared for big events such as pregnancy and menopause? And what about aging? How can we make that go as pleasantly as possible? For the answers to these questions and more, we consulted with several area doctors, specialists in their fields, for a basic guide to women’s wellness.
Margaret Eagan, M.D., board certified in internal medicine and endocrinology, is the owner of Canterbury Wellness Center. Dr. Eagan says that overall she finds women are lacking in exercise and heart-healthy diets, enduring too much stress and not taking care of themselves because they are focused on taking care of everyone else. To help us get on the right track, she offers the following guidelines for getting the most from an annual physical and demystifies some of the screening tests we need at various points in our lives.
During an annual physical, Dr. Eagan says women should expect to discuss appropriate screening tests, immunizations, supplements, diet and exercise and other preventive health care recommendations, such as using sunscreen and seatbelts and avoiding smoking. Dr. Eagan says women should go to their physicals well-prepared — by fasting in anticipation of blood work, writing out questions for the doctor, knowing their family and personal medical histories, bringing a complete list of all medications and supplements (with doses) and, mostly, by having an open mind.
Pap tests should begin at age 21 or earlier if a woman is sexually active. The test should definitely be performed within three years of beginning sexual activity. “Pap tests should be done annually, and if the results are always ‘normal,’ they should be repeated every two to three years for at least three‘normals,’ depending on individual risks,” explains Dr. Eagan. When test results come back as “abnormal,” she says it can mean anything from cells that are not quite normal and require another test, to cells that appear to be precancerous and require a biopsy to confirm whether or not they are cancerous and to determine treatment.
“Women should do breast self-exams at least monthly, preferably after their period,” says Dr. Eagan. She recommends that women begin doing the exams in their late teens and continue indefinitely. Mammograms should be done starting with a baseline exam at age 35 and then annually, starting at age 40. “You may need to begin earlier if you have a family history of pre-menopausal breast cancer,” she advises. Abnormal mammograms are common, according to Dr. Eagan, and usually mean that further imaging is recommended. She says that sometimes a biopsy is recommended, but even then, most abnormalities are benign. If a breast lump is felt, even if the mammogram is negative, further investigation should be pursued.
“Colonoscopies should begin at age 50,” Dr. Eagan says. “However, stool screening for hidden blood should begin at age 30. People with a family history of colon cancer may need to begin earlier.”
Bone density tests should be done at the start of menopause or earlier if certain risk factors are present. Cholesterol, thyroid and blood count screenings should be done in the late teens or early 20s (every three to five years) and then annually after age 40. The same goes for eye exams. Dr. Eagan also recommends having dental exams every six to 12 months and receiving immunizations according to age and risk factors.
Lorraine Dugoff, M.D., is the associate professor of maternal fetal medicine and clinical genetics, department of obstetrics/gynecology, at the University of Colorado Denver School of Medicine. She offers some advice to women to help their pregnancies run smoothly, starting before conception. “Whether women are planning to become pregnant or just know they are of child-bearing age and want to be prepared, there are several things they should do,” says Dr. Dugoff. First, women should take a vitamin containing 0.4 mg (400 micrograms) of folic acid for at least three months prior to conception. This will reduce the chances of delivering a baby with spina bifida.
Next, a woman should maintain an ideal body weight; quit smoking; avoid high caffeine intake, which has been associated with an increased risk of miscarriage; make sure her PAP test is up-to-date; and have a mammogram prior to pregnancy. “If a woman has diabetes, she should work with her doctor to make sure that her blood sugars are in good control prior to conception to decrease her chances of having a baby with birth defects,” Dr. Dugoff says. If a woman has other medical conditions, she should consider scheduling a preconception visit with a high-risk obstetrician to make sure her medical condition is under control and that the medications she is taking are safe during pregnancy.
Women should talk with their doctors regarding ethnically appropriate carrier screening for some genetic conditions, including cystic fibrosis and Tay-Sachs disease. They should also make sure they have had a rubella vaccination prior to pregnancy and that they eat a balanced diet and get exercise. Age does have an effect on fertility. Dr. Dugoff says that conception occurs by the second month of unprotected intercourse in approximately 50 percent of women under age 27, whereas it takes three to four months for 50 percent of women to conceive between the ages of 35 and 39. Approximately 8 percent of women younger than 27 are infertile; 14 percent of women between 27 and 34 are infertile; and 18 to 28 percent of women between ages 35 and 40 are infertile. So how old is too old to have a healthy pregnancy? Dr. Dugoff says it depends on the woman and her circumstances. “We do know that the risk of pregnancy complications is higher in older women, especially women over 40,” says Dr. Dugoff. Those women should take the same precautions recommended for all women, including engaging in regular moderate exercise and attaining an ideal body weight.
