Helping Women Evaluate and Improve Their Health

For many women, the years between the ages of 40 and 60 mark the time when they begin seriously considering their own health concerns. New and often overdue media attention is increasingly focusing on women's health matters such as heart disease, hypertension, diabetes, breast cancer, osteoporosis and menopause.

For women in their middle years who want to discuss medical issues with a knowledgeable health care professional, undergo a thorough one-on-one health assessment or, if necessary, be referred to a physician or other health care provider, Froedtert & Medical College offers the Total Health for Midlife Women Program.

Since the program began in 2003, more than 100 women have taken advantage of the program. "Actually, we welcome women of all ages," says Program Coordinator Marlys Swanson, RN, BSN, whose nursing background includes both home-care nursing and women's health. Vanessa Barnabei, MD, PhD, Associate Professor and Director of the Division of General Obstetrics and Gynecology at the Medical College of Wisconsin, serves as Medical Director for the program.

No two patient profiles are exactly the same, notes Swanson. "Empty nesters, women undergoing changes or challenges in their careers, those with concerns about their bones or their heart - that's fairly typical," she says.

"So far, most patients I've seen are women with problems maintaining their ideal weight, and women who are approaching menopause or are in menopause and they just don't feel like they used to. Also, now that fewer women are on hormone replacement therapy (HRT), they have concerns about how to manage their vasomotor symptoms (such as hot flashes and night sweats) and how to prevent osteoporosis."

Evaluation, Discussion, Health Assessment
A visit typically lasts between 75 and 90 minutes, says Swanson, and is not a physical exam but rather an evaluation of their current health status. The visit always begins with Swanson asking two questions: "What brought you here?" and "Do you have any specific questions or concerns that I could help you with?" After addressing those topics, Swanson conducts a wide-ranging health risk assessment with discussions about:

• The health history of the woman and her family
• Any medications she is taking
• Any surgeries she has had
• Whether she experiences symptoms such as frequent headaches, digestive or bowel problems, muscle or joint pain, or urinary incontinence
• If she has fallen recently or has had any fractures
• If she feels stress or anxiety
• If she has any sexual concerns
• Personal habits including smoking, alcohol or other drug use, exercise and nutrition
• If she has experienced any physical abuse in her life

"If the results indicate they have never had a mammogram or are overdue for one, we help set up an appointment for that," says Marlys Swanson. "We do the same if they haven't had a pelvic exam and Pap smear recently. Some women ask about that when they call for their appointment; if possible, we arrange the tests for the same day." She may also recommend a screening test for bone density to determine the woman's risk for osteoporosis.

Women who have established physicians may continue receiving health care through that doctor's health system. If they do not have a relationship with a physician, Swanson can help them find a primary care doctor through the Froedtert & Medical College network. If they have a problem that should be further evaluated by a dietician, social worker or psychological counselor, she can help arrange that, too.

Stress, Menopause and Health
"Women often are juggling so many responsibilities - at home, at work, with children, with aging parents - that they neglect their own health. Some women have told me, 'I never realized how much stress I have in my life,'" Swanson says. "Other times they are aware of problems, but they have never discussed them with anyone before."

Women approaching menopause - those in the phase called perimenopause - may be undergoing changes they have never experienced before and are puzzled by them. These can include symptoms like changes in the menstrual cycles, accompanied by increased yeast infections, fatigue, headaches, and dryness or itching. They may be gaining weight for no apparent reason, and feel moodier than usual. "They need reassurance. Many feel relieved to learn their symptoms are not unusual," said Swanson, who provides patients with materials they can take home and study.

In 2002, after results from the decade-long Women's Health Initiative study showed that women using hormone replacement therapy had slightly higher risks for breast cancer and heart disease, many physicians advised women to stop taking the drugs. Many women in menopause are questioning whether they can safely take HRT, both to relieve menopause symptoms and to help prevent osteoporosis. "Along with alternative/complementary remedies, I discuss the pros and cons of HRT so women can make an informed decision along with their medical provider," says Swanson.

Recognizing Risks for Heart Disease
Many women in midlife and older remain unaware that heart disease is a great health risk for them. Swanson discusses possible symptoms of heart attack, which in women often differ significantly from men's symptoms. Where men might experience crushing chest pain that can radiate down the left arm, women's symptoms are often more subtle. They can include neck, jaw or shoulder pain, nausea, fatigue or shortness of breath.

Only 50% to 60% of women experiencing a heart attack report the chest pain or pressure of typical angina. (In men, the percentage is 80% to 99%.) Swanson helps women understand the importance of preventing heart disease with diet, exercise, and maintaining a healthy weight. She also discusses the importance of quitting smoking and having regular tests for cholesterol and blood sugar.

After the visit, Swanson says, "Women are free to call me any time with further questions or concerns." Visits to the Total Health for Midlife Women Program are covered by most insurance plans; women without insurance pay $130.

An advisory team of physicians and other experts from disciplines including Gynecology, Patient Education, Pediatrics, Primary Care, Psychiatry, Research, Surgery, and Women's Sports Medicine oversees the Total Health for Midlife Women Program.

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.