Blood Pressure

High blood pressure (hypertension) often causes no symptoms for years, but increases your chance of stroke and heart attack, as well as affecting your health in other ways. This is why it is called “the silent killer”.

The Systolic, or top, number measures pressure as your heart pumps. The Diastolic, or bottom, number measures pressure as your heart rests. Both numbers are important. The more blood your heart pumps, and the narrower your arteries (resistance), the higher your blood pressure.

What does your Systolic blood pressure result mean?

  • < 120 is NORMAL
  • 120 to 139 is PREHYPERTENSION, or borderline. Even this increases your chance of heart disease.
  • 140 and higher is HYPERTENSION, or high blood pressure.

What does your Diastolic blood pressure result mean?

  • < 80 is NORMAL
  • 80 to 89 PREHYPERTENSION, or borderline.
  • 90 and higher is HYPERTENSION, or high blood pressure.
back to top

Fasting Glucose (sugar)

Diabetes is sometimes called “the woman’s disease”, because after 45 years old, twice as many women as men have diabetes. The fasting glucose (sugar) test screens for diabetes. It should be taken after not eating or drinking for at least 8 hours.

If < 100 mg/dL NORMAL
100 to 125 mg/dL PREDIABETES, or “impaired fasting glucose”. This is a risk factor for type 2 diabetes.
126mg/dL and above DIABETES

If you are diagnosed with pre-diabetes or diabetes, often learning how to eat a heart healthy diet and increasing your physical activity will improve your sugars, and lower your chance of developing heart disease, kidney disease and stroke.

Screening for Ovarian Cancer

At this time, there are unfortunately no good screening tests for ovarian cancer. Screening tests are meant to screen for cancer when the woman is not having any symptoms. To be a good screening test, the test should:

  • Find the disease or cancer early, when it may improve health or help the woman live longer
  • Have a low chance of a false negative, or missing the cancer if it is there
  • Have a low chance of a false positive, meaning appearing to be abnormal when there is no cancer there. This often leads to more tests. When there is a concern about ovarian cancer, this can lead to unnecessary surgeries. Therefore, screening tests themselves have risks.

None of the screens for ovarian cancer can reliably find early cancers or decrease the chance of dying from ovarian cancer. They miss most of the early cancers. There is so much research trying to find a helpful screen, and we continue to be hopeful that a useful screen will be found.

The symptoms of ovarian cancer can be somewhat vague and non-specific. They include consistent and frequent symptoms of:

  • Abdominal pressure, fullness, swelling, or bloating
  • Having to urinate frequently
  • Discomfort or pain in the pelvis

The key here is that the symptoms are occurring frequently and consistently, especially for more than a few weeks.

Other symptoms might include:

  • Persistently having indigestion, gas, or nausea
  • Unexplained changes in bowel habits, such as constipation
  • Feeling full quickly or loss of appetite
  • Pain during intercours
  • A persistent lack of energy
  • Pain in the lower back
  • Changes in your periods

If you have these symptoms, or a strong family history of ovarian and/or breast cancer, you should discuss testing with your healthcare provider.

back to top

Pap Smears and Cervical Cancer Screening

  • “Cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow up.” The Pap test looks for pre-cancers and cancers of the cervix. It is recommended regularly for all women beginning at age 21, or within 3 years of the first time you have sex – whichever is first.
  • The Pap test looks for changes in cells or abnormal cells in the cervix. If the test result is abnormal, you may need additional testing to determine if there is a cancer or pre-cancer. The Pap test has been one of the most effective screens for cancer that we have.
  • The HPV (Human Papilloma Virus) test may be added to your Pap test if you are 30 or older, and in women who have unclear results from your pap test. The HPV is a virus that can cause cells in the cervix to become cancerous. The HPV test screens for the viruses that most commonly cause cervical cancer.
  • Ask your healthcare provider how often you should be screened for cervical cancer. This will be individualized depending on your previous Pap results and risk factors.
back to top

Colon Cancer Screening

Colon cancer is the third most common cancer in women. Screening is meant to find people who have the cancer before they have symptoms, when there is a high chance of cure. If we wait for symptoms, there is a significant chance the cancer will have spread, and chance of cure is much lower. Cancers found early are often cured by simply removing the growth.

Because this is a relatively common cancer, and so curable in early stages, it is recommended that all people be screened at 50 years old, earlier if there is a family history of colon cancer or polyps, or other risk factors. Screening is recommended at earlier ages if there are certain symptoms. These symptoms include:

  • Changes in your bowel habits: more or less frequent than normal
  • Constipation: difficulty having a bowel movement
  • Diarrhea: loose or watery stools
  • Bright red or dark red blood in your stool, or black, dark colored “tarry” stool
  • Stools that are thinner than normal, or feeling as if you cannot empty your bowels completely
  • Abdominal (midsection) discomfort, bloating, frequent gas pains, or cramps.

If you have any of these for two or more weeks, you should see your healthcare provider and consider screening.

