On average, women tend to be better about seeking medical attention than men when they don't feel well -- but there is still a segment of the female population that still only schedules an annual trip to the gynecologist -- and if you're a part of that community, you may be missing out on other screenings, conversations and telltale signs that allow for early detection and intervention.

According to Dr. Sheena Antonio-Collie, so much historically has been done with the gynecological aspect to women's health that sometimes they tend to neglect everything else that could lead to disastrous results and potential problems later on.

The internal medicine specialist who spoke at a recent Doctors Hospital distinguished lecture series said that lasting health and wholeness are possible if women discover and practice behaviors that are associated with true health and wellness. She said, historically, women used to live shorter lives than men, up until about 50 years ago, and that there are many reasons postulated as to why women lived a lot less years than men. One of the reasons that has stood out to her is that once a woman completed her reproductive years, she simply dies, having completed her evolutionary purpose.

"I think that is why historically issues in women's health centered almost completely around reproductive life -- prenatal care, perinatal care, menopause. It was once believed that the uterus and the ovaries were the controlling organs -- the center of all diseases in women, as a result, women's health centered, and to some degree today, around the vagina and the breasts. But women are definitely more than vaginas and breasts," said the doctor.

According to Dr. Antonio-Collie, today's philosophy is a comprehensive approach, focusing on health and wellbeing throughout the life span, rather than just the absence of disease.

"This holistic model focuses on womanhood as the important variable in recognizing forces that impact on health to allow for a wellness approach," she said. "Today's women outlive men by more than six years statistically, which means that women live longer with chronic illnesses, so the burden of aging rests on women [who] are usually the primary caretakers for the elderly, primary caretakers for children, and often they are the primary decision makers when it comes to healthcare," she said.

Diseases specific to women

Some diseases or health issues that occur in women only include ovarian cancer and certain types of breast cancers. Some illnesses are common in both men and women, but they affect women differently. Even though disease symptoms may be similar, the affects of the condition and the necessary care can vary significantly for women.

"For example, breast cancer occurs disproportionately more in women, and although heart disease is the leading cause of death in both men and women, women are more likely to die after a heart attack than a man. And stroke occurs more in women than in men, largely because there are additional risk factors for stroke in women such as the use of birth control pills, pregnancy as well as migraines that could also lead to stroke," said the doctor.

"So women ought to have a heightened awareness of her health issues and give herself the opportunity to challenge these potential chronic diseases."

Specific screening for women

The internal medicine specialist said health screenings are one way women can challenge potential chronic diseases. Screenings should be age-appropriate and a woman and her physician should determine what screenings are necessary based on age, family history and social history.

Smokers, she said, should be tested earlier or have additional testing for heart disease. Those with a first-degree relative who has breast cancer would probably need to have mammograms done before age 35 because of a high prevalence of early breast cancer in women in The Bahamas.

As for cervical cancer, Dr. Antonio-Collie said Pap smears are still the hallmark; women should begin having their Pap smears done at age 21, and they should be done at least every three years. From the age of 30, she believes women should be tested for the human papilloma virus -- the virus medical practitioners think is largely responsible for cervical cancer. It's a test that she said should be done every five years.

Osteoporosis screening is done with a bone mineral density test; that test should begin at least by age 65 or earlier for post-menopausal women, those who have a family history of osteoporosis, have a low body weight or thin frame, if they smoke or are inactive, or if they drink too much alcohol.

Other screenings involve blood pressure checks that should be done a minimum of every two years for those women with normal blood pressure, annually if blood pressure is even slightly above normal. Cholesterol testing, she said, should start at age 21, and should happen every two years or annually if the person is high risk. She said everyone should have an HIV test done at least once in their lifetime if they are low risk, and more frequently for those who participate in high-risk behavior.

Dr. Antonio-Collie said colorectal screening should be done by age 50, and can be completed with a colonoscopy, which should be taken every seven to 10 years, or the fecal-occult blood testing, which should be done every two to three years. A person and his or her doctor should decide what form of screening would be appropriate, based on risk factors, family and social history as well.

Top 15 health concerns for women

A recent survey done in Florida, showed that the top 15 health concerns for women were premenstrual syndrome (PMS), endometriosis, polycystic ovarian syndrome (PCOS), fibroids, yeast infections, urinary tract infection (UTI), menopause, breast and cervical cancers, heart disease, osteoporosis, arthritis, obesity, metabolic syndrome, depression and autoimmune diseases (lupus).

"PMS is a condition which manifests with distressing physical behavioral and psychological symptoms in the absence of anything organic, or any underlying psychiatric disease and reoccurs regularly during the luteal phase or ovulation part of each menstrual cycle which disappears or significantly regresses by the end of the menstrual cycle.

Risk factors include high caffeine intake, alcohol abuse, stress, anxiety, history of depression, increasing age, being overweight, family history of the disease and dietary factors (low levels of certain vitamins and minerals).

Psychological symptoms include irritability, mood swings, depression, feeling out of control; behavioral symptoms include aggression, reduced cognitive abilities and forgetfulness, increase in accidents (reduced concentration); physical symptoms include fatigue, headaches, breast tenderness, bloating, pelvic pain, joint pain, acne, appetite changes and swelling.

