Women's health refers to the branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a woman's physical and emotional well-being.
Women's health includes a wide range of specialties and focus areas, such as:
- Birth control, sexually transmitted infections (STIs), and gynecology
Breast cancer is cancer that starts in the tissues of the breast. There are two main types of breast cancer:
- Ductal carcinoma starts in the tubes (ducts) that carry milk from the breast to the nipple. Most breast cancers are of this type.
- Lobular carcinoma starts in the parts of the breast, called lobules, which produce milk.
In rare cases, other kinds of breast cancer can start in other areas of the breast.
- Some risk factors you can control, such as drinking alcohol. Others, such as family history, you cannot control.
- The more risk factors you have, the more your risk increases. But, it does not mean you will develop cancer. Most women who develop breast cancer do not have any known risk factors or a family history.
- Understanding your risk factors can help you take steps to lower your risk.
Some women are at higher risk for breast cancer because of certain genetic markers or variants that may be passed down from their parents.
- Genes known as BRCA1 or BRCA2 are responsible for most cases of inherited breast cancers.
- A screening tool with questions about your family's history as well as yours can help your health care provider whether you are at risk for carrying these genes.
- If you are at high risk, a blood test to see if you carry the genes.
- Certain other genes may lead to an increased risk of breast cancer.
Breast implants, using antiperspirants, and wearing underwire bras do not increase the risk for breast cancer. There is also no evidence of a direct link between breast cancer and pesticides.
Early breast cancer often does not cause symptoms. This is why regular breast exams and mammograms are important, so cancers that don't have symptoms may be found earlier.
As the cancer grows, symptoms may include:
- Breast or lump in the armpit that is hard, has uneven edges, and usually does not hurt.
- Change in the size, shape, or feel of the breast or nipple. For example, you may have redness, dimpling, or puckering that looks like the skin of an orange.
- Fluid from the nipple. Fluid may be bloody, clear to yellow, green, or look like pus.
In men, breast cancer symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include:
- Bone pain
- Shortness of breath
- Swelling of the lymph nodes in the armpit (next to the breast with cancer)
- Weight loss
Exams and Tests
The health care provider will ask about your symptoms and risk factors. Then the provider will perform a physical exam. The exam includes both breasts, armpits, and the neck and chest area.
Women are encouraged to perform breast self-exams each month. However, the importance of self-exams for detecting breast cancer is debatable.
Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.
Ovarian cancer is the fifth most common cancer among women. It causes more deaths than any other type of female reproductive organ cancer.
The cause of ovarian cancer is unknown.
Risks of developing ovarian cancer include any of the following:
- The fewer children a woman has and the later in life she gives birth, the higher her risk for ovarian cancer.
- Women who have had breast cancer or have a family history of breast or ovarian cancer have an increased risk for ovarian cancer (due to defects in genes such as BRCA1 or BRCA2 ).
- Women who take estrogen replacement only (not with progesterone) for 5 years or more may have a higher risk for ovarian cancer. Birth control pills, though, decrease the risk for ovarian cancer.
- Fertility medicine probably does not increase the risk for ovarian cancer.
- Older women are at highest risk of developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.
Menopause is the time in a woman's life when her periods (menstruation) stop. Most often, it is a natural, normal body change that most often occurs between ages 45 to 55. After menopause, a woman can no longer become pregnant.
During menopause, a woman's ovaries stop releasing eggs. The body produces less of the female hormones estrogen and progesterone. Lower levels of these hormones cause menopause symptoms.
Periods occur less often and eventually stop. Sometimes this happens suddenly. But most of the time, periods slowly stop over time.
Menopause is complete when you have not had a period for 1 year. This is called postmenopause. Surgical menopause takes place when surgical treatments cause a drop in estrogen. This can happen if both of your ovaries are removed.
Menopause can also sometimes be caused by drugs used for chemotherapy or hormone therapy (HT) for breast cancer.
Heart disease and women
People often do not consider heart disease a woman's disease. Yet cardiovascular disease is the leading killer of women over age 25. It kills nearly twice as many women in the United States as all types of cancer.
