Insights

In honor of National Women’s Health & Fitness Day, several UC Health physicians are working together to raise awareness in the region about the top health concerns among women and recommended tips for everyday health and wellness.

WHAT ARE THE TOP CONCERNS FOR WOMEN’S HEALTH?

ONE | Heart Disease

According to the Centers for Disease Control and Prevention (CDC), only 56% of women recognize that heart disease is the leading cause of death for women. While sometimes heart disease is thought of more prominently among men, the CDC reported that this disease was responsible for 1 in 5 female deaths in 2019.

Further, most women between the ages of 40 and 60 have at least one or more risk factors for heart disease and may not even realize it.

Post-menopause as well as early menstruation are uncontrollable risk factors for heart disease that are specific to women.

However, many risk factors can be helped. In fact, in 95% of deaths from heart disease, the individual had at least one of these major risk factors: 348

• Smoking.
• High blood pressure.
• High blood cholesterol.
• Overweight.
• Physical inactivity.
• Diabetes.

For instance, people who smoke are up to six times more likely than nonsmokers to suffer a heart attack. Smoking is the No. 1 cause of preventable death and disease in the United States. Other risk factors such as age and family history cannot be helped.

You can reduce your risk for heart disease by up to 82% by adopting a heart-healthy lifestyle.

To keep your heart healthy, it is vital to maintain all the following heart-healthy habits:

• Healthy diet. Roughly half of your overall diet should include fruit and vegetables.
• Regular physical activity. Experts recommend at least 150 minutes of moderate-intensity physical activity (brisk walk, light-effort bicycling, cleaning) or 75 minutes of vigorous-intensity physical activity (hiking, jogging at 6 mph, fast bicycling) per week.
• Stop (or never start) smoking. For those who have a heavy smoking history, consider a lung screening. A lung screening uses a low radiation CT scan to detect lung cancer early.
• Make time to relax. Anger and stress can damage your heart. Allot 15-20 minutes a day to sit quietly or enjoy one of your favorite hobbies to reduce stress.

Heart and vascular disease symptoms are not always typical or easy to diagnose — which is why our team is equipped with the latest imaging technology to get to a diagnosis as quickly as possible — and you back to your healthy-heart self.

TWO | Breast Cancer

The most common type of cancer in women in the U.S. is breast cancer. Breast cancer begins in the breast and occurs when cells change and grow. The ducts and lobules are the two parts of the breast where cancer is most likely to start.

There are approximately 240,000 new cases of invasive breast cancer as well as 50,000 new cases of noninvasive breast cancer diagnosed each year in the U.S.

The major identified risk factor categories for this type of cancer pertain to hormone and family history. In addition to this, other prior medical problems, including past history of premalignant breast biopsies, dense breast tissue and history of chest wall radiation, can increase a woman's risk for breast cancer. While these risk factors are important, 70% of newly diagnosed women have no special risk factors except female sex and advancing age.

Research has indicated that women with the following lifestyle risk factors have an increased chance of developing breast cancer:

• Alcohol use.
• Smoking.
• High weight or obesity.
• Limited exercise.
• Poor diet.

Did you know, the University of Cincinnati Cancer Center is home to the region's only triple-accredited breast cancer center?

THREE | Gynecological Health - Ovarian and Cervical Cancer

Ovarian Cancer

Ovarian cancer starts in the ovaries, walnut-sized organs located on both sides of the uterus. Cancer can affect any of the complex cells within the ovaries and since only women have ovaries, this type of cancer can only be found in women.

Ovarian cancer often shows no symptoms until after it has spread outside of the ovaries. Even then, symptoms tend to be vague and are like those of other more common diseases.

How is ovarian cancer diagnosed?

If your healthcare provider thinks you may have ovarian cancer, you will need certain exams and tests to be sure of this. Diagnosing ovarian cancer starts with having a conversation with your healthcare provider. He or she will ask you questions in regard to your health history, your symptoms, risk factors, reproductive history (such as if you've ever been pregnant) and family history of disease. Your healthcare provider will also give you a physical exam.

What tests might I need?

