WOMEN’S HEALTH AND

PREVENTIVE CARE
 PREVENTIVE HEALTH CARE

• Preventive health care aims to prevent disease from

occurring (primary prevention)
• Reduce progression of disease by identifying it before it
becomes symptomatic (secondary prevention)
• Decrease the impact of disease if it does occur (tertiary
prevention)
 PREVENTIVE HEALTH CARE

• Examples of preventive health care recommendations

➢ Daily aspirin use for adults with cardiovascular disease risk,
➢ Advising smokers to quit and offering assistance in quitting,
➢ Annual influenza vaccine for patients aged 50 years or
older,
➢ Colorectal cancer screening for adults aged 50 years or
older, and
➢ Breast cancer screening for women aged 40 years or older
PREVENTIVE HEALTH SERVICES BY
COMMUNITY PHARMACISTS
➢ EDUCATION
➢ SCREENING
➢ MAKING REFFERALS
➢ MEDICATIONS
➢ CONTRACEPTION
 HEALTHY BEHAVIORS

5 A’s (Ask, Advise, Assess, Assist, Arrange)

• Tobacco use (counseling and intervention)
• Alcohol misuse (screening and counseling)
• Healthy diet and physical activity (counseling)
• Intimate partner violence (screening)
• Sexually transmitted infections (counseling)
 HORMONAL CONTRACEPTION

• Pharmacists should be familiar with the different types of

hormonal contraceptives and their appropriate use,
including emergency contraception.
• Pharmacist should know when to refer the patient
 PREGNANCY AND
BREASTFEEDING
• Safety and appropriateness of medications during
pregnancy and breastfeeding
• Provide counseling to women who are pregnant or
breastfeeding.
 MENOPAUSE

• Management of symptoms
• Hormone replacement therapy
• Counseling
 WOMEN'S CANCERS

• Be familiar with the different types of cancers that affect

women, including breast cancer and cervical cancer
• Be able to provide information on cancer screening and
prevention.
 OSTEOPOROSIS

• Know the risk factors and treatments for osteoporosis,

which is more common in women than men.
• Prevention
• Counseling
 SEXUAL HEALTH

• Pharmacists should be knowledgeable about sexually

transmitted infections and be able to provide counseling
and testing services.
• Prevention
• Counseling
• Medications
 RECOMMENDATIONS BY AGE
GROUPS
Age 11-12
➢ Human papillomavirus (HPV) vaccination is recommended
for all girls (and boys) for protection from types of HPV
that can cause cancers, such as cervical cancer, and genital
warts.
 RECOMMENDATIONS BY AGE
GROUPS
20 21-29 30-40 40

Start annual visits to PAP test every 3 years HPV testing + PAP Mammogram every
gynecologist year. (signs of breast
cancer at early stage )

Breast exam every 1 to If normal, only PAP Annual Breast exam

3 years every 5 years
 RECOMMENDATIONS BY AGE GROUPS

• Colon cancer screening can detect cancer at an early stage,

when it is easier to treat.

45-50 65 75

Colon cancer screening at age A bone mineral density scan Mammograms and colon cancer
50 screening if recommended by
the physician

