General Women's Health

Acupuncture Allergies Alzheimer's Disease Androgen Anxiety Disorders Asthma Atherosclerosis Attention Deficit Hyperactivity Disorder Bacterial Vaginosis Biofeedback Bipolar Disorder Birth Control Pills Blood Donation and Transfusion Breast Augmentation and Reduction Breast Cancer Breastfeeding Breast Reconstruction Caregiving Cervical Cancer Chiropractic Chlamydia Cholesterol Chronic Fatigue Syndrome Clinical Trials Colon Cancer Contraception Depression Diabetes Dry Eye Syndrome Eating Disorders Endometriosis Epilepsy Estrogen Fibroids Fibromyalgia Fitness Flu/Colds Gastroesophageal Reflux Disease (GERD) Genetic Testing Genital Herpes Glaucoma Gonorrhea Health Insurance Heart Disease Hepatitis High Blood Pressure HIV/AIDS Homeopathy Human Papillomavirus Hypnosis Hysterectomy Incontinence Infertility Irritable Bowel Syndrome Legal Health Tools Liposuction Lung Cancer Lupus Macular Degeneration Medication Safety Menopause Menstrual Disorders Metabolic Syndrome Migraine Multiple Sclerosis Naturopathy Nonsurgical Aesthetic Procedures Nutrition Obesity Ocular Allergies Oral Health Osteoarthritis Osteopathic Medicine Osteoporosis Ovarian Cancer Overactive Bladder Pain Management Pelvic Organ Prolapse Pelvic Pain Peripheral Arterial Disease Polycystic Ovary Syndrome Pregnancy Premenstrual Syndrome Preparing for Surgery Progesterone Rheumatoid Arthritis Schizophrenia Scleroderma Sexual Dysfunction Sinusitis Sjogren's Syndrome Skin Cancer Skin Health Sleep Disorders Smoking Stress Stroke Substance Abuse Tai Chi Teen Health Thyroid Disorders Trichomoniasis Urinary Tract Conditions Urinary Tract Infection Uterine Cancer Vaccines Varicose Veins Violence Against Women Vulvodynia Weight Management Yeast Infections Yoga

Editor's note: This is by no means a complete guide to women's health.just the highlights. For detailed information or resources about a particular condition or disease, see other topics covered at this site or contact the National Women's Health Resource Center (NWHRC): info@healthywomen.org; 1-877-986-9472; or visit: http://www.healthywomen.org

Your good health starts with you. Take steps to reduce your risk of disease and talk to your health care professional about your health concerns. Women now demand more from medical research and from the health care system. As a result, more women have become partners in their medical care, working with their health care professionals to make medical decisions. Here are several tips that you can follow to be an active partner in managing your health.

• Be an informed consumer. Read as much as you can about health and wellness strategies and about any specific health conditions you may have. Ask your health care professional to recommend sources you can trust. Be sure to review any recommendations you read about with your health care team. Health-related Web sites, such as http://www.healthywomen.org produced by the National Women's Health Resource Center, and other Web sites produced by major health organizations are good places to start. Look for .org, .gov and .edu Web addresses to help gauge their reliability and accuracy.

• Know your family medical history, and learn about other factors that may put you at higher risk for disease. Common diseases, such as heart disease, cancer, and diabetes, and even rare diseases, like hemophilia, cystic fibrosis, and sickle cell anemia, can run in families; in other words, they have a genetic component. For example, if one generation of a family has heart disease, it is not uncommon for the next generation to also have a tendency toward it. Creating a family health history, or portrait, that traces the illness in your family, from your grandparents to your parents on down, can be enormously helpful to your health care professional in anticipating your risk for certain diseases and being proactive to keep you and your family healthy. To encourage all families to learn more about their health, the U.S. Surgeon General's Office has created a free computerized family health history tool, called "My Family Health Portrait," which can be downloaded here.

• Maintain a healthy lifestyle. Exercising, developing and maintaining a healthy diet, not smoking and managing stress can help keep you healthy.

• Always ask your health care professional for a full explanation of any pharmaceutical or other treatments she/he prescribes, including the side effects that you may experience.

• Schedule regular medical checkups and screenings to monitor your current health and identify potential problems early.

• Seek a second medical opinion if you feel you need more information. This may be especially important if you ever face surgery or treatment for a chronic or life-threatening illness. Your health insurer may also require a second opinion.

• Be aware of disease symptoms. Know when to seek medical care and where to turn if you develop symptoms.

Medical Treatments

Learn the Benefits and Risks

The terms "benefits" and "risks" are tossed around quite a bit. What do they really mean when referring to your health? A benefit is something that can increase your well-being. A risk is something that could potentially cause harm, which you should be aware of. When someone suggests you are "at risk" for developing a particular disease, it means that you have a greater chance of developing the condition than someone else without the same risk. But it does not mean that you will absolutely develop the condition. In many cases, you can do a great deal to minimize your risks.

