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WOMEN AND ADOLESCENT HEALTH - PARAS BLISS

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Title: WOMEN AND ADOLESCENT HEALTH - PARAS BLISS


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Women and Adolescent Health Dr Preeti
Raheja Consultant Obstetrics Gyanecology Paras
Bliss, New Delhi
2
INTRODUCTION
  • Adolescence refers to the stage from puberty to
    adulthood, and includes the psychological
    experiences of the child during this period.
    Adolescence is described as being the teenage
    years from thirteen to eighteen years of age
    however, puberty decides the onset of
    adolescence. Therefore, adolescence occurs in
    some children as early as nine years of age.

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  • During adolescence there is a large degree of
    psychological growth as children make adjustments
    in their personality due to the rapid physical
    and sexual development which are characteristic
    of this period of life. Adolescents face ongoing
    conflict and difficulty adapting to the sudden
    upsurge of changes in body. These changes cause
    unrest and confusion in the adolescents inner
    selves and in the way they perceive the world.

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CONTENTS
  • Physiological changes
  • Menstruation
  • Abnormalities and symptoms that require
    consultation
  • Aspects of nutrition
  • Sexual Education
  • Cervical cancer vaccination

5
PHYSIOLOGICAL CHANGES
  • Rapid Growth
  • You can expect rapid growth in height and weight
    during your child's adolescence. Girls experience
    their growth spurt between the ages of 9 and 14,
    You can also expect your teen to gain weight, as
    girls put on fat. Variances in growth can cause
    teenagers to feel self conscious about their
    bodies. Teens may feel they are all limbs -- and
    at times, this could be true.

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PHYSIOLOGICAL CHANGES
  • STAGES OF PHYSIOLOGICAL CHANGES
  • Development of the breasts Also known as
    Thelarche and which marks the full development of
    the breasts from minor buds by the age of 12.
  • Pubarche starts between the age of 10-15, where
    in hair growth starts around the pubic and
    axillary regions along with the thickening of
    other hair.
  • Menarche is the onset of the first menstruation
    marks the beginning of puberty for girls. This
    can start anytime between 10 and 15 years old,
    and this marks the beginning of fertility.
    Menstruation typically starts two years after
    breast buds develop, which can be as early as 8
    year old.

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PHYSIOLOGICAL CHANGES
  • Hair Growth
  • One of the more noticeable and celebrated changes
    in teenagers is hair growth. Both males and
    females can expect pubic hair to grow. This may
    start as much as three years earlier in females,
    starting as early as age 9 and reaching adult
    patterns by age 14. Armpit and leg hair will also
    develop during this time.

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PHYSIOLOGICAL CHANGES
  • Body Odor and Acne
  • Two disturbing changes during adolescence are the
    occurrence of body odor and acne. Hormones that
    cause sexual maturation and other body changes
    also lead to increased oil production. Both males
    and females will notice changes in their skin as
    it becomes coarser and the sebaceous glands
    produce more oil that can cause acne and
    blackheads. Sweat glands also become more active,
    and the combination of sweat and oils causes an
    odor, making the use of deodorant a necessity.
    Teens need to be more vigilant with hygiene to
    keep up with their body changes.

9
MENSTRUATION
  • Menarche typically occurs within 23 years after
    thelarche (breast budding), at Tanner stage IV
    breast development, and is rare before Tanner
    stage III development. By age 15 years, 98 of
    females will have had menarche. An evaluation for
    primary amenorrhea should be considered for any
    adolescent who has not reached menarche by age 15
    years or has not done so within 3 years of
    thelarche. Lack of breast development by age 13
    years also should be evaluated.

10
Cycle Length and Ovulation
  • Menstrual cycles are often irregular during
    adolescence, particularly the interval from the
    first cycle to the second cycle. Most females
    bleed for 27 days during their first menses.
    Immaturity of the hypothalamicpituitaryovarian
    axis during the early years after menarche often
    results in an ovulation and cycles may be
    somewhat long however, 90 of cycles will be
    within the range of 2145 days, although short
    cycles of less than 20 days and long cycles of
    more than 45 days may occur. By the third year
    after menarche, 6080 of menstrual cycles are
    2134 days long, as is typical of adults.