You may have one or more of the following tests:

• Pelvic exam.
• Ultrasound.
• CT scan.
• CA-125 blood test.
• Biopsy.

Cervical Cancer

Cervical cancer is the occurrence of abnormal growth of the cells of the cervix, the lower end of the uterus that connects the uterus to the vagina. This type of cancer cell growth typically starts in the outer layer called the squamous cells.

In most women, cervical cancer is caused by the human papillomavirus (HPV). HPV infection is very common and often goes away on its own. However, in some instances, over time, HPV can lead to cervical cancer. HPV infection is strongly linked to cervical cancer. But it's important to keep in mind that most women with HPV don’t develop cervical cancer.

Other risk factors include:

• Smoking.
• Other lifestyle factors, such as diet and activity.
• Being overweight.
• Long-term use of birth control pills (oral contraceptives).
• Having chlamydia or herpes (sexually transmitted diseases).
• Having a weak immune system.
• Having multiple full-term pregnancies.
• Having a full-term pregnancy before age 17.
• Having a family history of cervical cancer.

Talk with your healthcare provider about your risk for cervical cancer.

How is cervical cancer diagnosed?

Cervical cancer is found when doing a routine Pap test. Your healthcare provider will ask you about your health history, symptoms, risk factors and family history of disease. Your provider will do a physical exam and a pelvic exam.

You may also have one or more of these tests:

• Pap and HPV tests.
• Colposcopy.
• Biopsy.

The only way to confirm cancer is through a biopsy. This is where small pieces of tissue are taken from the cervix and then checked for cancer cells.

Did you know the UC Health Gynecologic Oncology Center offers a team of double board-certified gynecologic oncologists?

FOUR | Depression and Anxiety

Depression

Depression effects the whole body. This involves one’s body, mood and mind. With this said, depression is more than feeling blue or unhappy and it is not a sign of personal weakness. It is important to recognize that depression is in fact an illness and just like any other illness, depression often requires treatment.

While there is no clear cause, depression has been linked to chemical imbalances in the brain. In addition to this, environmental, mental health, physical and inherited factors can play a role in the causation of depression.

According to Jyoti Sachdeva, MD, director of women's mental health at UC Health’s West Chester Hospital and associate professor in the Department of Psychiatry and Behavioral Neuroscience at the UC College of Medicine, women have one-and-a-half to three times higher rates of depression.

This means women are about twice as likely to have depression than men, as many hormonal factors and potential additional stresses may add to this increased rate in women. Dr. Sachdeva explains that women are specifically at risk during times of hormonal changes such as puberty, menopause, pregnancy and postpartum.

For instance, many women are at an increased risk after giving birth to a baby. In this situation, women have hormonal and physical changes in addition to the added responsibility of caring for a new baby. In some women, these factors can lead to postpartum depression (PPD). In fact, 1 in 5 women experience this.

The “baby blues" are common in new mothers and typically last for a week or two. A full-blown depressive episode is not typical and requires treatment. Untreated postpartum depression can have severe consequences for the mother, child and family.

Treatment may include counseling, medication or a combination of both. If you or your loved one is experiencing signs of depression, seeking professional help, including speaking with your primary care physician, is the first step to take. Without treatment, symptoms may last weeks, months or even years.

These symptoms can include the following:

• Depression-persistent sadness.
• Loss of interest in activities one earlier enjoyed.
• Inability to experience joy.
• Poor appetite.
• Weight loss or gain.
• Poor sleep.
• Low energy.
• Poor libido.
• Poor focus.
• Feelings of guilt, hopelessness, worthless.
• In severe cases, suicidal thoughts.
• In case of PPD, may present with obsessive worry about baby's well-being.

Anxiety

Anxiety is a natural part of the body’s defense system. In fact, normal anxiety can be helpful as it works to alert your body of a threat. In this state, an individual’s feelings can often range from a vague sensation of worry to physical sensations such as a racing heartbeat. However, when an individual has an anxiety disorder, this response can happen at inappropriate times when there is no apparent threat.

Anxiety can become an issue when it interferes with day-to-day life, is hard to control and occurs for months. With some anxiety disorders, the anxiety is way out of proportion to the threat that triggers it. With others, anxiety may occur even when there isn’t a clear threat or trigger.

