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Common Women's Conditions

Heart Disease

Heart disease and women

Mention the term "heart attack" and most people imagine a pudgy, middle-aged man drenched in sweat and clutching his chest. Few people seem to consider cardiovascular disease (CVD) as a woman's disease.

But according to the American Heart Association, cardiovascular disease is the leading killer of women over age 25. It kills nearly twice as many women in the United States than all types of cancer, including breast cancer. Only 13 percent of women think heart disease is a threat to their health.

The misleading notion that heart disease is not a real problem for women can be blamed in part on medical research. For a very long time, heart disease studies have focused primarily on men. Changes are under way, but some doctors still fail to recognize the warning signs displayed by female patients.

EARLY HEART SIGNS

Studies have shown that women have undiagnosed warning signs weeks, months, and even years before having a heart attack.

Significant differences exist in the symptoms displayed by women and men. Men typically experience the "classic" heart attack signs: tightness in the chest, arm pain, and shortness of breath. Women's symptoms -- nausea, an overwhelming fatigue, and dizziness -- are strikingly different and are often chalked up to stress. Women have reported that they have had a hard time getting their doctors to listen to them about these early warning symptoms.

Unusual fatigue, trouble sleeping, shortness of breath, indigestion, and anxiety were the top 5 symptoms reported by both black and white women in the study. However, black women had more intense episodes and reported them more often.

ACT IN TIME

Recognizing and treating a heart attack right away dramatically improves a patient's chance for survival. The typical American, however, waits 2 hours before calling for help.

Studies have shown that drugs that dissolve coronary blood clots during a heart attack can reduce the death rate in both men and women, although women have a higher risk of stroke from the therapy. Unfortunately, statistics show that a woman in the midst of having a heart attack receives clot-busting therapy much later than a man would.

Women coming into the hospital for a heart attack have a higher death rate and higher risk of complications. A premenopausal woman having a heart attack has twice the death rate of a similarly aged man, according to experts.

Know the warning signs and always call 911 within 5 minutes of the onset of symptoms. By acting quickly, a heart attack victim is less likely to experience cardiac arrest (where the heart stops beating).

PREVENTION TIED TO BELIEF

There is no denying that an ounce of prevention is worth a pound of cure. But preventing a disease means believing you are actually at risk -- and many women fail to see that.

Women are advised to take charge of their health by working with their doctor to address risk factors, and keep tabs on cholesterol levels, blood pressure, and lifestyle.

According to the American Heart Association, low blood levels of "good" cholesterol (high density lipoprotein, or HDL) are a stronger predictor of heart disease death in women than in men. Also, a major study showed that post-menopausal women taking hormone replacement therapy have an increased risk of heart attack and death by coronary artery disease.

WOMEN & HEART DISEASE

  • Cardiovascular disease kills about one woman a minute.
  • Sixty-four percent of women who die suddenly of heart disease have no previous symptoms.
  • More women than men will die within the first year after a heart attack
  • The rates of women who die from cardiovascular disease are much higher than those who die from breast cancer.

Source: American Heart Association/Go Red For Women

The American Heart Association has published guidelines regarding prevention of cardiovascular disease in women. Women are categorized based on their likelihood of experiencing a cardiovascular event (heart attack, stroke, death) in the next 10 years:

  • High risk -- the woman has a greater than 20% chance of an event in next 10 years. Examples of women at high risk include those with have a history of stroke, heart disease, vascular disease in legs, abdominal aortic aneurysm (AAA), diabetes, and chronic kidney disease.
  • Intermediate risk -- the woman has a 10 - 20% chance of event in next 10 years. Examples of women at intermediate risk include those with calcium in coronary arteries, metabolic syndrome, multiple heart risk factors, and women with family history of early heart disease.
  • Lower risk -- the woman has less than a 10% chance of event in next 10 years. Women at the lowest risk have none of the above-mentioned conditions and one or less risk factors for heart disease.

The guidelines recommend the following lifestyle changes:

  • Do not smoke or use tobacco.
  • Maintain a healthy weight. Women who need to lose or keep off weight should get at least 60 - 90 minutes of moderate-intensity exercise on most days. To maintain your weight, get at least 30 minutes of exercise a day, preferably at least 5 days a week.
  • Women who recently had a heart attack, angina, angioplasty, or a stent procedure should join a cardiac rehabilitation program.
  • Eat a heart healthy diet. The diet includes a variety of fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, and sources of protein low in saturated fat.
  • Watch your weight. Women should strive for a body mass index (BMI) between 18.5 and 24.9 and a waist smaller than 35 inches.
  • Get checked and treatment, if necessary, for depression.
  • High-risk women should take omega-3 fatty acids supplements.
  • Folic acid supplements may be considered in some high-risk women if a higher than normal level of homocysteine has been detected. (These should not be taken after coronary revascularization.)