Men have a greater risk for heart disease earlier in life than women. Women's risk increases after menopause.
EARLY HEART DISEASE SIGNS
Women may have warning signs that go unnoticed for weeks or even years before a heart attack occurs.
- Men most often have the "classic" heart attack signs: tightness in the chest, arm pain, and shortness of breath.
- Women's symptoms can resemble those of men.
- Women may also complain of other symptoms, such as nausea, fatigue, indigestion, anxiety, and dizziness.
ACT IN TIME
Recognizing and treating a heart attack right away improves your chance for survival. On average, a person having a heart attack will wait for 2 hours before calling for help.
Know the warning signs and always call 911 or the local emergency number within 5 minutes of when symptoms begin. By acting quickly, you can limit damage to your heart.
MANAGE YOUR RISK FACTORS
A risk factor is something that increases your chance of getting a disease or having a certain health condition. You can change some risk factors for heart disease. Other risk factors you cannot change.
Women should work with their health care provider to address risk factors they can change.
- Use lifestyle measures to keep your blood cholesterol levels in the right range. Targets for cholesterol levels vary, depending on your risk factors. Ask your provider which targets are best for you.
- Keep your blood pressure in a healthy range. Your ideal blood pressure level will depend on your risk factors. Discuss your target blood pressure with your provider.
Estrogen is no longer used to prevent heart disease in women of any age. Estrogen may increase the risk for heart disease in older women. However, it may still be used for some women to treat hot flashes or other medical problems.
- Estrogen use is probably safest for women under age 60.
- It should be used for the shortest possible period of time.
- Only women who have a low risk for stroke, heart disease, blood clots, or breast cancer should take estrogen.
Some women (especially those with heart disease) can take a low-dose aspirin daily to help prevent heart attacks. Some women will be advised to take low-dose aspirin to prevent stroke. Aspirin can increase the risk for bleeding, so check with your provider before beginning daily aspirin treatment.
LIVE A HEALTHY LIFESTYLE
Some of the risk factors for heart disease that you CAN change are:
- DO NOT smoke or use tobacco.
- Get plenty of exercise. Women who need to lose weight or maintain their weight should get at least 60 to 90 minutes of moderate-intensity exercise on most days. To maintain your health, get at least 30 minutes of exercise a day, preferably at least 5 days a week.
- Maintain a healthy weight. Women should strive for a body mass index (BMI) of between 18.5 and 24.9 and a waist smaller than 35 inches (90 cm).
- Get checked and treated for depression, if necessary.
- Women with high cholesterol or triglyceride levels may benefit from omega-3 fatty acid supplements.
If you drink alcohol, limit yourself to no more than one drink per day. DO NOT drink just for the purpose of protecting your heart.
Good nutrition is important to your heart health, and it will help control some of your heart disease risk factors.
The Pap test checks for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
This test is sometimes called a Pap smear.
How the Test is Performed
You lie on a table and place your feet in stirrups. Your health care provider gently places an instrument called a speculum into the vagina to open it slightly. This allows the provider to see inside the vagina and cervix.
Cells are gently scraped from the cervix area. The sample of cells is sent to a lab for examination.
How to Prepare for the Test
Tell your provider about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may affect test results.
Also tell your provider if you:
- Have had an abnormal Pap test
- Might be pregnant
DO NOT do the following for 24 hours before the test:
- Douche (douching should never be done)
- Have intercourse
- Use tampons
Try not to schedule your Pap test while you have your period (are menstruating). Blood may make the Pap test results less accurate. If you are having unexpected bleeding, do not cancel your exam. Your provider will determine if the Pap test can still be done.
Empty your bladder just before the test.
How the Test will Feel
A Pap test causes little to no discomfort for most women. It can cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam.
You may bleed a little bit after the test.
Why the Test is Performed
The Pap test is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap tests.
Screening should start at age 21.
After the first test:
- You should have a Pap test every 3 years to check for cervical cancer.
- If you are over age 30 and you also have HPV testing done, and both the Pap test and HPV test are normal, you can be tested every 5 years. HPV (human papillomavirus) is a virus that causes genital warts and cervical cancer.
