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Women's Health Screening

You can screen yourself for possible medical problems by answering the following questions. Similar to the questions given at school physicals before clearing an athlete for participation in sports, the following list of questions is designed to identify disease or injury risks. A "yes" answer suggests that you discuss this with your primary care physician or health-care professional. You might also see a sports medicine doctor, especially if your problem is related to pain. If you have already seen a doctor in regards to the questions here, be sure you are following her recommendations as you continue your exercise or sports activity.

Do you have any pain that often limits your activity?	YES	NO
Do you have a pain that has come and gone for more than one week?	YES	NO
Do you have any muscle weakness that does not seem to get stronger?	YES	NO
Do you feel you tire out more easily than others?	YES	NO
Do you easily get short of breath?	YES	NO
Have you ever passed out during or after exercise?	YES	NO
Have you ever been told you have a heart murmur?	YES	NO
Do you ever feel chest pain?	YES	NO
Does your heart race or skip beats?	YES	NO
Has anyone in your family died from a heart condition before age 50?	YES	NO
Do you ever wheeze or have trouble catching your breath?	YES	NO
Do you cough a lot?	YES	NO
Do you get colds or sinus problems more than once every two months?	YES	NO
Have you recently had an illness lasting longer than one week?	YES	NO
Have you been in the hospital in the past year for an illness?	YES	NO
Have you ever had a sudden rash or hives?	YES	NO
Have you ever hit your head hard enough to pass out?	YES	NO
Do you ever feel light-headed or dizzy?	YES	NO
Do you suffer from daily or weekly headaches?	YES	NO
Have you ever had a seizure?	YES	NO
Have you ever lost your memory?	YES	NO
Do you have any loss of feeling anywhere?	YES	NO
Do you experience muscle cramps lasting more than five minutes?	YES	NO
Do you have trouble with diarrhea or constipation?	YES	NO
Have you ever had blood in your stool or urine?	YES	NO
Do you bruise easily?	YES	NO
Do you get cold easier than others and have trouble keeping warm?	YES	NO
Have you recently lost weight without trying?	YES	NO
Do you feel you have been urinating more than usual?	YES	NO
Do you have swelling of a joint or limb?	YES	NO
Have you had repeated sprains or fractures to the same area?	YES	NO
Have you had fractures that were not due to a fall or accident?	YES	NO
Have you ever had frostbite?	YES	NO
Have you ever passed out from heat or dehydration?	YES	NO

If you are diagnosed with a medical problem, you will probably still be allowed to exercise, but you might have some limitations or precautions. If you have any questions, make sure you ask your doctor specifically about the type of activity you are interested in, how often you will be doing it, at what level of competition, and for how long each exercise session will last. Some doctors are more knowledgeable than others with regard to exercise activity and risk factors; you might want to see a primary care sports medicine specialist (one who is a family practitioner, internist, or pediatrician). Some common medical problems and their associated limitations to exercise are outlined in the following chart.

Medical Problems and Their Risks with Exercise

Problem	Limitations/Risks
Bleeding problems	be careful with injuries and falls
Carditis (inflammation of the heart)	severe restrictions of exercise intensity
High blood pressure	avoid heavy weight lifting
Congenital heart disease	possibly limited per doctor
Irregular heartbeat	possibly limited per doctor
Mitral valve prolapse	usually no limits
Hear murmur	possibly limited per doctor
Diabetes	watch blood sugars if more than 30 minutes exercise
Diarrhea	watch fluid status and increase salt/potassium
Eating disorders	limited if severe and nutrition poor
Fever	do not exercise
HIV infection	no restrictions if currently healthy
Kidney disease	possibly limit contact sports
Liver disease	possibly limit contact sports
Cancer	possible limits after surgery or chemotherapy
Concussion	no contact sports if more than three in lifetime
Seizures	possibly limited, make sure medications taken
Obesity	avoid overheating and dehydration
Asthma	might need to modify environment, take medications
Bronchitis	possibly limit exertion
Sickle cell disease	avoid overheating/overcooling, dehydration
Skin diseases	if contagious, contact not allowed
Enlarged spleen (mononucleosis)	no contact sports

Lifestyle
There are also lifestyle risk factors that can lead to medical problems. These can be screened with the following questions. If you can answer any of these questions with a "yes," reconsider your behavior, as this might lead to serious problems. Behaviors can be hard to correct; if you need help, speak to your health-care provider, therapist, school counselor, social worker, or a family member or close friend you feel you can talk to and confide in.