Anxiety disorders tend to run in families and are most common in women and younger people. However, no age, race or gender is immune to anxiety disorders. The good news is that it can be treated.

Talk to your healthcare provider and rule out any physical problems that may be causing the anxiety symptoms. If an anxiety disorder is diagnosed, seek treatment. Just like depression, anxiety is an illness, and it can respond to treatment. Most types of anxiety disorders will respond to talk therapy (counseling) and medication. Also, you can work with your primary care physician to develop valuable coping skills. Good sources of support or guidance can be found at your local hospital, mental health clinic or an employee assistance program.

Here are some things you can do to cope:

• Do what you can. Keep in mind that you can’t control everything. Change what you can. And let the rest take its course.
• Exercise. This is a great way to ease tension and help your body feel relaxed.
• Stay away from caffeine and nicotine. These can make anxiety symptoms worse.
• Stay sober. Don't use alcohol or unprescribed medicines. They only make things worse in the long run.
• Learn more about anxiety disorders. Keep track of helpful online resources and books you can use during stressful periods.
• Try stress management. Try methods such as meditation.
• Talk with others. Think about joining online or in-person support groups.
• Get help. Find professional mental health services if your symptoms can't be managed or reduced with the above methods.

FIVE | Reproductive Health Issues

According to the American Society for Reproductive Medicine, infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. Women with a known history of irregular periods, are above the age of 35 years old, or have a known cause of infertility should seek management sooner or after 6 months of attempting pregnancy.

Suruchi Thakore, MD, UC Health physician and assistant professor in the Department of Obstetrics and Gynecology at the UC College of Medicine, explains that some of the more common risk factors for infertility include:

• Age and weight.
• Medical problems affecting your hormones, ovulation or the overall function of the reproductive system, including polycystic ovarian syndrome (PCOS) or endometriosis.
• Environmental factors and lifestyle choices.
• Medical treatments such as chemotherapy or radiation therapy.
• Sexually transmitted infections or prior ectopic pregnancies.
  • Surgery within the pelvis, especially involving the ovaries and fallopian tubes.

While certain risk factors, such as age, are uncontrollable, Dr. Thakore goes on to explain that others can be modified. There are in fact ways to reduce your risk of infertility, such as:

• Maintaining a healthy diet and weight (ideally a BMI between 18 and 35).
• Stop/never start smoking or excessive alcohol and drug use.
• Quick identification and management of sexually transmitted diseases.
• Limit exposure to toxic chemicals or treatments.

Further, while age is a leading cause of infertility, options for fertility preservation (called egg freezing or “oocyte cryopreservation”) at a younger age prior to desiring children can be considered to counter age-related fertility decline.

Recommended Tips for Everyday Health

Fitness and Wear for Muscle and Joint Health

According to data from the CDC, joint pain secondary to arthritis is more prevalent in women than men and is highest among adults ages 45 to 64.

Research indicates this may be due to decreased physical activity after high school and women tending to have lower levels of physical activity compared to men. This lack of regular physical activity can lead to weight gain, which ultimately results in more pressure being put on an individual’s joints, causing pain.

“That’s why exercise is so important, as it helps break down this pain cycle,” says Melissa Summers, MD, UC Health orthopaedic sports medicine and shoulder surgeon and assistant professor in the Department of Orthopaedics and Sports Medicine at the UC College of Medicine.

It is recommended by the U.S. Department of Health and Human Services that adult men and women engage in at least 150 minutes per week of moderate-intensity aerobic activity (anything that gets your heart beating fast).

What physical activities are recommended?

• If you prefer vigorous-intensity aerobic activity (like running), the minimum is 75 minutes per week. This should be combined with at least two days per week of muscle-strengthening activity.
• Low impact activities, such as biking and swimming, tend to be less stressful on joints than high impact activities, such as running and jumping.
• For muscle strengthening, be sure to focus on all areas of the body, including the neck, back and core. And remember, any exercise, even five minutes, has significant health benefits.

