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

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

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

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.

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

Global population of age 60 yrs.

Currently - 580 million

INDIA - 90 million

48.2% - Female in India 55% - Widows70% - dependent on others50% - Postmenopausal women

Source:Report on the Status of Elderly in Select States of India, 2011

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

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

Decreased fertility rates

Increased life

expectancy

Increase in aging

population

TEN LEADING CAUSES OF DEATH20-59YRS >60 YRS

PERCENTAGE DEATHS BY CAUSE INWHO REGIONS

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.

•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

LONG TERM PROBLEMS

Osteoporosis Heart Disease Depression

Of Menopause

Of Ageing• Arthritis• Cancers• Diabetes• Hypertension• Problems of Hearing, vision

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

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

THE RISK FACTORS FOR HEART DISEASE

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.

INCIDENCE OF MOST COMMON CANCERS AMONG FEMALES

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.

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

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

HEALTH PROMOTION Increasing awareness of health issues

Exercise

Healthy diet

Smoking and alcohol cessation

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.

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

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

SCREENING TESTS Self breast examination

Mammogram

Examination by physician

Pap smear tests

Bone mineral density

Lipid screening

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.

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

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

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.

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.

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.

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

 

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

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

THANK YOU