As an aside, some couples believe they can alter their chance for choosing the gender of their child based on the timing of intercourse before ovulation. Dr. Dugoff says this is a myth. “A large study confirmed that the timing of intercourse did not affect the ratio of females to males conceived,” she explains. Once pregnant, a woman should continue to take a vitamin containing 400 milligrams of folic acid during the first trimester and avoid alcohol, tobacco and any drugs that are contraindicated in pregnancy, including Accutane, says Dr. Dugoff. Pregnant women should schedule regular prenatal visits while continuing to eat well, avoiding raw oysters and unpasteurized cheeses and refraining from changing cat litter. Regardless of a mother’s age, there is much of concern during a pregnancy, including birth defects, chromosomal abnormalities, premature birth and genetic diseases such as cystic fibrosis or sickle-cell anemia. There are screening procedures for many of these occurrences. Prenatal ultrasounds can screen for many major birth defects. A combination of ultrasounds and maternal serum screening can test for Down syndrome and some other chromosomal abnormalities.
“All women should be offered screening for Down syndrome and spina bifida,” says Dr. Dugoff, who was part of a study that found that 80 percent of Down syndrome cases could be detected as early as nine weeks after conception, given optimal screening. Women have a choice about whether they want to pursue the results of the screening with ultrasound or to pursue carrier screening for certain genetic conditions, including cystic fibrosis and Tay-Sachs disease. Dr. Dugoff says that two of the biggest mistakes women make in terms of pregnancy and childbirth are exposure to medications that are contraindicated in pregnancy and not calling their doctor with their concerns.
Once the child-bearing years are past, women face another important phase of their lives with menopause. “Menopause is when a woman has had no menstrual periods for 12 consecutive months,” explains Cara Hyman Dawson, M.D., an internal medicine staff physician at Rose Hospital and clinical faculty member at the University of Colorado Health Sciences Center. Every woman’s experience through menopause is different, with varying start and end times and symptoms. The average age at menopause is 51, but it can occur years before or after that time. The onset can be influenced by genetics and even cigarette smoking, which can bring on menopause about two years early. Perimenopause, the first stage, can start an average of six years before actual menopause. Many women don’t even realize they are in perimenopause because they feel they are too young for menopause to be starting.
Some of the typical signs of menopause, more subtle in perimenopause, are changes in usual menstrual patterns and symptoms such as hot flashes, night sweats and vaginal dryness. Lesser known signs include disturbances in sleep patterns, mood swings and fluctuations in sexual drive. “Some women are very symptomatic with the above, while other women stop menstruating but have no other symptoms,” says Dr. Dawson. For women with significant symptoms that disrupt their work and family lives, Dr. Dawson says a combination of estrogen and progesterone can be used to reduce the symptoms. “HRT (Hormone Replacement Therapy) should be used short term, ideally for three to five years, to manage symptoms,” she says. After that, some women are at risk for an increased risk of breast cancer and cardiovascular disease. Dr. Dawson says that for women with a personal or family history of breast cancer or women with multiple cardiac risk factors (hypertension, elevated cholesterol, strong family history of coronary artery disease, tobacco use, diabetes), HRT is not recommended. Although no medication to date can limit symptoms as effectively as HRT, Dr. Dawson says some drugs such as antidepressants (SSRIs), neurontin and herbal medications with phytoestrogen properties (soy, black cohosh and evening primrose) may reduce symptoms. Finally, Dr. Dawson stresses that “menopause is not a disease or disorder; it is a physiologic, normal event in a woman’s life.”
Wendy Kohrt, Ph.D., is a professor of medicine in the division of geriatric medicine at the University of Colorado Denver. She says, “Technically, we do not know what aging is because we do not yet understand what causes aging.” However, she says, we do know that aging is characterized by gradual changes in biological structure, such as the loss of muscle and bone mass, and function, such as the decline in cardiovascular fitness. The rate at which we age is probably genetically determined, but it can be accelerated by behavioral and environmental factors, such as the lack of physical activity, which accelerates the rate of bone loss; a poor diet, which increases the development of atherosclerosis (“hardening of the arteries”); and too much sun exposure, which accelerates aging of the skin.
Dr. Kohrt says it is difficult to know just how much aging really varies among individuals. “However, because people differ widely in their behaviors and environmental exposures, the rates at which they age also vary widely,” she points out. “Even within an individual, some people may have a slow decline in physical function but a fast decline in cognitive function, or vice versa.