- Most women can stop having Pap tests after age 65 to 70 as long as they have had 3 negative tests within the past 10 years.
You may not need to have a Pap test if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap test, cervical cancer, or other pelvic cancer. Discuss this with your provider.
A normal result means there are no abnormal cells present. The Pap test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly, and follow-up Pap tests should find any changes in time for treatment.
What Abnormal Results Mean
Abnormal results are grouped as follows:
ASCUS or AGUS:
- This result means there are atypical cells, but it is uncertain or unclear what these changes mean.
- The changes may be due to HPV.
- They may be due to inflammation of unknown cause.
- They may be due to lack of estrogen as occurs in menopause.
- They may also mean there are changes that may lead to cancer.
- These cells could be precancerous and they could be coming from the outside of the cervix or inside the uterus.
LOW-GRADE DYSPLASIA (LSIL) OR HIGH-GRADE DYSPLASIA (HSIL):
- This means changes that may lead to cancer are present.
- The risk of progression to cervical cancer is greater with HSIL.
CARCINOMA IN SITU (CIS):
- This result most often means the abnormal changes are likely to lead to cervical cancer if not treated
ATYPICAL SQUAMOUS CELLS (ASC):
- Abnormal changes have been found and may be HSIL
ATYPICAL GLANDULAR CELLS (AGC):
- Cell changes that may lead to cancer are seen in the upper part of the cervical canal or inside the uterus.
When a Pap test shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap test, your previous history of Pap tests, and risk factors you may have for cervical cancer.
For minor cell changes, providers will recommend another Pap test or repeat HPV testing in 6 to 12 months.
Follow-up testing or treatment may include:
- Colposcopy-- Colposcopy is a procedure in which the cervix is magnified with a binocular-like tool called a colposcope. Small biopsies are often obtained during this procedure to determine the extent of the problem.
- An HPV test to check for the presence of the HPV virus types most likely to cause cancer.
- Cervix cryosurgery.
- Cone biopsy
- Endometrial biopsy.
- Vaginal ultrasound.
Polycystic ovary syndrome (PCOS) is a condition in which a woman has increased levels of male hormones (androgens). Many problems occur as a result of this increase of hormones, including:
- Menstrual irregularities
- Skin problems, such as acne and increased hair growth
- Increased number of small cysts in the ovaries
- Insulin resistance, with an increased risk of developing diabetes
PCOS is linked to changes in hormone levels that make it harder for the ovaries to release fully-grown (mature) eggs. The reasons for these changes are unclear. The hormones affected are:
- Estrogen and progesterone, the female hormones that help a woman's ovaries release eggs
- Androgen, a male hormone that is found in small amounts in women
Normally, one or more eggs are released during a woman's cycle. This is known as ovulation. In most cases, this release of eggs occurs about 2 weeks after the start of a menstrual period.
In many women with PCOS, mature eggs are not released. Instead, they stay in the ovaries with a small amount of fluid (cyst) around them. The affected ovary may be slightly enlarged. There can be many of these. However, not all women with the condition will have ovaries with this appearance.
Women with PCOS have cycles where ovulation does not occur every month which may contribute to infertility. The other symptoms of this disorder are due to the high levels of male hormones.
Most of the time, PCOS is diagnosed in women in their 20s or 30s. However, it may also affect teenage girls. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has similar symptoms.
Uterine fibroids are tumors that grow in a woman's womb (uterus). These growths are typically not cancerous (benign).
Uterine fibroids are common. As many as one in five women may have fibroids during their childbearing years. Half of all women have fibroids by age 50.
Fibroids are rare in women under age 20. They are more common in African Americans than White, Hispanic, or Asian women.
No one knows exactly what causes fibroids. They are thought to be caused by:
- Hormones in the body
- Genes (may run in families)
Fibroids can be so tiny that you need a microscope to see them. They can also grow very large. They may fill the entire uterus and may weigh several pounds or kilograms. Although it is possible for just one fibroid to develop, most often there is more than one.
