Prevention strategies in women’s reproductive health

Prof William StonesHealth problems affecting women in the reproductive years can be favourably influenced by timely preventive interventions. Ovarian function is affected by a body mass index (BMI) at both extremes. Women who are too thin are likely to notice infrequent menstruation. Being overweight is associated with irregular or absent menstruation. Maintaining a balanced diet and exercise is important for optimal ovarian hormonal function and fertility. Screening is the early detection of changes that might lead to cervical cancer. The "Pap smear" is a small sample of skin cells taken from the cervix and examined under the microscope. When abnormalities are detected early, the abnormal area of the cervix can be treated in a minor procedure.Vaccine optionsWe now have the option of vaccination against human papilloma virus (HPV). This is the virus that causes pre-cancerous changes in the cervix.Voluntary counselling and testing for HIV infection has benefits for women in the reproductive years. It enables them consider their reproductive options and embark on pregnancy, should they wish to do so, under the best possible conditions.Tests offered to women in ante-natal clinics include screening for anaemia, blood group status, Hepatitis B, HIV and syphilis, and an ultrasound scan is offered at 20 weeks’ gestation. This is to identify foetal abnormalities.For HIV positive mothers (and those with other medical conditions in pregnancy) there is a need for close co-ordination between the physician and obstetrician to ensure the best outcome. The results of this approach to treatment have been excellent.While careful antenatal assessment can identify problems that might arise during pregnancy and childbirth, we recognise many complications occur ‘out of the blue’ and cannot be predicted. Therefore we emphasise the value of women knowing the danger signs during pregnancy. — The writer is a doctor at Aga Khan University Hospital

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