HEALTH MAINTENANCE IN WOMENAMERICAN FAMILY PHYSICIAN, VOL. 87, NO. 1, PP. 30

Marie Stoddard

An exam that provides doctors to spend FOCUSED time with patients to discuss disease prevention and health promotion• Advised to be performed

ANNUALLY

What is the Health Maintenance Exam?

Health Maintenance in Women

Doctors must be able to select services that BEST promote the health in ASYMPTOMATIC women In order to come to the best conclusion about what services the patient needs, questions regarding the following categories are important: History Family Planning STD’s Coronary Heart Disease Stroke Prevention Cancer Screening Osteoporosis Screening Immunizations

History

History: In addition to asking about the patient’s medical, social, and family history, it is important to also inquire about: Tobacco, Alcohol, and Illicit Drug Use (be

sure to provide cessation interventions) Depression Intimate partner violence

Family Planning

Premenopausal women should be asked about their reproductive plans Provide contraceptives to those who do not

want to conceive Provide those who are planning OR capable

of pregnancy a folic acid supplement Reduces the risk of neural tube defects

STD’s

High-risk sexually active adults: Multiple sexual partners Have or have had an STD within the past year, Currently in a non-monogamous relationship

It is advised that these patients receive an intensive behavioral counseling lasting more than 30 minutes in one session focused on abstinence, condom use, sexual practice changes, and vaccinations

Also, there is a need to screen these patients annually for chlamydia, gonorrhea and syphilis

Coronary Heart Disease

Leading cause of death in U.S. women Targeted screening for CHD risk factors is

important Current risk factors include:

Overweight and obesity Hypertension Dyslipidemia Type 2 Diabetes

It is advised that doctors consider a selective rather than routine counseling, depending on the aforementioned risk factors

Stroke Prevention

Women ages 55-79 recommended to take 75mg aspirin/day in order to lower the risk for an ischemic stroke This benefit outweighs the risk for GI

hemorrhage

Cancer Screening

Cancer is the 2nd leading cause of death in the U.S. Early screening leads to early diagnosis and the

greatest chance at survival The following cancers should be screened for:

Cervical cancer- Pap Test for those 21yrs and older; screening should be end at 65 yrs or post total hysterectomy

Breast cancer-Screening should begin at 40 without a specific discontinuation age

Colorectal cancer- Recommended for women between the ages of 50-75 years old

Ovarian cancer- the routine screening is not recommended because it does not reduce ovarian cancer mortality

Osteoporosis Screening

Osteoporosis affects 35 million women older than 50 yrs (expected to increase to 41million by 2020

Screening guidelines: Screen women 65 years of age Screen woman younger than 65 years with

fracture risk ≥ than that of a 65 year old woman

Immunizations

Immunizations should be given to all adults unless its contradicted in an individual patient