When we are healthy, making a decision about medical care seems straightforward. Your goal should be to get as much information as possible, learn and understand the benefits and risks of certain medications, procedures, or medical options and make a decision with the guidance of your health care professional that best meets your needs.

When diagnosed with a chronic or serious medical condition, suddenly the balance shifts-you are in a new, unfamiliar territory, yet you are expected to weigh the benefits and risks of treatments and to make the same types of decisions regarding your medical care. But often, when one is ill or confronted with a diagnosis, it is overwhelming. Decision-making may seem impossible. Physical and emotional stress can stop you in your tracks.

There are several steps you can take to become a partner in the health care decision-making process with your medical team-in sickness and in health-that can help make your experience a positive one. These steps can help you assess the benefits and risks of the medicines and other treatments that are recommended for your condition, so that you are comfortable with having made the best decision for you.

1. Modern medicine continues to evolve. Medical researchers are continually asking new questions and studying new theories about all types of diseases. This means that we do not have all the answers we need to treat many illnesses. Making medical decisions involves reviewing the most current knowledge available and making the best choice based on this information. Your health care professional should have the most up-to-date medical information, and you should feel comfortable asking her or him about the latest treatments for your condition.

2. Take time to assess how risk-sensitive you are. How much risk are you comfortable with? Do you consider yourself a risk-taker in some situations? Are you willing to accept some risks associated with a particular treatment, but not other types of risk? These kinds of questions can help you decide how much risk you're willing to accept when discussing certain medical treatment options. Your comfort level with risks and benefits associated with your medical care is critical to your decision-making process.

3. Ask a lot of questions. Because your health history is unique, you'll want to know how a certain medication will benefit you specifically. Likewise, your health care professional can provide more specific information about how medication or treatment options may affect you. All medication can cause side effects; be sure to ask specifically about side effects associated with any medication prescribed for you. Likewise, share any personal information your health care professional should know when considering treatment, such as what other medications you may be taking or health conditions you may have. Make sure to ask questions about anything you don't understand.

4. Make an effort to go behind the headlines. A recent study of the mass media reported that nearly one in four news stories about health research and older women omits crucial information. Discuss any research news you have questions about with your health care professional.

Maximize the Benefits of Drug Treatments

For almost any given medical condition, there are many pharmaceutical treatment options. The tips that follow can help you communicate with your health care professional so that she or he will be able to prescribe the treatment that best suits your medical needs:

• Share information about all medications you are currently taking (including prescriptions drugs and over-the-counter remedies as well as supplements and herbal or traditional medicines). Medications can interact with each other to cause uncomfortable or harmful side effects or may reduce effectiveness of one or more of the medications you take.

• Tell your health care professional if you are pregnant, or planning to be pregnant in the near future. Some medications pose special risks for pregnant women. There are also things you can do before you become pregnant to ensure the health of your baby such as consuming adequate amounts of folic acid, or folate, a B vitamin that can be found in some enriched foods and vitamin pills and has been shown to prevent serious defects in the fetal brain and spine. The U.S. Public Health Service recommends that all women who could possibly become pregnant get 400 micrograms (or 0.4 mg) of folic acid every day.

• Be sure you know or ask about the benefits of the medication she or he is prescribing.

• Ask about any of the common side effects associated with the medication being prescribed, as well as any potentially serious side effects and when you should call your health care provider to report new symptoms.

• Ask your health care professional or pharmacist if there is a time during the day that you should take the medication to maximize benefits and minimize possible side effects (for example, should you always take it with meals, or before bed?).

• Ask about taking your new medication with other medication, vitamins, or supplements that you already take.

• Sometimes starting a new medication can be worrisome. Be sure to voice all of your concerns to your health care professional so that she or he can identify other information about the medication that may lessen your doubts.

Once your health care professional has, with your input, decided on a pharmaceutical treatment that is right for you, there are several tips that you can follow to get the most from your medication:

• Always take a medication as prescribed-the dosage (daily amount and frequency) of a medication has been proven to provide the safest and most effective therapy. This information is indicated on the label.

• Follow any special instructions, such as "take with full glass of water."

• Take the medication for as long as your clinician has indicated, even if you no longer notice any symptoms.

• Contact your health care professional or pharmacist for guidance if you happen to forget to take your medication as prescribed (daily amount and frequency).

• Never take someone else's medication, even if your symptoms seem to be identical.

• Contact your health care professional if the common side effects that you are experiencing are causing you any discomfort or disrupting your life.

• Contact your health care professional immediately if you experience any serious side effects. Severe pain, heart palpitations, breathing difficulty or abnormal bleeding are examples of serious side effects.