TREATMENT RECOMMENDATIONS FOR WOMEN

Keep blood pressure under 120/80 mm Hg. Blood pressure drugs should be used when blood pressure is higher than 140/90 mm Hg. (Persons with diabetes may need medication at lower levels.)

Keep cholesterol levels under control:

  • LDL should be under 100 mg/dL
  • HDL should be greater than 50 mg/dL
  • Triglycerides should be less than 150 mg/dL

Depending on a woman's level of risk (low, intermediate, high), dietary changes and medicines may be needed to control cholesterol levels.

New guidelines no longer recommend hormone replacement therapy, antioxidant supplements, or folic acid to prevent heart disease in women.

Aspirin therapy (dose 75 mg to 325 mg a day) or a drug called clopidogrel may be prescribed for women at high risk for heart disease. Aspirin therapy is recommended for women over age 65 to prevent heart attack and stroke as long as blood pressure is controlled and the benefit is likely to outweigh the risk of gastrointestinal side effects. Regular use of aspirin is not recommended for healthy women under age 65 to prevent heart attacks.

Beta blockers should be used in all women with a history of heart attack or who have chronic heart disease, unless there is a medical reason not to.

ACE inhibitors should be used in high-risk women unless there is a medical reason not to.

Angiotensin receptor blockers should be used in women with heart failure or an ejection fraction less than 40% in whom ACE inhibitors did not work.

See also:

  • Atrial fibrillation
  • Diabetes
  • Stroke

References

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

 

Review Date: 2/20/2007
Reviewed By: Updated by A.D.A.M. Editorial Team: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by Alan Berger, MD, Assistant Professor, Divisions of Cardiology and Epidemiology, University of Minnesota, Minneapolis, MN. Review provided byVeriMed Healthcare Network. (2006)
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

OB/GYN Disorders

Vaginal discharge


Vaginal discharge refers to secretions from the vagina. Such discharge can vary in:

  • Consistency (thick, pasty, thin)
  • Color (clear, cloudy)
  • Smell (normal, odorless, bad odor)

Alternative Names


Discharge from the vagina

Considerations


Having some amount of vaginal discharge is normal, especially if you are of childbearing age. Glands in the cervix produce a clear mucus. These secretions may turn white or yellow when exposed to the air. These are normal variations.

The amount of mucus produced by the cervical glands varies throughout the menstrual cycle. This is normal and depends on the amount of estrogen circulating in your body.

Vaginal discharge that suddenly differs in color, odor, or consistency, or significantly increases or decreases in amount, may indicate an underlying problem like an infection.

Causes


The following situations can increase the amount of normal vaginal discharge:

  • Emotional stress
  • Ovulation (the production and release of an egg from your ovary in the middle of your menstrual cycle)
  • Sexual excitement

These conditions can lead to abnormal vaginal discharge:

  • Bacterial vaginosis (BV) -- Bacteria that normally live in the vagina overgrow, causing a grey discharge and fishy odor that worsen after sexual intercourse. BV is not sexually transmitted.
  • Cervical or vaginal cancer (rarely a cause of excess discharge)
  • Chlamydia
  • Forgotten tampon or foreign body
  • Gonorrhea
  • Other infections and sexually transmitted diseases
  • Trichomonas
  • Vaginal yeast infection

Home Care


To help prevent and treat vaginal discharge:

  • Keep your genital area clean and dry.
  • Avoid douching. While many women feel cleaner if they douche after menstruation or intercourse, it may actually worsen vaginal discharge because it removes healthy bacteria lining the vagina that are there to protect you from infection.
  • Use an over-the-counter cream or vaginal suppository, IF you know that you have a yeast infection.
  • Try to reduce stress.
  • Eat yogurt with live cultures or take Lactobacillus acidophilus tablets when on antibiotics to avoid a yeast infection.
  • Use condoms to avoid catching or spreading sexually transmitted diseases.
  • Keep your blood sugars under good control if you have diabetes.