Tips for every day “wear” to help with joint pain

• Wear stable, supportive shoes. According to Dr. Summers, our feet are our foundation, and if they are not functioning properly, it can result in altered mechanics in the knee, hip and lower back. Studies have shown that stable, supportive shoes improved knee pain on walking in patients with knee osteoarthritis.
• Avoid high heels - high heel use, especially in combination with additional weight, may contribute to increased osteoarthritis risk in women.
• Wear backpacks over purses. Purse and handbag wear can cause pain in the shoulders, neck and back. Using a backpack is ideal, as it distributes the weight more evenly across your back and shoulders. If using an over-the-shoulder bag, make sure it has thick or padded straps, and alternate sides you carry it on throughout the day.
• Avoid carrying heavy bags. Try to lighten the load you are carrying to the point where you don’t notice any strain from carrying it.

Frequent Stretching

According to Danielle Shoreman, MD, UC Health physical medicine and rehabilitation physician and assistant professor of clinical at the UC College of Medicine, regular stretching can reduce your risk of injury and enable your muscles to work most effectively. Also, stretching has been shown to increase blood flow to your muscles and help with soreness and healing.

“I find it is a great way to reduce stress, as it is important to relax and breathe while focusing on your stretching. It is a time to practice mindfulness and be in the moment,” says Dr. Shoreman.

Stretching can be a helpful tool in maintaining a healthy lifestyle, however, it is important to practice stretching using the proper technique.

Tips for stretching using proper technique

• Warm up. It is best to perform around five to ten minutes of low intensity movement (walking, jogging, biking) prior to stretching. This is important as it allows your muscles to warm up.
• Use gentle movement. Bring gentle movement into your stretching such as tai chi or yoga. These types of exercise can help reduce risk of falling and improve balance.
• Symmetry is key. When stretching, striving for symmetry from side to side is important, as asymmetry may increase your risk of injury.
• Focus on major muscle groups. Focus on stretching your large muscles and joints, such as your neck, shoulders, lower back, hips, thighs, calves and ankles. You can think about starting from the top of your head starting with your neck and back and progress down to the tips of your fingers and toes. Eventually, you can add in your wrist, fingers and toes.
• Sustain, don’t bounce. Stretching should be done using a smooth and sustained stretch. Avoid bouncing, as this is more likely to cause injury and worsen tightness. It is recommended that you hold each stretch for about 30-60 seconds.
• Don’t push to pain. While stretching, the goal is to feel tension but not pain. If you are in pain, it is important to back off until the point you don’t feel pain.
• Frequency. Stretching doesn’t have to be time-consuming. It is best to stretch regularly at least two to three times a week.

Regular Medical Screenings for Women

Regular medical screenings are essential for everyone’s health — men, women, young and old. In fact, staying up to date on wellness visits with your primary care physician, paired with routine screening tests, is essential for early detection that could save your life.

The purpose of a screening test is to find possible health concerns in people who may not exhibit any symptoms. The goal for these screenings is early detection so that if a concern is found, perhaps a change in lifestyle can be made and/or you can be monitored more closely to lower the risk of disease, or to find it early enough to treat it most effectively. While screening tests are not diagnostic, they are used to find out if more testing is needed.

Recommended Wellness Visits and Screenings for Women

Primary Care

At UC Health Primary Care, we are here to provide you and your loved ones with the best possible care. You don’t need to be sick to visit your primary care physician. Even if an individual is perfectly healthy, frequent visits can help them stay that way.

Having a primary care physician that you visit regularly can help ensure you receive continued care that is essential to your health. Even if you don’t have any new health concerns to address, visiting your primary care physician for care, including wellness visits, is important because it also allows your provider to check your overall health and wellness, and discuss ways you can keep yourself healthy and avoid illness down the road.

3D Mammography

Early detection of breast cancer increases treatment options and survival rates. A 3D mammogram, also called tomosynthesis, is an X-ray that creates a series of images of the breast that allows radiologists to view breast tissue layer by layer. This type of mammogram improves detection of cancer with fewer patient callbacks.

Gynecology

Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called "co-testing") every five years. This is the preferred approach. But, it is also acceptable to continue to have Pap tests alone every three years.