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  • Adolescents with cycles that are consistently
    outside of the range of 20 to 45 days should be
    evaluated for pathologic conditions, such as the
    polycystic ovary syndrome (PCOS), eating
    disorders, thyroid disease, hyper prolactinemia,
    or even such rare conditions as ovarian
    insufficiency (premature ovarian failure

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ABNORMALITIES AND SYMPTOMS THAT REQUIRE
CONSULTATION
  • Some of the common adolescent health issue that
    needs to be evaluated within time are
  • Abnormal uterine bleeding
  • Ovarian cysts
  • Breast abnormalities

14
Abnormal Uterine Bleeding
  • Abnormal uterine bleeding (AUB) is any form of
    bleeding that is irregular in amount, duration,
    or frequency. It can be characterized by
    excessive uterine bleeding that occurs regularly
    (menorrhagia), by heavy bleeding at irregular
    times (metrorrhagia), or a combination of both
    (menometrorrhagia). It can also be intermittent
    bleeding or sparse cyclical bleeding
    (oligomenorrhea). Dysfunctional uterine bleeding
    (DUB) is a subset of AUB and is defined as
    excessive, prolonged, or unpatterned bleeding
    from the endometrium without an organic cause and
    is frequently used synonymously with an ovulatory
    bleeding. In adolescents, up to 95 of AUB is
    DUB. However, because DUB is a diagnosis of
    exclusion, other potential causes of abnormal
    bleeding must be ruled out.

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  • Girls and adolescents with more than 3 months
    between periods should be evaluated. Although
    experts typically report that the mean blood loss
    per menstrual period is 30 ml per cycle and that
    chronic loss of more than 80 ml is associated
    with anemia, this has limited clinical use
    because most females are unable to measure their
    blood loss. Menstrual flow requiring changes of
    menstrual products every 12 hours is considered
    excessive, particularly when associated with flow
    that lasts more than 7 days at a time.

16
  • The diagnosis of pregnancy, sexual trauma, and
    sexually transmitted infections should be
    excluded, even if the history suggests the
    patient has not been sexually active.

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Ovarian Cysts
  • The most common ovarian cyst among adolescent
    girls is PCOS.
  • Polycystic ovarian syndrome, or PCOS, is a
    condition in which there is an imbalance in the
    female sexual hormones. This leads to the growth
    of ovarian cysts (benign masses on the ovaries).
    PCOS can cause problems with a womens menstrual
    cycle, fertility, cardiac function, and
    appearance.

20
Common characteristics of PCOS
  • Irregular menstrual periods
  • Unexplained Weight gain
  • Acne
  • Hirsutism- Appearance of thick and dense hair on
    the face
  • Mood swings
  • Infertility
  • Pelvic pain

21
Other types of cysts
  • Follicular cyst  A follicular cyst develops each
    month and contains the small egg within it. The
    sac ruptures during ovulation and the egg comes
    out of the cyst. Sometimes the cyst can grow
    larger than the normal size which is up to 3 cm.
    If the sac that holds the egg doesnt break open
    to release the egg, it can grow, anywhere in size
    from 1 inch to 4 inches across. Usually this type
    of cyst disappears in one to three months and
    often does not cause pain.

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  • Corpus luteum cyst  A corpus luteum cyst is
    normal and usually forms each month after the egg
    breaks out or ovulates. This type of cyst usually
    disappears by itself in a few weeks, but it can
    grow 3-4 inches across, and may bleed inside of
    the cyst or your belly. This type of cyst can
    cause pain in your abdomen (belly).
  • These problems can be cured by consulting a
    doctor on time.

23
Breast Abnormalities
  • Breast masses can cause anxiety for adolescent
    girls and their parents.
  • Breast masses can arise during any stage of
    puberty, so it is important to understand normal
    breast development. Thelarche (initiation of
    breast development) usually begins between the
    ages of 9 and 10 years.

24
Breast examination
  • Clinical breast examination. The American Cancer
    Society (ACS) in 2003 recommended that a clinical
    breast examination (CBE) be done at least every 3
    years for women in their 20s and 30s. For
    adolescents, the CBE serves as an opportunity to
    increase their ease with their bodies and with
    the examination itself and to bring up any
    breast-related concerns.
  • Breast self-examination. Teaching and performance
    of the breast self-examination (BSE) in
    adolescents remains controversial, given that the
    incidence of breast cancer in adolescents aged 15
    to 19 years is only 0.2 per 100,000. The American
    College of Obstetricians and Gynecologists does
    not recommend teaching adolescents BSE until the
    age of 19 years.

25
Common breast masses in adolescents
  • Fibrocystic changes. Breast lumps associated with
    cordlike thickenings are physiologic,
    hormone-induced breast changes and normal
    variants of regular breast tissue. Each month,
    they can become painful and enlarged during the
    week before menses, resulting in mastalgia. These
    breast changes are possibly related to the
    monthly hormone fluctuations of estrogen and
    progesterone.  

26
  • Fibroadenomas. Fibroadenomas comprise 68 of
    breast masses in adolescents and are believed to
    be caused by an abnormal response to estrogen.
    Fibroadenomas present as 2 cm to 3 cm masses but
    can enlarge during the menstrual cycle. Physical
    examination demonstrates a firm, mobile, oval or
    round, nontender, rubbery mass, separate from the
    underlying breast tissue and usually located in
    the upper outer quadrants. On ultrasound,
    fibroadenomas normally appear as a
    well-circumscribed, homogeneous, hypoechoic mass
    with smooth distinct borders. Generally, the
    width of the fibroadenoma is greater than its
    height.