If the discharge is caused by a sexually transmitted disease, your sexual partner (or partners) must be treated as well, even if they have no symptoms. Failure of partners to accept treatment can cause continual reinfection which may lead to a serious problem like infertility.

When to Contact a Medical Professional


Call your doctor right away if:

  • Your discharge is associated with fever or pain in your pelvis or abdomen.
  • You have been exposed to a sexual partner with gonorrhea, chlamydia, or other sexually transmitted disease.
  • You have increased thirst or appetite, unexplained weight loss, increased urinary frequency, or fatigue -- these may be signs of diabetes.

Also call if:

  • A child who has not reached puberty has vaginal discharge.
  • You think that your discharge may be related to a medication.
  • You are concerned that you may have a sexually transmitted disease or you are unsure of possible exposure.
  • Your symptoms worsen or last longer than 1 week despite home care measures.
  • You have blisters or other lesions on your vagina or vulva (exterior genitalia).
  • You have burning with urination or other urinary symptoms -- you may have a urinary tract infection.

What to Expect at Your Office Visit


Your doctor will take a medical history and perform a physical examination including a pelvic exam.

Medical history questions may include:

  • When did the changed or abnormal vaginal discharge begin?
  • Do you have the same amount and type of vaginal discharge throughout the month?
  • What does the discharge look like (color and consistency)?
  • Is there an odor?
  • Do you have pain, itching, or burning?
  • Does your sexual partner have a discharge as well?
  • Do you have multiple sexual partners or sexual partners that you do not know very well?
  • What type of birth control do you use?
  • Do you use condoms?
  • Is there anything that relieves the discharge?
  • Have you tried over-the-counter creams? Have they helped?
  • Do you douche? What kind of douche do you use?
  • Do you have any other symptoms like abdominal pain, vaginal itching, fever, vaginal bleeding, rash, genital warts or lesions, or changes in urination like difficulty, pain, or blood?
  • What medications do you take?
  • Do you have any allergies?
  • Have you recently changed the detergents or soaps that you use?
  • Do you frequently wear very tight clothing?
  • When was your last Pap smear? Have you ever had an abnormal Pap smear?

Diagnostic tests that may be performed include:

  • Cultures of your cervix.
  • Examination of vaginal discharge under the microscope.
  • A Pap smear.

Treatment depends on the underlying condition. Suppositories or creams may be ordered and antibiotics may be prescribed. Oral medication for fungus or Trichomonas may be used in difficult cases. Your sexual partner(s) may also need treatment.

References


Anderson M, Karasz A, Friedland S. Are vaginal symptoms ever normal? A review of the literature. MedGenMed. 2004; 6(4): 49.

Melville C, Nandwani R, Bigrigg A, McMahon AD. A comparative study of clinical management strategies for vaginal discharge in family planning and genitourinary medicine settings. J Fam Plann Reprod Health Care. 2005; 31(1): 26-30.

French L, Horton J, Matousek M. Abnormal vaginal discharge: what does and does not work in treating underlying causes. J Fam Pract. 2004; 53(11): 890-894.

 

Review Date: 8/17/2007
Reviewed By: Melanie N. Smith, M.D., Ph.D., Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Osteoporosis

Osteoporosis


Osteoporosis is the thinning of bone tissue and loss of bone density over time.

Alternative Names


Thin bones

Causes


Osteoporosis is the most common type of bone disease. An estimated 10 million Americans have osteoporosis, as well as another 18 million who have low bone mass, or osteopenia, which may eventually lead to osteoporosis if not treated.

Researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will suffer a fracture of the hip, wrist, or vertebra (bones of the spine).

Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both.

Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

As you age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. This can result in brittle, fragile bones that are more prone to fractures, even without injury.

Usually, the loss occurs gradually over years. Many times, a person will have a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and damage is severe.

The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women, especially those over the age of 50, get osteoporosis more often than men.

Other causes include:

  • Being confined to a bed
  • Bone cancer
  • Cushing syndrome
  • Excess corticosteroid levels due to on-going use of medicines for asthma, certain forms of arthritis or skin diseases, and COPD.
  • Hyperthyroidism
  • Hyperparathyroidism

White women, especially those with a family history of osteoporosis, have a greater-than-average risk of developing osteoporosis. Other risk factors include:

  • Absence of menstrual periods (amenorrhea)
  • Drinking large amount of alcohol
  • Early menopause
  • Eating disorders
  • Low body weight
  • Smoking
  • Too little calcium in the diet
  • Use of certain medications, including steroids and antiseizure drugs

Symptoms


There are no symptoms in the early stages of the disease.