‘Ideal’ aging would occur if we could maintain youthful levels of function until the day we die, which clearly does not happen,” says Dr. Kohrt. “‘Successful’ aging occurs if we reach our genetically programmed life span, but it is difficult to know what that is in humans. ‘Usual’ aging reflects the added effects of behavioral and environmental factors on the aging process,” she explains. How much of aging is in our minds and how much is actually in our bodies? “Because behavioral and environmental factors can ‘speed up’ the aging process, a person’s perceptions or beliefs about those factors could impact how they age,” Dr. Kohrt says, citing the example of a 60-year-old woman who believes she is too old to exercise vigorously. This belief could lead to behavioral changes — not exercising — which then contribute to loss of bone mass or the decline in cardiovascular fitness. As for the future of research on aging, Dr. Kohrt hopes from a clinical perspective that research will be carried out to document just how effective lifestyle intervention can be in preventing various age-related diseases such as osteoporosis and cancer. “For example,” says Dr. Kohrt, “although it is commonly believed that physical activity helps prevent osteoporotic fractures, we don’t have solid evidence for that. While exercise may make bones stronger, it is possible that people who are more active have an increased risk of falling (and possibly incurring a fracture) because of their activity level.”
Dr. Kohrt says that aging cannot be prevented, and there are currently no proven therapies for slowing the aging process in humans. There are some theories, however, such as studies that show that in animals, restricting calories by 20 percent to 40 percent has been found to slow the aging process by about 30 percent. The effect on humans isn’t known. For now, it is believed that certain behaviors, such as engaging in regular physical activity, eating a healthful diet or avoiding smoking, are often promoted as having “anti-aging” effects. But for Dr. Kohrt, “The more appropriate way to think of this is that those types of ‘good’ behaviors are necessary for ‘successful aging’. They are factors that enable an individual to achieve the best possible aging outcomes, but they do not prevent or reverse the aging process.” Following the usual recommendations is probably the best way to age successfully. According to Dr. Kohrt, the two modifiable factors that are most likely to lead to premature disability and/or death are smoking and physical inactivity. Generally, she recommends the usual advice — to be physically active, eat healthfully, don’t smoke, get preventive health care and avoid excess exposure to UV rays or pollutants. She believes this is probably the best way to age successfully. Dr. Kohrt says, “People may not perceive this as an easy way to age successfully, but there are no shortcuts!”
Women are caretakers. We are very good at taking care of everything and everyone else while letting our own needs slide. There is a very correct school of thought that says we can’t take care of others adequately if we haven’t taken care of ourselves. With knowledge, the willingness to get ourselves to the doctor and some understanding of the changes we all go through, we can have a life of good health for ourselves and those we love.
A Top-Down Approach
Being fit and in good health is not just good for the individual, it’s good for business. The International Center for Performance & Health (ICPH) uses an all-encompassing approach to help people and companies achieve their personal and professional goals. Through her company, CEO Andrea Wieland, M.B.A., Ph.D., helps executives, athletes and individuals, all in leadership positions, find more balance in their lives with a team-based, holistic-approach combination of physical, nutritional and mental-health assessments and coaching. According to Wieland, leaders are either contributing to the health of the organization or its dysfunction, or making no impact at all. “Though each employee can be viewed as an ultimate contributor to the organization, team members turn to leaders for the example of how to be creative, solve problems and set the course for success,” she says.
The concept for Wieland’s business comes from personal experience. After repeatedly trying to make the U.S. National Field Hockey team as goalkeeper, Wieland became very frustrated by what was preventing her from reaching her Olympic goals. A new coach brought in a team of experts in specific specialties to work with the team on leadership, sport psychology, nutrition, medical rehabilitation, strength and conditioning. Working within the context of a “team around the team,” Wieland’s team jumped from being ranked 11th to third in the world in six months. Two years later, in 1996, she attained her goal of being an Olympian. Wieland feels that anyone can benefit from using similar strategies. “Stress takes a tremendous toll on the mind, body and spirit, leaving folks feeling defeated, drained and ineffective, resulting in poor decisions and more fear and stress,” says Wieland. “Our program goes well beyond fitness and nutrition. ICPH is about serving the highest good, which I believe ultimately all humans want to practice. They have just been stuck in limited mind-sets, living selfishly, and have created unnecessary stress on themselves, others and the planet. ICPH seeks to change that by changing leaders.” On Feb. 19, 2009, ICPH will hold the Colorado’s Healthiest Executive Awards Breakfast, recognizing male and female senior leaders who model healthy lifestyles and actively promote health within their organization and community. The program is directed at creating awareness that healthy organizations and communities start with healthy leaders. The male and female winners for 2009 Colorado’s Healthiest Executive and the Most Improved in Health Executive will be announced. For more information, go to www.healthiest-executive.com or call ICPH, (303) 756-ICPH (4274).
Written by COURTNEY DRAKE-MCDONOUGH
Photography by STEVE GROER