Communicate More Effectively With Your Health Care Professionals

Communication is giving and receiving information. Nowhere is this exchange more important than in your relationship with your health care professional. Expressing your health needs and concerns and getting answers to your questions are key components of effective communication in the health care setting.

First, learn how your health plan or health care professional's office manages patients with symptoms or conditions that may need treatment. For minor symptoms, for example, some health plans may want you to call an advice line to evaluate your symptoms before you call the medical office for an appointment. Some health plans require your primary care provider to complete a referral form in advance of your visit to a specialist.

Ask your health care professional or your health plan's membership services office these questions about using services:

• When should I call your offices to report medical symptoms?

• What number should I call if symptoms occur after hours?

• Where will my family or I be treated if we need to be seen after hours?

• How long will it take to get an appointment to evaluate my symptoms?

• If I need emergency care, when and how do I need to notify my health plan? And where do I go for emergency care?

Questions for your pharmacist

Ask a pharmacist these questions, if you need information:

• What's the best way to manage the symptoms I'm experiencing?

• Are there over-the-counter (OTC) medications for these symptoms?

• What precautions should I take when using this medication?

• What common side effects associated with this medication should I know about?

• Could this medication interact with other medicines or OTC products I am taking?

Before going to your health care professional's office, take time to prepare for the visit. Preparing ahead will help you make the most of the time constraints on both you and your health care professional. Being prepared will help you provide your health care professional with detailed information about your symptoms or condition, and may help lessen any anxiety you have about your visit. Here's how you can prepare:

Organize your thoughts. Think about what you want to discuss with your health care professional during the visit. Write down any questions you have, and ask them during your visit. Some health care professionals may prefer you fax ahead your questions, if possible, so they have a chance to read them before your visit.

Prioritize. If you have more than a few items to discuss, put them in order so you are sure to ask about the most important ones first. If you think all of your questions or concerns cannot be discussed within one visit, convey this when you schedule your appointment.

Make a list. Think about your symptoms as thoroughly as possible. The more specific you can be, the more you will help your health care professional make a diagnosis and prescribe treatment. Write down:

• what the symptoms are

• when the symptoms started

• when the symptoms go away

• what the symptoms feel like (for example, is the headache a sharp pain or a dull ache?)

• any patterns to the symptoms

Pain symptoms can be especially difficult to discuss because they can be hard to explain or qualify. Using numbers or a scale (one to 10)-one being the least amount of pain and 10 being the most, for example-may help to express pain.

Become a health detective. Ask yourself the following:

• Did anything change in your lifestyle before the symptoms started? (For example, did you notice that rash after you ate a food you normally don't eat? Did you wake up with shoulder pain after you played a few games of tennis for the first time in years?)

• Did anything relieve the symptoms or make them worse? (A specific activity, like lying down, or a specific medication, such a pain reliever, for example.)

• Have the symptoms gotten better or worse over time?

• Has anyone in your family had similar symptoms?

Time it right. When you call to make the appointment, ask what days are busiest and what times are best to call. Ask what to do if you have an emergency, or when the office is closed.

Take a partner. It can be helpful to take a family member or friend with you when you go to the health care professional's office. You may feel more confident if someone else is with you. Also, a friend or relative can help you remember what you planned to tell or ask the health care professional. He or she also can also be an objective listener, and help you recall what the health care professional says.

Brown bag it. During a wellness visit or after discussing your symptoms, be sure to tell your health care professional all the medications you are taking, including prescription medications, over-the-counter medications, alternative treatments, herbs and vitamins. Tell him or her the doses, and how often you take them. Consider putting all your medicines and supplements in a bag, in their original containers, and take them to your health care professional's office to discuss specific medication.

Provide the big picture. Be sure to tell your health care professional about your lifestyle, including your diet, whether or not you exercise, how much alcohol you may drink, if you smoke and other care you receive from other health care professionals.

Don't forget about stress. The physical symptoms of stress include headaches, back pain, diarrhea and chest pain, among other symptoms. If he or she doesn't ask you, let your health care professional know about any major changes, stress, losses or emotional upheavals in your life lately. This information might be useful medically.

It can be hard to discuss certain health conditions, such as sexually transmitted diseases, sexual problems, urinary incontinence, dependencies on alcohol, tobacco and other drugs, abusive relationships and mental health issues, to name a few. You may expect your health care professional to recognize that you are struggling with a certain issue. Too often, women are embarrassed or ashamed to start a discussion. Many times, a health care professional may overlook a symptom, forget to ask about things that may affect your health or neglect to order a test. It may be up to you to start a discussion that could improve your health-or save your life. Be honest. You may be doing yourself harm by not disclosing pertinent medical information.