Symptoms occurring late in the disease include:

  • Bone pain or tenderness
  • Fractures of the wrists or hips (usually the first sign)
  • Loss of height over time
  • Low back pain due to fractures of the spinal bones
  • Neck pain due to fractures of the spinal bones
  • Stooped posture

Exams and Tests


Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. This test has become the gold standard for osteoporosis evaluation. For specific information on such testing, see bone density test.

A spine CT can show loss of bone mineral density. Quantitative computed tomography (QCT) can evaluate bone density, but is not as available and is more expensive than a DEXA scan.

In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones. However, Simple x-rays of bones are not very accurate in predicting who is more likely to have osteoporosis.

A urinary calcium test can provide some evidence of increased bone turnover, but is of limited value. A number of newer tests to evaluate bone turnover are becoming available. Ask your health care provider which test is best for you.

Treatment


The goals of osteoporosis treatment are to:

  • Control pain associated with the disease
  • Slow down or stop bone loss
  • Prevent bone fractures by minimizing the risk of falls

There are several different treatments for osteoporosis, including a variety of medications.

BISPHOSPHONATES

Bisphosphonates are a type of drug used for both the prevention and treatment of osteoporosis in postmenopausal women. Several bisphosphonates are approved for the treatment of osteoporosis in the United States. Most are taken by mouth, usually once a day or less. For example, some may be taken once a week.

While side effects are generally mild, potential side effects include stomach upset and irritation of the esophagus. Because bisphosphonates are difficult to absorb, these medicines should be taken on an empty stomach. You should not lie down or consume food or beverages (other than water) for at least 30 minutes after taking the medicine. Your doctor may also recommend taking calcium and vitamin D supplements.

CALCITONIN

Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection. The main side effects are nasal irritation from the spray form and nausea from the injectable form.

While calcitonin slows bone loss and reduces the risk of fractures, it appears to be less effective than bisphosphonates.

HORMONE REPLACEMENT THERAPY

Reduced estrogen levels during and after menopause may affect a woman's bone strength. Based on early studies, many physicians used to believe that hormone replacement therapy (HRT) might be help reduce the risk for bone fractures caused by osteoporosis in addition to treating menopausal symptoms and reducing the risk for heart disease. However, the Women's Health Initiative (WHI) led health care providers to revise their recommendations regarding HRT.

The WHI study showed that women taking HRT had 34% fewer hip fractures and 24% fewer fractures than women not receiving hormones. However, women who took estrogen with or without the hormone progesterone for 5 or more years had an increased risk for stroke, heart disease, breast cancer, and blood clots.

Estrogens are still used to prevent osteoporosis but are not approved to treat a woman who has already been diagnosed with the condition. If you are considering taking HRT to prevent osteoporosis, discuss the risks with your doctor.

PARATHYROID HORMONE

Teriparatide (Forteo) is approved in the United States for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures. The medicine is given through daily shots underneath the skin. You can give yourself the shots at home.

RALOXIFENE

Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. However, it does not appear to prevent other fractures, including those in the hip. It may have protective effects against heart disease and breast cancer, though more studies are needed.

The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

EXERCISE

Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Some of the recommended exercises include:

  • Weight-bearing exercises -- walking, jogging, playing tennis, dancing
  • Resistance exercises -- free weights, weight machines, stretch bands
  • Balancing exercises -- tai chi, yoga
  • Riding stationary bicycles
  • Using rowing machines
  • Walking
  • Jogging

Any exercise that presents a risk of falling should be avoided!

DIET

You should follow a diet that provides the proper amount of calcium, vitamin D, and protein. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available.

High-calcium foods include low-fat milk, yogurt, ice cream, cheese, tofu, salmon, sardines (with the bones), and leafy green vegetables, such as spinach and collard greens.

Your doctor may recommend calcium and vitamin D supplements. Vitamin D helps your body absorb calcium. Ask your doctor what dose is best for you.

STOP UNHEALTHY HABITS

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

PREVENT FALLS

It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good. Other ways to prevent falling include wearing well-fitting shoes, avoiding walking alone on icy days, and using bars in the bathtub, when needed.

MONITORING

Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1-2 years. However, such monitoring is controversial and expensive.