Do you smoke?	YES	NO
Do you drink more than seven alcoholic drinks a week?	YES	NO
Have you ever used any street drugs?	YES	NO
Do you often forget to wear a seatbelt?	YES	NO
Do you forget to wear a helmet while biking or motorcycling?	YES	NO
Do you have trouble sleeping on more than two nights a week?	YES	NO
Do you feel stressed out with no relief in sight?	YES	NO
Do you throw up after eating?	YES	NO
Do you use laxatives on a regular basis because you "feel full"?	YES	NO
Do you take pills or teas to help you lose water weight?	YES	NO
Have you ever taken anything to help you lose weight?	YES	NO
Have you ever taken anything to help you gain muscle or strength?	YES	NO
Have you ever taken any drugs to keep you awake or alert?	YES	NO

Nutritional Health
Nutrition is an essential part of inner body health and athletic performance and, thus, is an important area of assessment and monitoring in athletic women. Health and performance problems can be due to poor nutrition, and poor nutrition can be due to poor health and performance. Athletic performance is one of the best indicators of nutrition. With the right nutrition, you perform at your best with low incidence of injury or illness. If you are feeling tired and run down, weak, irritable, or cramping, nutrition can be a factor. Weight is, of course, a good guide, as any quick change of weight can signal nutrition problems. It is always recommended to take a multivitamin daily to ensure nutrient balance. This along with a well-rounded diet of proteins, carbohydrates, and fats is essential. To quickly assess your nutritional habits, ask yourself the following questions:

Do you skip meals?	YES	NO
Do you always feel hungry?	YES	NO
Do you restrict yourself of certain foods?	YES	NO
Do you feel that you cannot quench your thirst?	YES	NO
Do you crave salty, sugary, or fatty foods often?	YES	NO
Do you take more than three vitamins or supplements a day?	YES	NO
Do you worry about your nutrition or weight on a daily basis?	YES	NO

If you have more than two "yes" answers, refer to this article for more information, and make an appointment to see a doctor or nutritionist.

Exercise and Cancer
Cancer is very common; there is a one in eight chance any woman will get breast cancer at some time in her life. Other common types of cancer are colon, skin, cervical, ovarian, uterine, brain, bone, and lymphoma (cancer within the lymph nodes). We are fortunate to have various treatments and cures for many of these cancers, and researchers continue to search for more.

Cancer treatment is stressful on the body and can interfere with a regular exercise plan. It is important to try to maintain a flexible exercise schedule, because it is hard to predict how you will feel or how your body will react. Still, there are many people who stay physically active at moderate levels while being treated with chemotherapy or radiation. In fact, light to moderate exercise has been shown recently to improve survival, decrease uncomfortable side effects and fatigue, and improve appetite, mood, stamina, and energy. Exercise can be difficult at first, as the body can become weak after surgery or treatments. Returning to pre-treatment levels of activity might take anywhere from half the time since treatment started to twice the time.

During treatment with chemotherapy, in particular, there are a few precautions and some measures that indicate you should take a break from exercise until your body is responding better. These include avoiding exercise on days of treatment and mornings of blood tests and avoiding crowded exercise settings and pools where germs can easily spread. Blood levels of potassium and sodium must be close to normal (above 3 and 130, respectively) to prevent heart or muscle problems, and your blood count should include a platelet count more than 25,000 and a hemoglobin of more than 11 to prevent bleeding problems or poor oxygen supply to necessary organs.

Avoid Aerobic Exercise If You Have These Symptoms

• Extreme fatigue
• Confusion
• Fever
• Dizziness
• Bleeding
• Blurry vision
• Irregular pulse or heartbeat
• Light-headedness
• Sudden swelling in an arm or leg
• Nausea or vomiting
• More than three episodes of diarrhea in the past 24 hours
• Unable to eat more than 1,000 calories in the past 24 hours
• Shortness of breath
• Chest pain Chemotherapy treatment in the past 24 hours
• Platelets less than 25,000
• Hemoglobin less than 11
• Sodium less than 130
• Potassium less than 3

On days you cannot exercise for one of the above reasons, consider gentle/beginning yoga with simple sitting or floor postures including breathing and relaxation components. Gentle pilates exercises or stretching classes are usually tolerated as well.

If you have had surgery, check with your surgeon to see when you can safely return to aerobic activity. For breast cancer patients who have had a lymph node resection or mastectomy, lifting on that side is usually not recommended for at least four weeks to prevent lymphedema (arm swelling). You should, however, begin moving the shoulder and arm through its full range within the first week after surgery and continue every day thereafter to prevent scar tissue from forming. Both chemotherapy and radiation cancer treatments can lead to dry, irritated, and sun-sensitive skin. This can be managed and relieved by using sunscreen, covering up with clothing when possible, using ointments liberally to prevent chafing, and using generous amounts of moisturizer. A humidifier can help, as can drinking lots of fluids and eating fruits and vegetables. Exercise also improves skin conditions, as it increases blood flow to the skin.

Tips for Exercising While Recovering from Cancer

• Start with gentle walking or cycling
• Try light exercise three days a week with rest days in between
• Alternate aerobic activity days with stretching and conditioning days
• If you cannot tolerate 20 to 30 minutes, break the sessions into 10 minutes each
• Start low, go slow, and increase gradually—no more than 10 percent a week
• Do not get discouraged if you have a "tired" day—rest and try again tomorrow!
• Make exercise enjoyable with good music, a good friend, or in front of a good TV show

Reproductive Health
There is an entire specialty of medicine devoted just to women—obstetrics and gynecology (OBGYN). Family practitioners also are trained in basic obstetric and gynecological care, although they do not do surgery. Seeing your gynecologist or family practitioner once a year to maintain reproductive health and screen for problems is highly recommended. For women without other health problems, OBGYNs sometimes function as their primary care doctors. However, your health care is more comprehensive if you also have an internist or primary care doctor.