The test generally recommended is a colonoscopy, where the doctor sedates you and uses a thin tube to look through your rectum and entire colon. The test is generally done every 7 to 10 years if you are low risk and no polyps or tumors are found at your first test.

Some centers are offering a “virtual colonoscopy” instead of the colonoscopy. This test uses either a cat scan (CT) or MRI to look for polyps and cancers. These tests have not yet been fully researched and compared with colonoscopy for how well they find early cancers. Therefore, they are not yet being encouraged for screening as an alternative to colonoscopy.

back to top

Healthy Weight

To determine if your weight is a risk, we look at

  • Body mass index (BMI)
  • Waist circumference (WC)
  • Risk factors that may go along with being overweight

1. Body Mass Index (BMI)

BMI compares your weight to height, as an indicator of total body fat. There are calculators and tables that are used to determine your BMI. If you are very athletic and muscular, it may overestimate body fat. If you are older and have lost muscle mass, it may underestimate your body fat.

What do the BMI results mean? < 18.5 Underweight 18.5 – 24.9 Normal 25 – 29.9 Overweight 30.0 and above Obesity

2. Waist Circumference (WC)

WC is used to determine the amount of abdominal fat you have. This helps to predict your risk for heart disease, high blood pressure, diabetes, high cholesterol, and other health problems. People with a higher WC (“pear shape”) may have a higher chance of these health problems.

WC is most helpful to measure if your BMI is between 25 and 34.9. A high risk waist circumference is: For women, > 35 inches For men, > 40 inches

3. Other risk factors

There are many other things that should be factored in to determine what your risk may be of developing heart disease, high blood pressure, diabetes, and other illness related to weight. Your healthcare provider will assess these.

back to top

Screening for Thyroid Disease

When to start screening for thyroid disease is controversial. Based on the evidence, it is reasonable to begin screening at age 45. We may screen earlier if there is a strong family history, or if you have certain symptoms. Unfortunately, these symptoms are often very vague and not specific for just thyroid disease. They also may be common symptoms when there is no disease at all.

An under-active thyroid (hypothyroid) is more common than over-active (hyperthyroid). Symptoms might be:

  • Fatigue
  • Weakness
  • Weight gain or increased difficulty losing weight
  • Coarse, dry hair
  • Dry, rough pale skin
  • Hair loss
  • Difficulty tolerating cold
  • Muscle cramps and frequent muscle aches
  • Constipation
  • Depression
  • Irritability
  • Memory loss
  • Abnormal periods

Obviously, there are many other reasons why you may have these symptoms. If you have concerns, discuss screening with your healthcare provider.

back to top

Bone Density Results

Osteoporosis is a condition where bones are thinner and weaker, and at risk of breaking. This is most common in the back and hip. To learn whether you have osteoporosis, a bone mineral density (BMD) test is done. This is also called a bone mass measurement. BMD is most commonly measured with a central DXA (“dexa”) test of the hip and spine (back). To make the test as accurate as possible, is best to have any additional DXA tests done on the same machine in the same location.

The result from the DXA is listed as a “T-score”. This compares your results with that of a normal, healthy young adult at 30 years old, at the peak of their bone density. We all lose bone mass at individual rates as we get older. We want to measure how much bone you have lost since your peak bone mass. The t-score is used to diagnose osteoporosis. The lower the t-score (negative numbers), the lower your bone mass. Depending on your result of the DXA, your provider will let you know how often to repeat it to monitor how quickly you are losing bone mass.

What your t-score means:

  • A t-score between +1 and -1 is NORMAL.
  • A t-score between -1 and -2.5 means you have low bone density or OSTEOPENIA.
  • A t-score of -2.5 or lower means you have OSTEOPOROSIS.

The DXA also includes a Z-score, which compares your results to other women your own age and body size. This is not used to diagnosis osteoporosis, but may be a clue as to whether there may be other reasons than age and menopause to explain your bone loss, especially when testing young men and women before menopause.

Should you be treated for osteopenia or osteoporosis?

Post-menopausal women with t-scores below -2.0, and those with scores below -1.5 who have certain other risk factors should consider treatment. Your provider will discuss these options with you. The goal with treatment is to decrease your chance of breaking your bones. Your healthcare provider can estimate your “absolute fracture risk”, which estimates your risk of breaking a bone in the next 10 years. This can help you to decide whether you should take medicine for a low t-score.

What else can you do to help keep your bones healthy and strong?

Calcium. For premenopausal women and post-menopausal women on estrogen, you need 1200 mg a day. If you are post-menopausal and not on estrogen, you need 1500 mg a day. It is best to get calcium from the foods you eat, but can be done with supplements also.

Vitamin D. We are just learning some of the benefits of Vitamin D and how it effects your health. You should take 800 to 1000 IU of Vitamin D each day. Exercise. Exercise strengthens bones and makes even thinner bones less likely to break. Exercise also improves coordination and lowers the chance you might fall and break a bone. Exercises where you are standing and holding your own weight are the best, including walking, hiking, and running. Doing push-ups and arm exercises will help with the bone strength in your arms. Yoga, pilates, and other exercises that improve balance also decrease your risk of falling

back to top