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

RELATED SURGERIES

There are no surgeries for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebra from becoming fractured by strengthening the bones in your spinal column.

The procedure involves injecting a fast-hardening glue into the areas that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

Outlook (Prognosis)


Some persons with osteoporosis become severely disabled as a result of weakened bones. Hip fractures leave about half of patients unable to walk independently. This is one of the major reasons people are admitted to nursing homes.

Although osteoporosis is debilitating, it does not affect life expectancy.

Possible Complications


  • Compression fractures of the spine
  • Hip and wrist fractures
  • Disability caused by severely weakened bones
  • Loss of ability to walk due to hip fractures

When to Contact a Medical Professional


Call your health care provider if you have symptoms of osteoporosis or if you wish to be screened for the condition.

Prevention


Calcium is essential for building and maintaining healthy bone. Vitamin D is also needed because it helps your body absorb calcium. Following a healthy, well-balanced diet can help you get these and other important nutrients throughout life.

Other tips for prevention:

  • Don't smoke
  • Avoid drinking excess alcohol
  • Get regular exercise

A number of medications are approved for the prevention of osteoporosis.

References


Cranney A, Papaioannou A, Zytaruk N, et al. Clinical Guidelines Committee of Osteoporosis Canada. Parathyroid hormone for the treatment of osteoporosis: a systematic review. CMAJ. 2006 Jul 4;175(1):52-9.

Gass M, Dawson-Hughes B. Preventing osteoporosis-related fractures: an overview. Am J Med. 2006 Apr;119(4 Suppl 1):S3-S11. Review.

Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause. 2006 May-Jun;13(3):340-67.

Poole KE, Compston JE. Osteoporosis and its management.BMJ. 2006 Dec 16;333(7581):1251-6. Review.

 

Review Date: 10/30/2007
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Depression

Depression


Definition


Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of time.

See also:

  • Adolescent depression
  • Depression in the elderly

Alternative Names


Blues; Discouragement; Gloom; Mood changes; Sadness; Melancholy

Considerations


Depression is generally ranked in terms of severity -- mild, moderate, or severe. The degree of your depression, which your doctor can determine, influences how you are treated. Symptoms of depression include:

  • Trouble sleeping or excessive sleeping
  • A dramatic change in appetite, often with weight gain or loss
  • Fatigue and lack of energy
  • Feelings of worthlessness, self-hate, and inappropriate guilt
  • Extreme difficulty concentrating
  • Agitation, restlessness, and irritability
  • Inactivity and withdrawal from usual activities
  • Feelings of hopelessness and helplessness
  • Recurring thoughts of death or suicide

Low self esteem is common with depression. So are sudden bursts of anger and lack of pleasure from activities that normally make you happy, including sex.

Depressed children may not have the classic symptoms of adult depression. Watch especially for changes in school performance, sleep, and behavior. If you wonder whether your child might be depressed, it's worth bringing to a doctor's attention.

The main types of depression include:

  • Major depression -- five or more symptoms listed above must be present for at least 2 weeks, but major depression tends to continue for at least 6 months. (Depression is classified as minor depression if you have fewer than five depression symptoms for at least 2 weeks. In other words, minor depression is similar to major depression except it only has 2 - 4 symptoms.)
  • Atypical depression -- occurs in about a third of patients with depression. Symptoms include overeating and oversleeping. These patients tend to have a feeling of being weighed down and react strongly to rejection.
  • Dysthymia -- a generally milder form of depression that lasts as long as two years.

Other common forms of depression include:

  • Postpartum depression -- many women feel somewhat down after having a baby, but true postpartum depression is rare.
  • Premenstrual dysphoric disorder (PMDD) -- depressive symptoms occur one week prior to menstruation and disappear after you menstruate.
  • Seasonal affective disorder (SAD) -- occurs during the fall-winter season and disappears during the spring-summer season. Likely to be due to lack of sunlight.

Depression may also occur with mania (known as manic-depression or bipolar disorder). In this condition, moods cycle between mania and depression.

Depression is more common in women than men and is especially common during the teen years. Men seem to seek help for feelings of depression less often than women. Therefore, women may only have more documented cases of depression.

Causes


Depression often runs in families. This may due to your genes (inherited), learned behavior, or both. Even if your genes make you more likely to develop depression, a stressful or unhappy life event usually triggers the onset of a depressive episode.

