Panic disorder

Panic disorder is characterized by recurrent panic attacks with intense fear of losing control or dying during the attack. There is such marked fear of another panic attack that certain situations or places are avoided (Table 7.7). Approximately half of women with panic disorder also suffer from agoraphobia (fear of the marketplace), an intense irrational fear of being alone in places from which escape is impossible such as crowded public places or elevators.50 The lifetime prevalence of panic...

Major depressive disorder

MDD has been reported in more than 20 of women aged 40-60 years who attended an inner-city primary care practice.1 By definition, symptoms must last for at least two consecutive weeks, be a significant change in usual functioning, and directly impair ability to conduct normal activities. A classic MDD presentation in a middle-aged woman is of fatigue interfering with managing housework cooking family responsibilities, loss of interest in hobbies and activities, gradual neglect of friends, and...

Menopause and diabetes Type 2 diabetes and menopause

Menopause is defined as the cessation of menses for one year. Erratic menses that may occur before that time is known as perimenopause. As the population ages, estimates suggest that by 2015,45 of all women will be 45 years or older, an age often associated with changes in the menstrual cycle.13 The decrease in endogenous estrogen associated with the onset of menopause can be associated with fluctuations in sex hormone levels and increased relative androgen levels, which can contribute to...

Hypertension

C.C. is a 51-year-old woman with borderline hypertension. She's been successful in losing a few pounds, and her pressure today is 138 86 mm Hg. She's concerned because the nurse at work told her she needed to cut out all salt from her diet if she wanted to get her pressure down, but all the salt-free foods she's tried have been awful. The connection between sodium and hypertension is not as strong as was once believed. The degree of salt sensitivity varies among patients. While moderation in...

The Framingham coronary heart disease prediction equation a new tool to improve coronary heart disease risk

One does not simply go from having risk to not having risk by crossing some numerical threshold. The magnitude of the risk factor is important. The actual value of the risk factors can be used to predict CHD risk more accurately.7 Readily available calculators that are easily downloaded from the Internet into handheld devices should now be used routinely to assess the patient's CHD risk. These calculators work by incorporating multiple patient data, including...

Spiritual aspects of menopause

Spiritual aspects of menopause deal with challenges to a woman's view of herself, her world, and, often, her god. Women's religious and spiritual beliefs play an important role in their views of life and medical illness. In this chapter, spirituality will be defined as beliefs that give meaning to one's life and provide connection to the trascendant.4 Religion will refer to a formal set of sacred beliefs, rituals, and practices. Many clinicians fail to consider the important role that spiritual...

Primary prevention and risk factors

Although men experience UI, women are twice as likely to suffer the symptoms (Figure 21.1). The risk of UI increases with age, but it should not be considered a natural part of aging. Young women may also have incontinence during physical activity and postpartum. The risk of UI is related to body mass and race, but not to parity, caffeine or alcohol intake, smoking, physical activity, or previous gynecological surgery.25 Pregnancy complications have been related positively to later UI,...

Alternatives to hormone therapy including complementary treatments

Table 10.11 lists some of the alternatives to HT. Table 10.12 lists some ineffective and or harmful therapies. Although over 85 of women experience hot flushes, most women find that their symptoms resolve or improve over two to five years. More than 30 of women use complementary and alternative measures, such as acupuncture, natural estrogen, herbal supplements, and plant estrogens to control symptoms. Most studies of menopausal interventions demonstrate a 20-30 improvement in the symptoms of...

Hormonally related depression in midlife women Premenstrual dysphoric disorder

Middle-aged women who continue to menstruate are at risk for premenstrual dysphoric disorder (PMDD). The premenstrual phase is also a period of increased vulnerability to a mood disorder or to worsening symptoms of a current major depressive disorder or dysthymic disorder.28 Suicide attempts, completed suicides, and psychiatric hospitalizations are more likely to occur during the late luteal phase. Education of women and their families about premenstrual vulnerability allows women and families...

Psychological aspects of menopause Menopause as a transition

Menopause is a transition encompassing a developmental stage in the lifecycle, during which women gradually adapt to biologic, social, psychological, and spiritual changes that accompany recognized physiologic changes. While women throughout the world experience menopause, diagnosis is often difficult because it canbe made only in retrospect. Along withbiologic changes, significant psychological events occur during mid life, including changing relationships with children, marital instability,...