Lesbians are less likely to seek routine health care because of the discomfort of coming out to health care professionals; they also may lack access to health insurance or lack the financial resources to get medical services. With fewer doctor visits, lesbian and bisexual women are less likely to have mammograms and professional breast exams. Additionally, because lesbian and bisexual women are less likely to need birth control, they are less likely to have regular gynecological check-ups and Pap tests. Choosing a health care professional who is comfortable and experienced with discussing lesbian health issues is important to ensuring that your health care needs are properly addressed. The Gay & Lesbian Medical Association provides a helpful physician referral service. The GayHealth web site also has a healthcare provider referral service. It can also be helpful to ask other lesbian women in your community for a referral to health care professionals that they have found open and supportive of health issues for gay women.

Ask questions! Asking questions is key to getting what you want from the visit-no matter what type of medical visit it is. If you're visiting a health care professional for a wellness checkup, ask about:

• ways to make your lifestyle healthier, including your dietary and exercise practices

• when to schedule health screenings and regular office visits

• which screenings you should pursue.

If your health care professional recommends a test or treatment option, ask:

• Why is this option recommended?

• What is the test or treatment designed to do?

• Are there other treatments or options I should consider?

• How can I find out if my insurance will pay for the recommended test or treatment?

• Whom should I call to find out test results and when? (Make sure you always receive a complete report on any tests you have done).

Speak up. Share your point of view with your health care professional. No one knows your body or the habits and lifestyle of a person in your care as well as you do. Your health care professional needs to know what's working and what's not.

Follow up. It's important to follow your health care professional's instructions exactly they way he or she prescribed them. Ask if there is a circumstance in which you should discontinue the medication, but in general, don't stop taking any medications unless you are instructed to do so. If you feel any negative side effects, call your health care professional as soon as possible. If your symptoms or condition require a follow-up visit, ask:

• when you should schedule your next visit

• what, if anything, you should do or not do until your next visit.

Communication Break Down

Even in the best scenarios, communication can break down from time to time. Your health is worth the effort to resolve communication issues with your health care professional if you are not satisfied with his/her performance or treatment you receive from other members of your health care team. Working through communication problems may be preferable to finding another health care professional.

Here are steps you can take to help resolve communication problems:

1. If you don't have enough information about your condition, ask for more.

2. Don't downplay your concerns. Health care professionals see a wide variety of patients with various health concerns each day. Each person's issues are important and need to be dealt with satisfactorily. In other words, it is not acceptable for a health care practitioner to put a patient off by saying "don't worry," or "it isn't important."

3. Offer to call again. If you feel rushed during an appointment, tell your health care professional that you don't feel you've been given enough time to discuss everything. He or she may be busy, but that doesn't necessarily mean that your health care professional doesn't want to help. Ask if you can make a follow-up call or return appointment to further discuss your condition.

If you have tried to resolve the communication problems with your health care professional and the situation continues, you have several options:

• Consider finding another health care professional

• Contact an advocate. Most health care plans have patient advocates who represent the patient, and can help you talk to your health care professional. If you belong to a large health plan, you can also contact the system administrator. Hospitals have patient advocates on staff to help you resolve issues relating to care received while you are hospitalized.

Age-Specific Health Care Notes

Health Issues for Women Ages 14 to 25

Maturing from girlhood to womanhood is an exciting and challenging phase of life. Now is the time to take charge of your health, understand those changes, be on the look out for red flags and establish good health habits for a lifetime.

Your first period

Some key issues for a woman during this time of life include getting your first period (most girls get their periods before the age of 14), having your first pelvic exam, avoiding sexually transmitted diseases, developing healthy eating habits, avoiding risky behaviors that involve alcohol, tobacco and other drugs and learning how to feel good about yourself.

Your breasts begin to grow, you develop body hair and you notice that you seem to be taller than you were yesterday. These are all signs of puberty. You are starting to mature. A girl's first period is a major event and it typically happens around the age 12, but can happen when you are nine or 17. Your period, or menstruation, is the monthly shedding of the lining of your uterus when no pregnancy has occurred. The average period lasts four to six days. Hormonal changes before and during can make you feel uncomfortable. When symptoms are severe and recur with each menstrual period, they are classified as premenstrual syndrome (PMS). Some of the most common physical and emotional PMS symptoms include:

• irritability-anxiety and/or depression
• weight gain
• bloating and water weight gain
• food cravings
• headaches
• joint, muscle or back aches
• menstrual cramps

To ease the symptoms of PMS:

• add more calcium and vitamin D to your diet by consuming more low-fat dairy products or by taking a calcium supplement daily. Good sources of dietary calcium include: low-fat milk and diary products, broccoli, dark greens like turnip greens, cooked collards, salmon and sardines, tofu and other soy products, almonds and calcium-fortified orange and grapefruit juice. Vitamin D is available from fortified milk and products made from fortified milk; supplements, including multivitamins with vitamin D and calcium supplements with vitamin D; sun-exposed skin

• eat more complex carbohydrates, such as fruits, vegetables, grains and beans

• decrease the amount of refined sugar you eat

• avoid or cut back on caffeine and nicotine

• avoid alcohol, if you are over 21. (It is not only illegal for anyone under age of 21 to be drinking, it is also very dangerous.)