Depression may be brought on by:

  • Alcohol or drug abuse
  • Childhood events like abuse or neglect
  • Chronic stress
  • Death of a friend or relative
  • Disappointment at home, work, or school (in teens, this may be breaking up with a boyfriend or girlfriend, failing a class, or parents divorcing)
  • Drugs such as sedatives and high blood pressure medications
  • Medical conditions such as hypothyroidism (underactive thyroid), cancer, or hepatitis
  • Nutritional deficiencies (such as a lack of folate and omega-3 fatty acids)
  • Overly negative thoughts about one's self and life, self blame, and ineffective social problem solving skills
  • Prolonged pain or having a major illness
  • Sleeping problems
  • Social isolation (common in the elderly)

Home Care


If you are depressed for 2 weeks or longer, you should contact your doctor, who can offer treatment options. Regardless of whether you have mild or major depression, the following self-care steps can help:

  • Get enough sleep.
  • Follow a healthy, nutritious diet.
  • Exercise regularly.
  • Avoid alcohol, marijuana, and other recreational drugs.
  • Get involved in activities that make you happy, even if you don't feel like it.
  • Spend time with family and friends.
  • Try talking to clergy or spiritual advisors who may help give meaning to painful experiences.
  • Consider prayer, meditation, tai chi, or biofeedback as ways to relax or draw on your inner strengths.
  • Add omega-3 fatty acids to your diet, which you can get from cold-water fish like tuna, salmon, or mackerel.
  • Take folate (vitamin B9) in the form of a multivitamin (400 to 800 micrograms).

If your depression occurs in the fall or winter months, try light therapy using a special lamp that mimics the sun.

Many people try a popular over-the-counter herb called St. John's wort. Some studies do suggest that this herbal remedy may be helpful for mild depression, but not moderate or severe. Be aware that St. John's wort has potential drug interactions and should NOT be taken with prescription antidepressants, birth control pills, protease inhibitors for HIV, theophylline, warfarin, digoxin, reserpine, cyclosporine, or loperamide. Talk to your doctor if you are thinking about trying this herb for mild depression.

If you have moderate to severe depression, the most effective treatment plan will likely be a combination of counseling and medication.

When to Contact a Medical Professional

Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others.

Call your doctor right away if:

  • You hear voices that are not there
  • You have frequent crying spells with little or no provocation
  • You have had feelings of depression that disrupt work, school, or family life for longer than 2 weeks
  • You have 3 or more depressive symptoms
  • You think that one of your current medications may be making you feel depressed -- DO NOT change or stop any medications without consulting your doctor
  • You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning

What to Expect at Your Office Visit

A complete history, a psychiatric interview, and a physical examination will be performed to try to classify your depression as mild, moderate, or severe and to see if there is an underlying, treatable cause (such as alcohol abuse or an underactive thyroid). Hospitalization is usually recommended if suicide seems possible.

Expect some exploration of the issues and events associated with your feelings of depression. Your doctor will ask you about:

  • Your depressive moods and other symptoms (sleep, appetite, concentration, energy)
  • Possible stressors in your life, and support systems in place
  • Whether thoughts about ending your life have ever crossed your mind
  • Drug and alcohol use, and about the medications you are currently taking, if any

Treatment will vary according to the cause and severity of your depressive symptoms, as well as your personal preference. The most effective therapy for moderate or severe depression is a combination of antidepressant medication and psychotherapy.

For mild depression, counseling and self-care measures without medication may be enough.

If you are taking medications for other purposes that could cause depression as a side effect, these may need to be changed. DO NOT change or stop any of your medications without consulting your doctor.

For people who are so severely depressed as to be unable to function, or who are suicidal and cannot be safely cared for in the community, psychiatric hospitalization may be necessary.

Prevention


Healthy lifestyle habits can help prevent depression, or lessen the chances of it happening again. These habits include eating properly, sleeping adequately, exercising regularly, learning to relax, and not drinking alcohol or using drugs.

Counseling may help you through times of grief, stress, or low mood. Family therapy may be particularly important for teens who feel blue.

If you feel socially isolated or lonely, try volunteering or getting involved in group activities.

References


Moore D, Jefferson J. Major Depressive Disorder. In: Handbook of Medical Psychiatry. 2nd ed. Mosby, Inc., 2004; 134-141.

Screening for Depression Recommendations and Rationale. US Preventive Services Task Force, Guidelines from Guide to Clinical Preventive Services: 3rd ed. Rockville, Md. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; May 1, 2002.