27
  • Two options exist for management of
    fibroadenomas. They can be monitored via serial
    clinical examinations every 3 to 6 months because
    up to 50 of lesions decrease in size or
    disappear after 5 years. Alternatively, referral
    to a surgeon for an excisional biopsy is
    indicated for patients whose fibroadenomas
    continue to grow or who are uncomfortable with
    only clinical monitoring.

28
ASPECTS OF NUTRITION
  • Eating healthy food is important at any age, but
    its especially important for teenagers.
  • As your body is still growing, its vital that
    you eat enough good quality food and the right
    kinds to meet your energy and nutrition needs.
  • Boys require an average of 2,800 calories per
    day.
  • Girls require an average of 2,200 calories per
    day.

29
Important Nutrients
  • Protein
  • Proteins are the most essential body building
    sources, which are very important to be included
    in the diets of an adolescent. The densest
    sources of protein include teenage favorites such
    as Chicken, Fish, Eggs and Cheese.

30
  • Carbohydrates
  • In planning meals, we want to push
    complex-carbohydrate foods and go easy on simple
    carbohydrates. Complex carbs provide sustained
    energy that's why you often see marathon runners
    and other athletes downing big bowls of pasta
    before competing. As a bonus, many starches
    deliver fiber and assorted nutrients too. They
    are truly foods of substance filling yet low in
    fat.
  • Most nutritionists recommend that complex
    carbohydrates make up 50 to 60 of a teenager's
    caloric intake.
  • Simple carbs, on the other hand, seduce us with
    their sweet taste and a brief burst of energy but
    have little else to offer and should be minimized
    in the diet.

31
  • Dietary Fat
  • Fat should make up no more than 30 of the diet.
    Fat supplies energy and assists the body in
    absorbing the fat-soluble vitamins A, D, E, and
    K. But these benefits must be considered next to
    its many adverse effects on health. A teenager
    who indulges in a fat-heavy diet is going to put
    on weight, even if he's active.

32
  • Dietary fat contains varying proportions of three
    types
  • Monounsaturated fat the healthiest kind found
    in olives and olive oil peanuts, peanut oil and
    peanut butter cashews walnuts and walnut oil,
    and canola oil.
  • Polyunsaturated fat found in corn oil, safflower
    oil, sunflower oil, soybean oil, cottonseed oil,
    and sesame-seed oil.
  • Saturated fat is the most cholesterol laden of
    the three found in meat and dairy products like
    beef, pork, lamb, butter, cheese, cream, egg
    yolks, coconut oil, and palm oil.

33
  • Vitamins and Minerals
  • Adolescents tend to most often fall short of
    their daily quotas of calcium, iron, zinc, and
    vitamin D.
  • Unless blood tests and a pediatrician's
    evaluation reveal a specific deficiency, it's
    preferable to obtain nutrients from food instead
    of from dietary supplements.

34
SEXUAL EDUCATION
  • Adolescent girls should be at the heart of a
    life course approacha young adolescent girl is
    still a child, but often she will soon become a
    mother. Adolescent pregnancy is associated with
    higher risk of maternal mortality and morbidity,
    stillbirths, neonatal deaths, preterm births, and
    low birth weight. In addition to actions to
    prevent adolescent pregnancy and encourage
    pregnancy spacing, efforts are required to ensure
    that pregnant and lactating teenage mothers are
    adequately nourished.

35
  • Psychological and social aspects of adolescents
    development are less often described in
    connection with adolescent health than their
    physical growth and maturation characteristics.
  • Girls aged between 12-14 years are more likely to
    be talked or forced into having unplanned and
    unprotected sex giving way to teenage
    pregnancies. About two thirds of teen pregnancies
    occur in girls aged between 18-19 years.

36
CERVICAL CANCER VACCINATION
  • Cervical cancer is one of the most common cancers
    in females in our country. The main causative
    agent for most these cancers are due to HPV. It
    is a cancer which affects the females of later
    age group. Primary prevention for this cancer is
    possible through the HPV vaccine. Young girls in
    the age group of 11-13 are advised to take this
    vaccine in order to protect them from cervical
    cancer at later age.

37
  • One can get HPV from sexual contact, including
    vaginal, oral, and anal sex. Most people infected
    with HPV don't know they have it because they
    don't notice any signs or problems. People do not
    always develop genital warts, but the virus
    is still in their system and it could be causing
    damage. This means that people with HPV can pass
    the infection to others without knowing it.
  • Because HPV can cause problems like genital warts
    and some kinds of cancer, a vaccine is an
    important step in preventing infection and
    protecting against the spread of HPV.

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END NOTE
  • The health and nutrition statuses of women and
    children are intimately linked. Improving the
    health of women and children, therefore, begins
    with ensuring the health and nutritional status
    of women throughout all stages of life, and it
    continues with women being providers for their
    children and families.

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