Women’s health care in the 1990’s Tu My Linh
Vietnamese(VPS) Vietnamese(VSCII)	Summarized and translated by Do Kim Anh

In the 1990 decade, women’s life expectation will be twice as long as women’s who lives in a hundred fifty years ago. We now live longer than our ancestors, in large due to the advance of technology, also in part due to quitting smoking, avoiding drug, being cautious of sexual lifestyle, exercising and new attitude toward eating healthy, and personal hygiene.

Vietnamese residing in Canada comprise of people with differences social status and education background. Therefore my task addressing this health care topic to a general audience is quite a difficult one. I will be focusing on a number of topics which are important to women. I will be using diapositives and overheads to help you follow along with this presentation.

Women must be familiar with the screening test available and other health issues related to women, from childhood until the golden age in today society.

1- Regular check-ups (screening)

 There are periodic screening tests that women must take regularly in order to be able to detect earlier the following illnesses and diseases.

A- High blood pressure.

 Regular blood pressure screening is the least expensive yet most effective way to pinpoint high blood pressure (hypertension). Hypertension is a hidden illness that can lead to many other diseases and illnesses. Women under 40 should have their blood pressure checked every three years, and women over 40 should check every year.

B- Self-breast examination.

 Self-breast examination is a method of detecting possible signs of breast cancer and is a first step for women to participate in the process of taking care of their health. With self-breast examination, women can detect up to 80% of any kind of lump in their breast. Women should take at least 10 to 15 minutes every month to examine their breast, and especially examine themselves one week after their menstrual period. It is recommended that:

• Women in their 40’s should have breasts examined by their physicians; in some cases women in their 20’s should do the same thing
• Women over 65, who do not have their mammogram taken should consider self-breast examination as an effective alternative.

I-  Breast Cancer:

 There are 10% of women who will have breast cancer before they reach 80 years-old.

  In the past 40 years, the number of women who died of breast cancer has not fallen.

 Those women over 50 have a greater chance of  getting breast cancer.

 Among a number of causes for breast cancer are: aging, giving birth too many times and family with breast cancer history.

Three ways to detect breast cancer:

• Routine breast examination with your doctor
• Self-breast examination
• Mammography

• Self-breast examination     20 year or older         every months
• Doctor’s routine checkup  20 to 40 years-old     every 3 years

                                          above 40 years-old   every year
• Mammography                  above 50 years-old   every year

 In the past 15 years, mammography has aided us in the detection of breast cancer. This method is very important because it can detect possible signs of breast cancer that other methods may have missed. It captures in an X-ray of the breast, that helps doctors distinguishing which breast tissue is normal and which is cancerous.

 Women under 30 rarely use mammography as a method of early detection, because according to statistic, less than 2% of these women have breast cancer. In this age category, women have their mammography taken if only when they detect a limp in their breast or have pain all around their breast. The sensitivity of the mammography is in the range of 85 to 90%.

 In the detection of breast cancer, the American Cancer Society and The American College of Radiology recommend;

• Mammography taken for the first time between 35 and 40 years-old
• Mammography taken every 12 or 24 months between 40 and 50 years-old
• Mammography taken every year for those over 50 years-old

II- "Pap smear:" to detect the uterine cancer

 This method is to examine the tissue of the uterus by the pap smear test. With this early detection of the cancer, doctors can  treat the problem as soon as it is detected. This test has reduced 90% of the uterine cancer.

 The Canadian Preventive Task Force and the US Preventive Task Force recommend a pap smear test every 3 years for women with low risk. The American College of Obstetricians and Gynecologists and the American Cancer Society recommend a pap smear test every year for all women.

Who is require to have a "pap smear" test done?

• All women who are actively in sex
• All women who use birth control
• All women over 80 years-old
• All women who are pregnant

• Women 18 years or older and actively in sex
• The chance of pre-cancerous is very high among young people
• Women over 40 years-old have a very high risk for invasive cancer.

• Avoid using the vaginal douche (48 hours before the test)
• Avoid using vaginal cream or jelly (48 hours before the test)
• Avoid sexual intercourse (24 hours before the test)
• Avoid taking a pap smear test during your menstrual period

 The Preventive Canadian Task Force recommends to stop screening after 65 years-old, because the chance of getting uterine cancer after this age is very rare. Even with such statistics, the American College of Obstetricians and Gynecologists still recommends that they should not screening, no matter at what age you are.

 Note: Women who have their uteruses removed not because of cancer and have their routine pap smear test done before the operation, will not have to take any more pap smear.

III- STD- sexually transmitted diseases

 STD, AIDs and Hepatitis-B are transmitted through sexual intercourse.

 There are 20 different viruses and 50 different diseases that comprise of STD. They have wreaked havoc in our own society. They are the causes for one third of the cases in women who are sterile in Canada, who have miscarriages, abnormal pregnancies, pelvic inflammatory diseases and other deadly diseases.

 In the past decade there was an epidemic of STD among the young women's generation. Diseases such as clamydiose, gonorrhea, herpes, condylomes, have spread very widely even through with the knowledge that this disease can be preventable with very simple measures taken.

Here are some preventive measures for STD

• Use condom with your sex partners
• Use birth control pills (to reduce possible complications of STD)

 Condom is probably the easiest method to use. Now there is also available in the market, a feminine condom called  "Reality". This has helped women in the prevention of STD and unwanted pregnancy. Of course young women today want to take more responsibility in controlling their sexual lifestyle.

Spermicide, non oxynols as guard against STD.

 This kind of spermicide is the most popular. If used properly, this spermicide can effectively prevent gonorrhea, clamydiose, herpe and the HIV virus

IV- Hepatitis B

 Hepatitis B is a type of disease which is transmitted by sexual intercourse or by blood. In North America and Canada, 60% to 70% of Vietnamese carry it.