• consume less salt or foods high in sodium; eat fewer high-salt snacks and drink more water

• avoid sodas and drink beverages without caffeine such as herbal teas and water

• keep moving; just by walking 20 to 30 minutes three times a week you can increase endorphin and serotonin production in the brain giving you more energy and a mood lift, decrease stress and anxiety and improve your sleep

Your first pelvic exam

Your first pelvic exam is an important step in taking charge of your health. Obstetricians and/or gynecologists (OB/Gyn) or nurse practitioners are usually the type of health care professional you would see, but a family doctor, general internist and other specialist may also perform these examinations. Generally, you do not need to have a gyn exam until age 21, or within three years of becoming sexually active. During this exam, a health care professional looks and feels your pelvic area for health problems. A Pap test, which is used to detect abnormalities in your cervix that may be cancerous, may or may not be part of your first pelvic exam. Cervical cancer can develop whether you are sexually active or not, although it is almost always linked to HPV, a sexually transmitted virus.

The American Cancer Society (ACS) recommends the following guidelines for Pap screenings in young women:

Begin having screenings within three years of beginning of vaginal intercourse, but not later than 21 years of age. If a health care professional uses a conventional Pap test, have one each year until you reach age 30.

If a liquid-based Pap test is used, screening can be done every two years, provided results are normal. Once a woman turns 30 and has had three consecutive "normal" Pap tests, screening can be done every two to three years.

Your health care provider may suggest getting a Pap test more often if you have certain risk factors such as human immunodeficiency virus (HIV) infection, a weakened immune system or multiple sex partners.

In addition to a pelvic exam, a breast exam should also be part of your visit. Your health care professional will look at and feel your breasts for anything abnormal, as well as show you how to do a breast self-exam (BSE) at home. He or she should also discuss the benefits and limitations of both types of breast examinations (clinical exams and self exams) and how often they should be done.

If you are sexually active, ask your health care professional if screening tests for sexually transmitted infections (STIs) (which used to be called sexually transmitted diseases [STDs]) can be done at your first visit. It's important to be tested for STIs, if you are sexually active, even if you don't have symptoms. Many STIs, chlamydia and gonorrhea, for example, don't cause symptoms until infections are advanced. Identifying and treating STIs early can help prevent long-term reproductive health problems, like infertility, from developing.

For information on contraceptive options visit the "Birth Control Pills" and "Contraception" topics at this Web site.

Build strong bones

Osteoporosis is a mostly preventable and treatable disease that thins and weakens your bones. According to the National Osteoporosis Foundation, in 2002, as many as eight million American women had osteoporosis, and nearly 22 million had low bone density or low bone mass, putting them at risk for developing the disease. Now is the time of life to make your bones strong. Here are three simple steps to prevent osteoporosis:

• Do weight-bearing exercise, such as brisk walking, regularly

• If you smoke, quit, or ask a health care professional about how to go about quitting.

• Increase the amount of calcium and vitamin D in your diet. The tables below show the recommended calcium and vitamin D amounts for different ages from the National Osteoporosis Foundation and the National Academy of Science:

You can get calcium from dairy products like milk yogurt and cheese, canned fish with soft bones (sardines, anchovies and salmon; bones must be consumed to get the benefit of calcium), dark-green leafy vegetables (such as kale, mustard greens and turnip greens) and even tofu (if it's processed with calcium sulfate). Some foods are calcium-fortified; that is, they contain additional calcium. Examples include certain cereals and other breakfast foods and orange juice. Talk to your health care professional about whether you need to take calcium supplements, if you don't think you're getting enough calcium from food sources.

Vitamin D is critical to calcium absorption and bone formation. Vitamin D deficiency can lead to the softening of bones in children and babies (rickets) and adults (osteomalacia). But bear in mind that high doses of vitamin D can cause kidney and abdominal problems. You can get your allowance of vitamin D through egg yolks, herring, sardines, tuna, salmon and fortified milk, and through exposure to sunlight, but only if you're not wearing a sunscreen (and sunscreen use is recommended for all women, including those of color, to reduce the risk of developing skin cancer). One three-ounce salmon fillet will provide you with 8 micrograms of vitamin D.

Recommended Vitamin D Intake

When eating is a problem

Eating disorders can be devastating mental illnesses that affect as many as seven million American women. People with eating disorders use food and dieting as ways of coping with life's stresses. Eating disorders are more common in younger women and teenage girls than in other individuals, but can affect women of any age.