World Health Organization. The World Health Report 2001 - Mental Health: New Understanding, New Hope. Geneva World Health Organization, 2001.

Guide to Clinical Preventive Services: Screening for Depression, Recommendations and Rationale. Rockville, Md. US Preventive Services Task Force, Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. Ann Intern Med. 2002; 136(10): 760–764.

Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd ed. Arlington, VA: American Psychiatric Association; 2000.

Review Date: 1/28/2008
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz, Kelli A. Stacy, ELS. Benjamin W. Van Voorhees, MD, MPH, Assistant Professor of Medicine, Pediatrics and Psychiatry, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network (5/17/2007).
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Breast Biopsy

Breast biopsy


A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders.

Alternative Names


Biopsy

- breast

How the Test is Performed


Breast tissue samples may be obtained by a needle biopsy or open biopsy. The sample may consist of connective tissue, fat lobules, or milk ducts.

If the area of interest cannot be felt or is difficult to find, x-ray or ultrasound imaging may be used to help locate it. For an imaging-guided needle biopsy, imaging is used at the same time as the biopsy. For an open biopsy that requires imaging, the area of interest is marked with a needle or wire prior to surgery.

NEEDLE BIOPSY

The injection site is cleaned, then injected with a local anesthetic. Fluid or cells may be removed with a needle attached to a syringe (fine needle aspiration), but removal of a piece of tissue requires a special needle apparatus. Several samples may be taken from the same area. When imaging is used, a small metal clip may be placed into the breast in the area of the biopsy to mark it for future mammograms.

Once the tissue sample has been taken, the needle is removed, and pressure is applied to the site to stop any bleeding. A bandage will be applied to absorb any fluid.

OPEN BIOPSY

An open biopsy may remove part (incisional biopsy) or all (excisional biopsy) of the area of interest. If the entire lump or area of interest is removed, this method may also be called a lumpectomy.

Usually, you lie on your back for the procedure. Depending on the patient and the size of the lump, choices of anesthesia include local anesthesia, local anesthesia with sedation, or general anesthesia. An incision is made and breast tissue removed. Sometimes, testing is done for a preliminary diagnosis at the time of the procedure, but obtaining a final diagnosis requires more time.

After the tissue sample is taken, the incision is sutured, and a dressing and bandage are applied.

If general anesthesia is administered, vital signs (temperature, pulse, rate of breathing, blood pressure) will be monitored for at least an hour after completion of the procedure. Pain medication may be prescribed.

How to Prepare for the Test


  • Your medical history will be taken, and a manual breast exam performed.
  • An informed consent form must be signed. If you are going to have general anesthesia, you may be asked to fast for 8 to 12 hours before the test.
  • If you take medications (including aspirin or herbals), ask your doctor whether to discontinue these before the biopsy.

How the Test Will Feel


There may be a sharp, stinging sensation when the local anesthetic is administered. During the procedure, you may feel slight discomfort or light pressure.

After the test, the breast may be sore and tender to the touch for several days. If an incision is made, pain medication will probably be prescribed. For needle biopsy, over-the-counter pain medication should be adequate.

Why the Test is Performed


A biopsy is the only way to determine if tissue is benign (non-cancerous) or malignant (cancerous).

Normal Results


A normal result means there is no sign of cancer.

What Abnormal Results Mean


Benign tumors include:

  • Adenofibroma
  • Fibrocystic breast disease
  • Intraductal papilloma
  • Mammary fat necrosis
  • Mastitis
Cancerous tumors include:
  • Adenocarcinoma
  • Colloid carcinoma
  • Cystosarcoma
  • Infiltrating carcinoma
  • Inflammatory carcinoma
  • Intraductal carcinoma
  • Lobular carcinoma
  • Medullary or circumscribed carcinoma
  • Sarcoma

Ask your doctor about your specific condition and how it applies to you.

Risks


  • There is a slight chance of infection at the injection or incision site.
  • Excessive bleeding is rare, but may require draining or re-bandaging. Bruising is common.
  • There will be a scar. Depending on the amount of tissue removed and how the breast heals, the appearance of the breast may be affected.
  • Depending on the results of the biopsy, further surgery or treatment may be needed.

Considerations


Most breast lumps are detected during a manual breast exam or mammography. A discharge from the nipple may indicate the presence of a cancerous tumor. Even if the biopsy results are benign, discuss ongoing breast screening with your doctor.