African-American women at the PAP test

age of 45
 WOMEN OF CHILDBEARING
POTENTIAL
Preventive medication: folic acid supplementation
• Because many women do not consume the necessary
amounts of folic acid through diet alone and there is a high
rate of unplanned pregnancies, supplementation in the form
of a folic acid tablet or multivitamin containing folic acid is
recommended for all women of childbearing potential,
regardless of pregnancy intention
 WOMEN OF CHILDBEARING
POTENTIAL
• For most women of childbearing potential, 400 μg (0.4 mg)
is the recommended daily dose.
• Women with certain risk factors should be advised to take
higher doses:
➢ Women with diabetes (usually 4–5 mg/d),
➢ Women using anti-epileptic drugs (usually 4 mg/d), or
➢ Who have experienced a previous NTD-affected pregnancy
(usually 4 mg/d)
 WOMEN OF CHILDBEARING
POTENTIAL- CONTRACEPTION
 ORAL CONTRACEPTIVE PILLS
Oral Contraceptive pills
Combined Oral Contraceptive
(COC)
Progestin-only Pill (POP)
Minipill*
Emergency Contraceptive Pill ( ECP)
Contain both estrogen and a
progestin
Contain only progestin
Progestin or ulipristal acetate
Prevents pregnancy in emergency
(unprotected/ accidental intercourse)
Taken daily, irrespective of
intercourse. Effectiveness depends on
regular intake
Taken daily, irrespective of
intercourse. Effectiveness depends on
regular intake
At the same time every day ( a
window of max 3 hours) safe for
breastfeeding women
Single dose, within 3 to 5 days after
intercourse.
Not effective if already pregnant
 ORAL CONTRACEPTIVE PILLS

• When to start
• What to do if patient forgets the pill
• Contraindications
• Management of side effects
• Counseling
• Refer for other methods
 VITAMINS AND MINERALS IN
PREGNANCY AND BREASTFEEDING

❖FOLIC ACID
✓ The need for folic acid is higher in fetal development.
✓ At least 400 mcg per day of folic acid as a supplement for at
least one month before and three months after conception
✓ Multivitamin preparations formulated specifically for
pregnant women will also contain sufficient folic acid.
IRON

➢ In the second and third trimester of pregnancy, there are

increasing iron demands due to an expanded red cell
volume and demands of the developing fetus and placenta.
➢ Iron supplementation is not necessary in every pregnancy
• safe in breastfeeding mothers, as iron passes very poorly
into the breastmilk.
CALCIUM & VITAMIN D

❖CALCIUM is important in pregnancy and in breastfeeding for

fetal growth and breastmilk production. Despite increased
requirements, there is no need for extra calcium
supplementation beyond the normal recommended dietary
intake, while pregnant or breastfeeding
❖VITAMIN D is needed for the body to absorb and use calcium
✓ Some women may be at increased risk of vitamin D deficiency
including those with reduced sun exposure (dark-skinned,
veiled women, may be at particular risk)
IODINE

• Recommended iodine intake in pregnancy is 220mcg per

day, unless thyroid disease is present
• The increased intake can be achieved by use of a pregnancy
and lactation vitamin supplement containing iodine
VITAMIN A

❖ VITAMIN A is an essential fat-soluble nutrient. Supplements usually provide

vitamin A as retinyl esters, which are readily converted to retinol.
➢ Care should be taken to ensure there is not excessive intake of vitamin A
in this form (retinol), as this may increase the risk of birth defects in
pregnancy.
➢ However, beta-carotene is the plant form of vitamin A and is not
associated with birth defects.
➢ The best way to get adequate vitamin A in pregnancy is from food such as
meat, fish, leafy vegetables and dairy products.
✓ Retinol in skin care products is poorly absorbed through the skin and is
not anticipated to be a concern in pregnancy.
VITAMIN B12

❖VITAMIN B12 is generally obtained from animal foods in

the diet
➢ Vegetarian and vegan mothers (as well as those with
malabsorption) should be supplemented with Vitamin B12
while pregnant and breastfeeding.
❖ Multivitamin preparations designed for pregnancy and
lactation will cover the majority of vitamin needs.
PREGNANCY AND
BREASTFEEDING
 BREASTFEEDING

• Breastfeeding has the largest known impact of any preventive intervention

• Infant mortality rates are higher when infants are not breastfed due to
infections and illnesses such as pneumonia and diarrhea
• Mothers who do not breastfeed also have increased risks of breast and
ovarian cancer, obesity, type II diabetes and postpartum depression
 BENEFITS FOR BABY

• Less spit up, gas, diarrhea, and constipation

• Stronger immune system
• Better vision
• Lowers the risk of Sudden Infant Death Syndrome (SIDS)
• Fewer allergies, eczema, and asthma
• Lowers the risks of leukemia, diabetes, heart disease
• Less likely to become obese as adults
 BENEFITS FOR MOTHER