Eating disorders are treated with any combination of the following:

• therapy to help you develop a healthier attitude about your body-medical evaluations to stabilize you physically

• nutritional counseling to teach you healthy eating habits

• medication, such as antidepressants, to address emotional health problems

• family therapy to establish the support system you need for full recovery

Recognize symptoms of depression

Teenagers have emotional ups and downs, but depression is not normal, it's a medical condition that can be successfully treated. Feeling "blue" or "down" for a short period of time isn't something to be concerned about. However, when these feelings don't go away or get worse, they may be signs of depression and should be evaluated. Here are some questions to help you identify symptoms of depression and figure out if you're depressed:

• Have you been sad a lot lately?

• Have you had crying spells?

• Is there a change in your productivity or your ability to concentrate?

• Does your future look bleak and or overwhelming to you?

• Do you have difficulty making decisions?

• Have you lost interest in aspects of life that used to be important to you?

• Do you feel excessively tired or lethargic and sleep more (or less) than usual?

• Do you feel guilty or like a failure?

• Do you think about killing yourself? Do you think about how you might kill yourself?

If you answer "yes" to any of these questions, you may be depressed. Talking to someone about these feelings can help you get the treatment you need. Depression is a treatable illness.

If you feel like killing yourself, seek help immediately. Call the Suicide Awareness/Voice of Education National Hotline: 1-800-784-2433.

Avoid alcohol, tobacco and other drugs

Dependencies on alcohol, tobacco or other types of drugs are complicated illnesses that present unique threats to women's health. Many people use tobacco, alcohol or other drugs to feel better. But, these chemicals will actually make you more depressed.

Parents who drink, smoke or use other drugs are just one of the reasons why teenagers and young women develop problems with alcohol, tobacco and other drugs. Other risks include:

• peer pressure

• a high level of family conflict

• a history of physical or sexual abuse

• depression

• targeted marketing by alcohol and tobacco manufacturers

• poor school performance

Not only is it illegal for anyone under the age of 21 to drink alcohol, it is also very dangerous. Many underage drinkers die not only in car crashes, but also from alcohol poisoning, violence and other alcohol-related accidents. Teens who drink heavily are more likely to be sexually active and put themselves at risk for contracting sexually transmitted infections and pregnancy. Tobacco use increases your risk not only for cancer, heart disease and other problems, but also poses particular dangers to female reproductive organs.

You may be addicted to alcohol, tobacco and/or other drugs if you recognize any of the following behaviors or descriptions about yourself:

• you have a strong craving to drink, smoke, or take other drugs

• you have been unable to limit your drinking on any given occasion

• you are hiding medication or sneaking pills

• you have problems with your job, schoolwork or relationships because of alcohol or other drug use

• you feel guilty about the amount of alcohol or drugs you consume

• you feel angry when confronted about drinking, smoking, or using drugs

• you need alcohol, a smoke, or to use drugs to get going in the morning

• you have "blackouts" or don't remember things after you drink or take other drugs.

If you recognize some of these behaviors in yourself, it's time to talk with a health care professional about getting help.

Health Issues for Women Ages 25 to 40

Looking good and feeling good happen for those women who invest at least a little effort into maintaining their health. The key? Moderation.

Recognizing the symptoms of stress

Juggling professional life, family schedules, money issues and care for elderly parents are only a few of the common stressors confronting women today. The following strategies may help you keep stress under control:

• eat a balanced, nutritious diet

• exercise regularly, because exercise can help to improve self-esteem and mental health, as well as physical fitness. Remember, when physical activity is painful, when you can't breath properly or if you feel faint or sick, you might be overdoing it and need to slow down. Even small amounts of regular physical activity-20 to 30 minutes three times a week, can help reduce the risks of cardiovascular disease and osteoporosis; relieve the pain and disability caused by arthritis and other chronic diseases; increase strength, endurance and flexibility

• schedule and prioritize your time; remember to make time for yourself

• balance work and play

• let yourself laugh and cry; laughter and tears help to release tension

• family therapy to establish the support system you need for full recovery

Skin care problems and solutions

Your skin is your body's first defense against disease and infection, and it protects your internal organs from injuries. The skin helps regulate body temperature and prevents excess fluid loss. It also helps to remove excess water and salt.

When skin becomes dry it needs water and oil, to help rejuvenate it. Most health care professionals recommend a simple cleansing regimen: a gentle cleanser using warm, not hot, water, no abrasive scrubs (they can cause broken blood vessels, scratch the skin and irritate clogged pores), regular sunscreen use, and when necessary, a moisturizer.

Anyone can develop skin cancer, although people with fair complexions tend to be more susceptible than people with darker skin tones. The earliest warning sign of severe skin damage is the development of actinic keratoses. These precancerous lesions appear as itchy, tender, crusty bumps on the back of the hands, lips, face or neck. Even one sunburn can increase your risk for developing skin cancer - so use sunscreen every day.

Reducing your exposure to the sun is the best way to keep your skin healthy.