References


Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004.

Whitman GJ. Ultrasound-guided breast biopsies. Ultrasound Clin. Dec 2006; 1(4); 603-615.

 

Review Date: 7/25/2007
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Mammogram

Mammography


A mammogram is an x-ray picture of the breasts. It is used to find tumors and to help tell the difference between non-cancerous (benign) and cancerous (malignant) disease.

Alternative Names


Mammogram

How the Test is Performed


You will be asked to undress from the waist up and will be given a gown to wear. Depending on the type of equipment used, you will sit or stand.

One breast at a time is rested on a flat surface that contains the x-ray plate. A device called a compressor will be pressed firmly against the breast to help flatten out the breast tissue.

The x-ray pictures are taken from several angles. You may be asked to hold your breath as each picture is taken.

Digital mammography is a recent technique that allows the x-ray image of the breast to be viewed and manipulated on a computer screen. It improves accuracy a little bit, but is not yet performed everywhere.

How to Prepare for the Test


Do not wear deodorant, perfume, powders, or ointments under the arms or on the breasts on the day of the mammogram. These substances may obscure the images. Remove all jewelry from your neck and chest area.

Notify your health care provider and the radiologist if you are pregnant or breastfeeding.

How the Test Will Feel


When the breast is compressed, there may be some discomfort.

Why the Test is Performed


Mammography is performed to screen healthy women for signs of breast cancer. It is also used to evaluate a woman who has symptoms of a breast disease, such as a lump, nipple discharge, breast pain, dimpling of the skin on the breast, or retraction of the nipple.

Screening mammograms are important for early breast cancer detection. The American Cancer Society recommends mammogram screening every year for all women age 40 and older. The National Cancer Institute recommends mammogram screening every 1 to 2 years for women age 40 and older. Experts recommend that certain women at high risk of breast cancer should also have a breast MRI along with their yearly mammogram. Ask your doctor if you need an MRI.

Guidelines from the American College of Physicians, however, debate whether women with a low risk for breast cancer should begin mammogram screening at age 40. The 2007 guidelines, instead, recommend that women in their 40s ask their doctor when they should begin having the test.

In addition to mammography, clinical breast exams (where the clinician palpates with the fingers) and monthly breast self-examinations are important for breast cancer screening. Women age 20 and older should receive clinical breast exams every 3 years; women age 40 and older should receive clinical breast exams every year. The American Cancer Society recommends that all women age 20 and older perform monthly breast self-examination.

These are general recommendations for mammography, clinical breast exams, and breast self-exam. Women should discuss with their personal physician how often to receive breast cancer screening, including mammography and clinical breast exam. Recommendations vary depending on personal risk factors such a strong family history of breast cancer.

Normal Results


Breast tissue that shows no evidence of mass (aggregations of cells) or calcification is considered normal.

What Abnormal Results Mean


A well-outlined, regular, clear spot is more likely to be a non-cancerous lesion such as a cyst.

A poorly outlined, cloudy area is more likely to suggest breast cancer (a cancerous lesion). However, not all breast cancers are perfectly round, and some cancers may appear well-defined.

Sometimes, the doctor will use ultrasound to further examine the problem and determine the next best step. When findings from a mammogram or ultrasound look suspicious, a biopsy is performed to determine if it a cancerous or non-cancerous condition.

Conditions under which a biopsy may be performed include:

  • Breast cancer
  • Breast infection
  • Fibrocystic breast disease
  • Lumps in the breasts
  • Breast pain
  • Nipple discharge

Risks


The level of radiation is low and any risk from mammography is exceedingly low. If you are pregnant and need to have an abnormality checked, the abdominal area will be shielded by a lead apron.

Considerations


Mammography is important because it can, in some cases, detect breast cancers before you can feel them with your fingers.

References


Smith RA, Salsow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: Update 2003. CA Cancer J Clin. 2003;53(3):141-169.

Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89.

Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently iagnosed breast cancer. N Engl J Med. 2007 Mar 29;356(13):1295-303. Epub 2007 Mar 28.

Qaseem A, Snow V, Sherif K, et al. Screening mammography for women 40 to 49 years of age: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146(7):511-515.

 

Review Date: 10/17/2007
Reviewed By: Benjamin Taragin, M.D., Department of Radiology, Columbia Presbyterian Medical Center, New York, NY. Review Provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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