• Less postpartum bleeding

• Lowers the risk of anemia
• Increased caloric intake
• Produces naturally soothing hormones
• Lessens the risk of osteoporosis
• Lowers the risk of breast, ovarian, and uterine cancers
• Delays menstruation
 HUNGRY BABY

• Baby will nurse for 10-45 minutes, advice to watch the baby
not the clock. 8-12 times a day.
• Advice the mother to feed on demand; supplemental or
bottle feedings will decrease milk supply, especially in the
early weeks.
• Advice the mother to stay hydrate
• Supply and demand
• The more mother nurses, the more milk she will produce
 WHEN TO REFER PATIENT TO
PHYSICIAN
• Pain, Bleeding in nipples
• Flu-like symptoms, fever, signs of infection
• Signs of depression
• Low baby weight
• Blood in milk
 POSTPARTUM PERİOD
(PUERPERİUM PERİOD)
• First 42 days after birth.
• Mother should continue to take vitamins (iron, calcium…)

• Nipples should be cleaned after every breast feeding session, ( creams, solutions,
sodium bicarbonate solution, washing with soap and water….)
• No sexual intercourse until no discharge
• Mother burns extra calories while breastfeeding, diet is not recommended.

• Pregnancy is not recommended at least for 12 months, breastfeeding protects from

pregnancy ( for 3 months) to some extend but can not be relied on.
• Progestin methods can be used for contraception
STORING MILK

• Advice patient to;

• Not to mix freshly pumped milk with already cooled milk
• Freeze milk in small portions
• Use oldest milk first
• Do not use microwave and do not refreeze the milk
 SORE NIPPLES

• Many mothers experience some level of nipple

soreness during the first few days after birth.
❖ Purified lanolin- when nipples are dry, it is not
harmful to baby and can be left on the nipples
during feedings
❖ Hydrogel pads instead of lanolin if nipples are
slightly damaged
• Avoid “nipple creams” other than purified lanolin.
• If there is cracking or bleeding; these injuries can
put the mother at risk for bacterial or fungal
infections, which can lead to a breast infection
called mastitis.
 EFFECTS OF MEDICATIONS IN
MILK SUPPY
• Metoclopramide It can increase milk supply by 66–100% within
2–5 days in total daily doses of 30–45 mg. ( can cause diarrhea
and depression)
• Domperidone At doses of 10–20 mg three times daily it has
comparable efficacy to metoclopramide. Little domperidone
passes into milk. Effects on the baby is less than with
metoclopramide
• Antipsychotics, cimetidine, reserpine, amoxapine, methyldopa
(increase milk supply by decreasing prolactin-inhibition)
 LACTATION SUPRESSION

❖Some women may require lactation suppression after

miscarriage, stillbirth, maternal illness or when they do not
wish to breastfeed. While breast stimulation should be
avoided, there is a risk of engorgement if the breasts are
not drained.
➢ Pharmacological options all have significant adverse effects.
The dopamine agonist BROMOCRIPTINE was associated
with maternal deaths from myocardial infarction and is no
longer recommended.
LACTATION SUPRESSION

➢ It has been replaced by a single 1 mg dose of long-acting

CABERGOLINE, ideally taken on the first postpartum day.
The common adverse effects are nausea, headache and
dizziness. If the woman changes her mind, it can be difficult
to restore milk production.
➢ Other drugs no longer used include large doses of
pyridoxine and diuretics.
➢ Estrogen is avoided because of the risk of
thromboembolism.
MEDICATIONS