These are groups of people who may carry the hepatitis B virus:

• Asians
• Alaskans and all the Pacific Islanders
• Those who use drugs through needles
• Those who have hepatitis B in their family history
• Those who are actively in sex
• Those in the medical field.

 If you are among the people who are likely to get hepatitis B, you should get an immunization shot against it. The hepatitis B shoots are given in three steps: one is given for the first time, then the second in the next month, and the last in 6 months later. Either or both parents who carry the Hepatitis B virus should have their children immunized.

V- Premenstrual syndromes (PMS)

 PMS are symptoms that strike 87% to 92% of women during their menstrual period. Approximately 3% to 5% of women have serious PMS symtoms.

What are PMS?.

 PMS are any number of symptoms that can affect women’s behavior, emotion as well as physical and mental states. PMS can strike any woman no matter what race, colour or social status she belongs. Today doctors know that PMS are caused by the changes of hormone level in the women body during their menstrual period, even though they can not pinpoint the exact causes for PMS.

Symptoms of PMS.

 There are at least 150 symptoms of PMS such as headaches, bloating, fatigue, anger, breast tenderness, water retention, anxiety, nervousness, depression, stress etc...

Possibilities related to PMS.

 The symptoms usually appear after the eggs have matured and detached themselves for the journey down to the fallopian tube. The symptoms usually appear at least 7 days before the first day of menstrual period.

 The symptoms usually affect women’s daily activities.

Diagnoses: counseling, exercising and dieting

• Counselling, explaining then defining the problems of PMS to patients who  suffer with PMS. Patients also need family support and sometime group counselling with a psychologist to deal with PMS
• Diet: to reduce salt, sugar, coffee and alcohol intake.
• Exercise: walk or jog above thirty minutes at least four times a week

 Antiprosraglandine reduces symptoms of PMS if taken regularly 6 days before menstrual period. 30% of those who take this medicine get better, 30 % experience no change and 30% experience sleepiness

 Use 100mg Pyridoxine (vitamin B6) regularly during the menstrual period does have some positive result, even though there is no research nor solid statistics to back it up.

Recent research has shown using the antidepressant Prozac at (20 to 40mg) a day will help alleviate depression and irritability

VI- Menopause

 The 90’s is the decade that has marked a significant break through in women’s health care. There is a new attitude toward menopause. Today, there are ways to help women after menopause live a longer and more healthy life.

 Today, in average, 1/3 of women under age 81 live in the menopause stage. The world is now facing with a large population of elderly. Today in Canada, there are over 3 million women who are over 50 and are in the menopause.

 Hormone treatments for women in menopause have helped them reduce in heart disease as well as osteoporosis and bring good mood to many of them.

Definition of menopause.

 Menopause occurs when a woman’s menstruation stops or when the ovaries can no longer produce eggs. Over the life span of a woman, she has approximately 400 menstrual periods. The level of estrogen and progestrogen usually reduce as a woman approaches menopause.

Pre-menopause and menopause

 Symptoms are irregular menstrual periods, bleeding abnormally, hot flashes accompanied by nausea, anxiety, sweating during the night, insomnia, dizziness, headaches, memory loss, frustration and anger as well as other general sicknesses.

Consequences of menopause:

• Women over 50 have more chance of getting breast cancer
• Heart diseases: during the years when women have menstrual periods, the chance of women getting heart disease is 20% less than that of men in the same age category. At the age 85, men and women have the same chance of this disease. This observation implies that estrogen may protect human bodies against the heart disease.

 Bone loss occurs during menopause. Four years after menopause starts, women experience bone loss at a rate of 1% to 3% a year, after that, at a rate of 0.6% a year. This problem makes women more susceptible to wrist, hip and spinal-cord fracture. Over 40% of women over 65 have one of the above three problems, and 20% of women at 90 and above have hip fracture. Here are a few causes leading to osteoporosis: menopause, fair skin, underweight, lack of exercising, excessive alcohol consumption, smoking, excessive coffee consumption and taking corticoids.

Relieving of symptoms of menopause:

• Estrogen treatments
• Estrogen pills
• Estrogen in transdermal patches forms.
• Estrogen cream
• To prevent osteoporosis, use hormone treatment during the first three years after menopause begins. Osteoroposis may resume after this treatment ends.

• Women who have heart conditions and blood clots
• Women who are likely to have breast cancer and uterine cancer.

• Endometer cancer

One out of 100 women have this form of cancer every year. This cancer usually appears two years after hormone treatment and with early detection, the rate of curing this form of cancer is 95%
• Breast cancer

The pros and cons of using hormone treatment can not be answered easily. Taking hormone treatments can lead to breast cancer for women in their 60’s and yet can help prevent heart diseases for women in their 70’s and helps prevent osteoporosis in their 80’s. There are still many debates and   research about hormone treatment.

• Exercising

When menopause starts, it is very important to maintain a healthy body by exercising or participating in some form of sports. This will help reduce the chance of getting osteoporosis.
• Proper diet

Eat healthy food by consuming these foods which are rich in fiber and avoid fatty foods. Eat calcium-rich foods like yogurt, milk, orange juice to help fight against osteoporosis. Take vitamin C and E and eat foods rich in beta carotene to help reduce the risk of getting heart diseases.

• Short term - to reduce the symptoms of menopause
• Long term - to help reduce heart disease, osteoporosis and cancer of the reproductive system.

 In conclusion, every person has a particular way of protecting their healthlife. The only importance is what advantage or disadvantage in the method you choose that fit in your life style as well as your condition