She said that premenstrual dismorphic disorder (PMDD) is the more severe form of PMS and is actually considered to be a psychiatric illness at this time. Treatment includes changes lifestyle in diet, complementary therapy and certain antidepressants that can be discussed with the doctor.

Yeast infections the doctor said are caused by a fungus called candida, which is normally found in the vagina but in low amounts. Risk factors for getting a yeast infection the doctor said include birth control pills, use of vaginal spermicides, the use of steroids which influences the hormones in the body, the use of antibiotics which alters the microbiology of the vagina, tight clothing (such as pantyhose and bathing suits, as yeast love dark, warm, moist environments) as well as uncontrolled or undiagnosed diabetes.

Symptoms include a thick white cottage cheese discharge and itching in the vaginal as well as the perianal area. Treatment includes over the counter topical creams, or prescription oral medications.

Menopause

Menopause is diagnosed after having no period for 12 months, according to Dr. Antonio-Collie. She said hormonal changes and clinical symptoms occur over a period leading up to and immediately following menopause, and that is referred to as peri-menopause (which is now referred to as menopausal transition). As a result of the transition a wide range of symptoms she said can occur that can begin up to six years prior to the end of a woman's final period and can continue for a variable amount of years after your final period. The doctor said other issues could present -- some negative, some positive.

"Treatment includes hormone replacement therapy (HRT) as well as symptomatic relief. There are modalities that are new that can help with the relief of the most common symptoms, the hot flash. A new medication, Brisdelle is the only non-hormonal medication that is FDA [Food and Drug Administration] approved for the treatment of hot flashes. Other natural remedies have been used throughout the ages with benefits to some women," she said.

Heart disease

While heart disease is the number one cause of death in both men and women, and is usually due to coronary heart disease where there is a blockage in one of the arteries of the heart, there are two types of heart disease that have been recently found to affect women more than men. They are coronary micro-vascular disease (MVD), a problem that affects the very tiny arteries of the heart, and broken heart syndrome, which she said is a true syndrome and occurs when there is extreme stress, leading to severe, but often short term heart failure.

"All women ought to be concerned about heart disease and begin guarding their heart by engaging in healthy lifestyles including a heart healthy diet, exercise and healthy relationships."

The prevalence of obesity in The Bahamas is widespread, according to Dr. Antonio-Collie who said the numbers reach up to between 40 and 50 percent of the adult population.

"The World Fact Book recorded obesity prevalence in The Bahamas for adults at 34.7 percent in 2008."

She said the problem is the long-term co-morbidities that can occur with obesity including many diseases as well as disabilities.

"Women are especially prone to obesity involving the hips, the thighs, and the abdomen. What can initially be regarded as figure-enhancing voluptuousness can quickly turn into a path to sickness and disability. Treatment is generally tailored to your individual life including a comprehensive lifestyle management," she said.

The three tiers of treatment include lifestyle, medications and weight loss surgery.

Depression

While depression she said isn't discusses as frequently, the doctor said that it's very common in women, who are more prone to depression than men. The internal medicine specialist said that even the patterns and symptoms of depression are different in women than in men. Factors that increase the risk of depression in women include hormonal issues, social pressures and the female response to stress.
Signs and symptoms of depression, she said, are the same for both men and women, but women tend to experience some symptoms different.

"Women tend to have a higher incidence of what we call atypical depression, so instead of sleeping and eating less and losing weight, they tend to sleep more, eat more (especially carbohydrates) and gain weight. Women also have a higher incidence of thyroid disease, which can cause or mimic depression, therefore, every treatment or evaluation for depression should include a check of your thyroid."

Therapy for depression consists mainly of psychotherapy and anti-depressant medication, but will also include diet, exercise as well as relaxation techniques.

"Every woman is empowered with the choice for good health and has a right to heal herself at her own pace. Information is necessary for us to be able to take charge of our health, and we should do so because we generally want to take charge of everyone else's health, instead of looking at our own," she said.

Interesting facts about women's health
o The first feminine pad was introduced in by Kotex in 1921.
o The first disposable pad was introduced in 1933.
o The modern bra came into existence in 1914 in New York. Before that, women wore corsets.
o The first birth control pill was introduced in 1960.
o Mammograms were introduced in 1969.
o Plan B or emergency contraceptives, or what we call the morning after pill, was introduced in 1999, but it became over the counter in 2006.

Specific screening for women by age
o 18-39 -- breast cancer screening (mammogram) at least every two years; cervical cancer (Pap test) begin at age 21 and take at least every three years, HPV testing at age 30.
o 40-49 -- breast cancer screening at least every two years or annually if high risk; Pap and HPV testing every three to five years at least.
o 50-64 -- breast cancer screening at least every two years or annually if high risk; Pap and HIV testing every three to five years at least; discuss osteoporosis test with your doctor.
o Over 65: Discuss breast cancer screening with your doctor after age 75; discuss pap test with your doctor after age 70-75; begin osteoporosis screening at age 65 and take at least once.

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