Fibroids can grow:
- In the muscle wall of the uterus (myometrial)
- Just under the surface of the uterine lining (submucosal)
- Just under the outside lining of the uterus (subserosal)
- On a long stalk on the outside the uterus or inside the uterus (pedunculated)
Common symptoms of uterine fibroids are:
- Bleeding between periods
- Heavy bleeding during your period, sometimes with blood clots
- Periods that may last longer than normal
- Needing to urinate more often
- Pelvic cramping or pain with periods
- Feeling fullness or pressure in your lower belly
- Pain during intercourse
Often, you can have fibroids and not have any symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause. A recent study also showed that some small fibroids shrink in premenopausal women.
Exams and Tests
Your provider will perform a pelvic exam. This may show that you have a change in the shape of your womb.
Fibroids are not always easy to diagnose. Being obese may make fibroids harder to detect. You may need these tests to look for fibroids:
- Ultrasound uses sound waves to create a picture of the uterus.
- MRI uses powerful magnets and radio waves to create a picture.
- Saline infusion sonogram (hysterosonography) -- Saline is injected into the uterus to make it easier to see the uterus using ultrasound.
- Hysteroscopy uses a long, thin tube inserted through the vagina and into the uterus to examine the inside of the uterus.
- Endometrial biopsy removes a small piece of the lining of the uterus to check for cancer if you have unusual bleeding.
What type of treatment you have depends on:
- Your age
- Your general health
- Your symptoms
- Type of fibroids
- If you are pregnant
- If you want children in the future
Treatment for the symptoms of fibroids may include:
- Intrauterine devices (IUDs) that release hormones to help reduce heavy bleeding and pain.
- Tranexamic acid to reduce the amount of blood flow.
- Iron supplements to prevent or treat anemia due to heavy periods.
- Pain relievers, such as ibuprofen or naproxen, for cramps or pain.
- Watchful waiting -- You may have follow-up pelvic exams or ultrasounds to check the fibroid's growth.
Medical or hormonal therapies that may help shrink fibroids include:
- Birth control pills to help control heavy periods.
- A type of IUD that releases a low dose of the hormone progestin into the uterus each day.
- Hormone shots to help shrink fibroids by stopping ovulation. Most often, this therapy is used only for a short time to shrink fibroids before surgery. They can also be used longer when small amounts of estrogen hormone are added back to reduce side effects.
Surgery and procedures used to treat fibroids include:
- Hysteroscopy -- This procedure can remove fibroids growing inside the uterus.
- Endometrial ablation -- This procedure is sometimes used to treat heavy bleeding associated with fibroids. It works best when the fibroids are small in size. It often stops menstruation completely.
- Uterine artery embolization -- This procedure stops the blood supply to the fibroid, causing it to shrink and die. This may be a good option if you wish to avoid surgery and are not planning to become pregnant.
- Myomectomy -- This surgery removes the fibroids from the uterus. This also may be a good choice if you want to have children. It will not prevent new fibroids from growing.
- Hysterectomy -- This surgery removes the uterus completely. It may be an option if you do not want children, medicines do not work, and you cannot have any other procedures.
Newer treatments, such as the use of focused ultrasound, are being evaluated in clinical studies.
If you have fibroids without symptoms, you may not need treatment.
If you have fibroids, they may grow if you become pregnant. This is due to the increased blood flow and higher estrogen levels. The fibroids usually return to their original size after your baby is born.
Complications of fibroids include:
- Severe pain or very heavy bleeding that needs emergency surgery.
- Twisting of the fibroid -- This can cause blocked blood vessels that feed the tumor. You may need surgery if this happens.
- Anemia (not having enough red blood cells) from heavy bleeding.
- Urinary tract infections -- If the fibroid presses on the bladder, it can be hard to empty your bladder completely.
- Infertility, in rare cases.
If you are pregnant, there's a small risk that fibroids may cause complications:
- You may deliver your baby early because there is not enough room in your womb.
- If the fibroid blocks the birth canal or puts the baby in a dangerous position, you may need to have a cesarean section(C-section).
- You may have heavy bleeding right after giving birth.
Thanks to MedlinePlus