Health Issues for Women Ages 40 to 55

Some women sail through their mid- to late 40s and 50s without a second thought about menopausal symptoms. For others, hormonal changes can make midlife less than "prime time." Most women can tell if they are approaching menopause because their menstrual periods start to change. This transitional time is often called "perimenopause" and lasts for two to eight years.

Hormonal fluctuations cause irregular menstrual patterns and other changes associated with menopause, including:

• hot flashes

• vaginal dryness

• urinary tract infections

• night sweats

• insomnia

• headaches

• heart palpitations

• mood changes

• anxiety and irritability

• memory lapses and diminished concentration

• new or worsening PMS symptoms

Some women experience only mild symptoms just prior to and following menopause.

Irregular menstrual periods are common as you get closer to menopause, but they also can be a symptom of gynecologic cancer or other conditions that may need medical attention. Remember, you can still get pregnant during the transition to menopause, even if your menstrual cycle is irregular, so continue to use birth control. Be sure to mention any menstrual problems during regular checkups or schedule an appointment to discuss them. Bleeding after menopause should always be reported and evaluated.

Menopause itself is one point in time that happens after 12 consecutive months with no menstrual period and no other biological or physiological cause for the end of your periods.

Menopausal hormone therapy (commonly referred to as hormone therapy or HT) has been widely used for short-term management of uncomfortable menopausal symptoms such as vaginal dryness and hot flashes, and as a long-term strategy for preventing diseases common in postmenopausal women (related to estrogen decline) such as osteoporosis. For many years, estrogen had been widely recommended to postmenopausal women as a way to prevent heart disease.

The safety of hormone therapy (often administered as combination of estrogen and progestin hormones) as well as estrogen-alone therapy (ET) is now in question. Concerns were triggered by one part of the Women's Health Initiative (WHI) -- one of the largest studies of women's health ever undertaken and still underway. A major question the WHI sought to answer was the benefit of combination estrogen-progestin hormone therapy for the prevention of coronary heart disease in healthy women between the ages of 50 to 79 years. The HT (estrogen-progestin) product used in the study was Prempro 0.625/2.5. The study found that not only did combination hormone therapy NOT prevent heart disease, it could potentially contribute to its development.

As a result of the findings, all estrogen-containing medications now carry a "black box" warning from the U.S. Food & Drug Administration (FDA) -- the strongest step the FDA can take to warn consumers of potential risks from a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen - risks identified by one arm of the WHI study, which was abruptly halted when the adverse health events were discovered in the subgroup of women taking HT. Interestingly, the part of the study evaluating estrogen therapy alone (no progestin treatment) did not identify increased risks for breast cancer or heart disease.

Also emphasized by the "black-box" warning is that estrogen products are not approved for heart disease prevention. It advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time. Women taking estrogen products are cautioned to have yearly breast exams, perform monthly breast self-exams and receive periodic mammograms.

New findings from a memory sub-study of the WHI indicate that postmenopausal women (age 65 and older) taking combination hormone therapy have twice the rate of developing dementia, including Alzheimer's disease, compared with women who do not take the medication. The study also found that the combination therapy did not protect against the development of mild cognitive impairment, or MCI, a form of cognitive decline less severe than dementia. The research, part of the Women's Health Initiative Memory Study (WHIMS) and reported in the May 28, 2003, Journal of the American Medical Association (JAMA), found the heightened risk of developing dementia in a study of women 65 and older taking Prempro.

Some more recent studies determined that taking HT right at the time of menopause did reduce the risk for heart disease and death, as well as other chronic medical conditions such as diabetes or hip fractures.

Because every woman's risk profile is different, women who are thinking about taking HT or ET or are currently taking it for whatever reason, should consider reviewing their options and treatment plans with their health care professional. Women who take ET products to prevent osteoporosis should discuss their personal risks for heart disease and breast cancer with their physician. Alternative treatments and preventive medications for osteoporosis are available.

Women who are currently taking HT should consult with their health care professionals before stopping their medication. How hormone medication is tapered off will depend on the type of medication being used. Stopping some hormone therapy regimens abruptly may make menopausal symptoms worse and symptoms long thought gone may also return after therapy is stopped.

More consideration is now given to "individualizing" HT for the woman who wants or needs to continue taking it for symptom relief. That is, carefully evaluating symptoms and preferences and discussing the wide-range of HT options now available.

Many women turn to "natural hormonal therapies," provided by herbs, supplements and plant-based estrogens (called phytoestrogens, commonly found in soy products and legumes) to help manage menopausal symptoms as alternatives to synthetic and other forms of estrogen. While research is just beginning to look at how these preparations may affect menopausal symptoms, there is little or no clear evidence that these strategies can help to prevent heart disease or other postmenopausal conditions. Neither is there a clear understanding of how much of these preparations should be used as a prevention strategy. It is also important to remember that all estrogens, even those that are plant-based, carry the same "black-box" warnings.