Mixed anxiety and depression

Anxiety and depression often coexist, especially in the primary care setting. Patients with combined symptoms are the largest group with psychiatric conditions seen in the primary care office, and a substantial minority (45 ) are not detected by primary care physicians.57 Almost half of the cases of anxiety and depression occur in the same patient at the same time.60 This comorbidity makes accurate diagnosis more difficult, treatment more complicated, and prognosis less favorable.50 Anxiety is...

Decreased arousal andor plateau

Arousal and plateau aspects of the sexual response cycle (SRC) require an intact vascular system, cyclic guanosine monophosphate (cGMP), and, probably, adequate androgen levels. Because this phase of the SRC includes muscular tension, some degree of muscle tone contributes to the sensation of heightened tension that occurs in this phase. As vaginal lubrication and penile erection are equivalent phases of the SRC, the clinician should be aware of medications, illnesses, and physiological changes...

Resistance training

Resistance training is the mode of exercise performed to stimulate the neuromuscular system. Variations of the number of sets, repetitions, rest period, and weight lifted determines the outcome of the training program. Programs designed to increase strength are typically performed at a high intensity (80 of the one-repetition maximum, 1RM) with long rest periods (two to three minutes) and low to moderate volume (one to three sets of eight to ten repetitions), whereas programs designed to...

Home blood glucose monitoring

Monitoring of blood glucose levels by the patient and the healthcare provider is a cornerstone of diabetes care. With the development of home blood glucose meters, the management of diabetes has changed dramatically. Based on findings from the DCCT, SMBG is recommended for individuals with diabetes to facilitate reaching goals for blood glucose levels.28 The optimal frequency of blood glucose monitoring in type 2 diabetes is not known, and the role of monitoring in diet-controlled type 2...

Perimenopause and menopause

Perimenopause is the time in a woman's life when she begins to experience the changes that lead to menopause. The World Health Organization (WHO) defines this as a period immediately prior to menopause (when the endocrinological, biological, and clinical features of approaching menopause commence) and the first year after menopause.1 This transition is caused by a decrease in gonadotropin and ovarian hormones. The ovaries produce decreasing amounts of estrogen and the target organs become less...

Primary and secondary prevention

Primary prevention focuses on reducing risk factors for stroke. The six most important factors are hypertension, atrial fibrillation, history of recent MI, diabetes, cigarette smoking, and alcohol abuse.Weightreduction in obese people and control of hyperlipidemia can reduce the risk of stroke (Table 13.2). Table 13.3 Individuals in whom warfarin use is recommended to reduce the risk of stroke Patients with atrial fibrillation and one or more of the following previous TIA, previous stroke,...

Summary

Endometrial cancer and its precursors are relatively common problems encountered in mid-life women. There is not any benefit to implementation of any screening modality (other than continuance of Pap smears and pelvic examination) in asymptomatic women. Nonetheless, women in their forties and with abnormal uterine bleeding and all women with postmenopausal bleeding should undergo diagnostic work-up unless slight irregular bleeding occurs in the first months of therapy with combined continuous...

Serum lipids

The desirable total cholesterol level is below 200 mg dl 5.2 mmol l .2,17 In the USA, 40 of women older than 55 have an elevated serum cholesterol.12 In Europe, 91 of women age 65-74 have an elevated cholesterol.2 Serum cholesterol rises with age.1,2 The higher the blood cholesterol level, the higher the CHD risk.4 The new National Cholesterol Education Program - Adult Treatment Panel NCEP-ATP III guidelines have made several changes to the recommendations for cholesterol screening and optimal...

Vaginal dryness

Approximately 40-80 of postmenopausal women have symptoms of atrophic vaginitis. These symptoms include decreased vaginal lubrication, dryness, itching, burning, dyspareunia, and urinary symptoms. Concurrent infection with Candida trichomonas or bacterial vaginosis exacerbates symptoms. The use of certain medications, including tricyclic antidepressants, anticholin-ergic agents, antipsychotics, antihistamines, cigarettes, and chemical sensitiz-ers such as douches and vaginal hygiene products ,...