➢ Common in pregnancy
• Nausea, vomiting
• Heartburn
• Constipation
• Hemorroid
• Coagulation problems
• Gestational diabetes, HT
 MEDİCATİONS FOR NAUSEA AND
VOMITING
➢ Approximately 50% of pregnancies ,typically manifest at weeks 2-12
➢ More severe in the mornings
➢ Certain foods and odors can cause nausea
➢ Recommended to eat small, frequent meals (dry foods )
➢ Isotonic solution, vitamin B6, anti-emetics ( Metoclopramide, Zofran
(ondansetron) )
➢ Excessive vomiting may indicate multiple pregnancies or molar pregnancy and
should be evaluated by a healthcare provider.
 MEDICATIONS WITHOUT
TERATOGENIC EFFECTS

Acetaminophen Docusate sodium Erythromycin

Cephalosporins Phenothiazines Penicillins ( amoxicillin)

Corticosteroids Thyroid hormones Multivitamins

Folic acid Metronidazole (Flagyl) after Antacids (magnesium)

the first trimester Avoid aliminium
 MEDICATIONS

• No medication is 100% safe in pregnancy and all should be

taken under supervision at minimum doses.
• Try to avoid all medications especially in thr first 3 months
of pregnancy and avoid polypharmacy when possible
• Do not use medications when it is not necessary such as
cold, acne and avoid triggers ( for migraine)
• Drug concentration peaks at 1-3 hours in breast milk,
recommend to breastfeed just before taking the medication
 MEDICATIONS

• If patient needs to use medications for a short period,

advice to stop breast feeding during the treatment period
• If medication is used once a day, recommend to take it
before baby goes to sleep for long time
• Delay drug therapy if possible
• Try to choose locally administered medications than
systemic if possible such as inhaled bronchodilators, topical
corticosteroids, decongestants ( they also reduce milk)
 MEDICATIONS

• Acetaminophen or Ibuprofen are safe when breastfeeding

• Drugs and Lactation Database (LactMed®)
• https://www.ncbi.nlm.nih.gov/books/NBK501922/
• https://mothertobaby.org/
• https://www.infantrisk.com/category/breastfeeding
 MENOPAUSE

➢When a woman permanently stops having menstrual periods, she has reached
the stage of life called menopause.
➢ Often called the change of life, this stage signals the end of a woman's ability
to have children.
 MENOPAUSE

Aging of the female genitourinary system includes fat athropy and hormonal
changes which are responsible from the following;
➢ Vaginal wall becomes thinner, shorthen and lose some of their elasticity
➢ The vagina produces less lubrication and at a slower rate during sexual
arousal
➢ The pH environment changes, making the vagina more susceptible to yeast
infection
➢ Pelvic floor muscles weaken and lead to stress incontinence
➢ Symptoms related to these changes can be reduced by replacing the lost
hormones
 PERIMENOPAUSE

➢ The transition phase before menopause is often referred to as

perimenopause.
➢ During this transition time before menopause, the supply of mature eggs in
a woman's ovaries diminishes and ovulation becomes irregular.
➢ At the same time, the production of estrogen and progesterone decreases.
➢ It is the big drop in estrogen levels that causes most of the symptoms of
menopause.
 MENOPAUSE

➢ Although the average age of menopause is 51, menopause can

actually happen any time from the 30s to the mid-50s or later.
➢ Women who smoke and are underweight tend to have an
earlier menopause, while women who are overweight often
have a later menopause.
➢ Generally, a woman tends to have menopause at about the
same age as her mother did.
 SYMPTOMS

➢Hot flashes
➢Vaginal athropy
➢Relaxation of the pelvic
muscles
➢Cardiac effects
➢Hair growth
➢Mental health changes
 TREATMENT

➢ Hormone therapy (HT) Combination of the female hormones estrogen and

progesterone during perimenopause and menopause.
➢ Estrogen therapy (ET) Estrogen alone, which is no longer being made by the
body. ET is often prescribed for women who have had a hysterectomy
➢ Estrogen alternatives "Synthetic estrogens," like ospemifene, improve
symptoms of vaginal atrophy without affecting endometrial cancer risk.
➢ Non-hormonal treatment Other types of medicines to relieve some of the
symptoms associated with menopause.
➢ Alternative therapies Homeopathy and herbal treatments, may offer some
relief from some symptoms of menopause.