For more information on hormone therapy and the importance of discussing all your options with your health care professional, visit the "Menopause" topic at this Web site.

A slower metabolism

Beginning in your mid-30s, you lose a quarter of a pound of muscle or more every year and gain at least that much in fat. You also lose nearly one percent of bone mass every year, with the most rapid and severe bone loss occurring for many women during the first five to seven years after menopause. These silent changes can catch up with you in your 50s, 60s and 70s. It's not all bad news. The good news is you can prevent complications by acting now. Women who exercise regularly have a better chance of avoiding osteoporosis than women who don't exercise.

Good nutrition is a start

All women should follow these general nutrition guidelines (with advice from your health care professional if you've got a particular health concern):

• get between 1,000 and 1,500 mg of calcium daily

• eat five or more 1/2cup servings of fruits and vegetables

• eat six or more 1/2cup servings of whole grains, complex carbohydrates like pasta, bread, cereal and beans

• eat foods containing omega-3 fatty acids, like mackerel, salmon, albacore tuna and walnuts and avoid foods containing saturated fats (often listed on the label as hydrogenated or partially hydrogenated fats).

• eat soy-rich foods, such as tofu, because they contain chemicals called phytoestrogens (also called isoflavones) that have a weak estrogen-like effect in the body.

Many older women don't eat enough to get the nutrients they need. Vitamin D and the B vitamins are particularly important to women as they age because these vitamins contribute to bone and heart health and may help reduce the risk of osteoporosis and heart disease-health risks for older women.

• Vitamin D is essential for calcium absorption by the body. It is found in fortified milk- and products made from fortified milk, and is absorbed by the skin from exposure to sunshine. Women ages 50 and younger need at least 200 IU (International Units)/day; starting at age 51, you need 400-800 IU/day. Women age 70 and older should increase their vitamin D intake to at least 600 IU/day.

• The B vitamins, especially folic acid, have been associated with lowering blood levels of homocystine (an amino acid, which in high levels, is associated with heart disease, stroke, and fractures). A multivitamin that contains all the B vitamins is good insurance for most women. Green leafy vegetables, lentils and orange juice are also good sources of folic acid.

Add some exercise and you'll be in good shape

For most healthy people, any vigorous activity, such as brisk walking, swimming, running or biking for at least 30 minutes three-to-four times each week provides health benefits to the heart, lungs and circulatory system. Moderate- to low-intensity activity, such as pleasure walking, gardening and housework for 30 minutes on most days provides some benefits. What's most important is to include exercise as part of your regular routine. Before starting any exercise, check with a medical professional.

Healthy Living For Women Ages 55 And Older

In the next decade, more women than ever before will be age 50 or older. Women face unique health issues beginning at age 50 and throughout the rest of their lives. Heart disease, osteoporosis, breast cancer and diabetes occur more often in older women than in younger women. Lung cancers cause the greatest number of cancer-related deaths in women, followed by breast cancer, then colon cancer. Some women face greater risks for developing one or more of these conditions than other women. Your family health history can influence your health risks in the years ahead. So can your lifestyle before and after menopause.

Exercising in your later years can help improve and maintain your health. Here's how:

• Weight training can greatly increase your overall muscle, ligament and tendon strength as well as bone density. This improves a woman's balance and ability to walk, resulting in maximum independence and a decreased incidence of falls. Strength training-lifting weights or exercising against resistance -- can also prevent or slow bone-weakening osteoporosis. Strength training also can lessen arthritis pain.

• Regular, active exercise such as swimming and running, raises your heart rate and may greatly reduce hardening and blockage of the arteries, a condition known as atherosclerosis. Atherosclerosis is a major cause of heart disease and stroke.

• Women who are physically active are less likely to develop adult onset diabetes; for women who have diabetes, exercise may help manage their diabetes better because exercise increases the body's ability to control blood glucose levels. Exercise also helps to control weight gain, a major risk factor for diabetes.

Taking medications safely

Almost half of older Americans take multiple medicines daily. These medications are prescribed to improve quality of life or to treat serious medical conditions that may develop in older adults. Yet, aging changes the way our bodies respond to drugs. The more medicines you take, the greater the chance for side effects and interactions. Moreover, taking medications incorrectly can make them less effective or even dangerous.

Are you becoming confused about all those bottles in the medicine cabinet? If you're taking multiple medications, it's very important to keep track because you may be seeing more than one health care professional for different reasons. Each health care professional should know what the other has prescribed for you. That's why you should keep a record of all the medicines you use, even over-the-counter medications like:

• aspirin or other pain/headache/fever medicine

• allergy medicine

• antacids

• cold medicine

• cough medicine

• diet pills/supplements

• laxatives

• sleeping pills

• vitamins

• minerals

• herbal supplements