As with all physicians, making an appointment is the best way to get answers to your health questions. This is why it is recommended that you see your OBGYN yearly and your primary health doctor at least once every two years. As a reminder, the following screening questions will help you determine whether you have any issues of possible concern. A "yes" answer to any of the following questions is a sign that you should see your gynecologist or family physician.

Do you have any foul-smelling discharge from your vagina?	YES	NO
Do you have any pain in the pelvis?	YES	NO
Do you have pain when you have sex?	YES	NO
Do you feel any breast lumps?	YES	NO
Do you have any drainage from your breasts?	YES	NO
Do you think you might be pregnant?	YES	NO
Have you missed your period more than twice in the past year?	YES	NO
Do you frequently miss your periods?	YES	NO
Do you have very heavy, painful periods?	YES	NO
Do you leak urine?	YES	NO

For women, preventive health measures include screening tests that rule out the most common types of cancers. Breast cancer, the greatest risk, is usually treatable if diagnosed early. Detection methods now may also include genetic screening, along with mammograms, recommended for women yearly after age 40 or 35 if you have risk factors. Breast self-exams should be done every month a few days after your period, once you have started having regular periods and for the rest of your life. Pap smears are done yearly after the age of 21 or if you are sexually active. After menopause, another screening test important for women is bone density testing; this should be done at least once to establish a baseline level of fracture risk.

If you are between the ages of 14 and 45, you should be getting your period every month unless you are pregnant or starting menopause. Stress, excessive exercise, and illness can cause a skipped period, but if this occurs more than two months in a row, speak with your doctor. Having your period means your hormones are balanced and your body is producing normal amounts of estrogen.

Premenstrual syndrome (PMS) is the occurrence of uncomfortable body changes a few days before your period. Treatment of PMS is based on preventing and relieving symptoms. Prevention strategies include a low-salt diet, low-sugar diet, proper sleep, and plenty of exercise. Calcium supplements, vitamin E, vitamin B6, or magnesium in an extra dose the week before your period can help, and adequate amounts of calcium and vitamins should be taken throughout the month.

Symptoms of PMS

Mood changes—	nervousness, moodiness, irritability, anger, anxiety, depression, edginess
Physical feelings—	sweet or salty cravings, hunger, headaches, feeling tired
Body changes—	bloating and water retention; weight gain; swollen, tender, and sore breasts
Depressive symptoms—	sleep problems, memory loss, confusion, fluctuating emotions, tears, suicidal thoughts

PMS with severe mood symptoms is medically classified and treated as premenstrual dysthymic disorder (PMDD). This is a mood disorder that disrupts work and other life activities related to the premenstrual part of the menstrual cycle. Medications have been approved for the treatment of PMDD and are typically taken for the last two weeks of the month of your cycle. If you are suffering from premenstrual symptoms that interfere with relationships, work, or athletic schedule, discuss possible treatment with your doctor.

Menopause
Every woman's body and mind respond differently to menopause. Occurring usually between the ages of 50 and 55, menopause has a bad reputation for causing unpleasant side effects such as hot flashes, moodiness, memorydisturbance, and vaginal dryness. Menopause is not a disease, but rather simply a natural process that occurs as the amount of estrogen and progesterone in the body changes, sometimes causing strange sensations. For those who have trouble with the uncomfortable side effects of menopause, medications can be helpful. Until recently, the most commonly prescribed medication was hormone replacement therapy (HRT), usually a combination of estrogen and progesterone. Treatment with HRT is less frequently prescribed after the 2002 Women's Health Initiative study found HRT to slightly increase risk of breast cancer in some women if taken for more than five years. Instead, lower doses are prescribed for a few years, or medications used to treat mood disorders (including Zoloft, Paxil, and Prozac) are also effective. Natural treatments for symptoms of menopause can also be helpful and include soy and black cohosh.

After menopause, your risk of heart disease goes up slightly. Speak with your doctor if you have any other health risks of cardiovascular disease such as high blood pressure, high cholesterol, had a mother or daughter with heart disease, or have diabetes. It might be worth it for you to take a "statin" medication to prevent heart disease. Also, your risk of osteoporosis increases after menopause; this risk can be established with a bone density test.

There are no limitations to exercise before, during, or after menopause. In fact, exercise can help manage and lessen uncomfortable symptoms experienced before and during menopause. Exercise can also lower the risks of health problems that can occur after menopause: Cardiovascular (aerobic) exercise prevents cardiovascular disease, and weight-bearing exercise (walking, jogging, weight lifting) prevents osteoporosis. Skill sports involving balance challenges such as golf and tennis help maintain posture, motion, flexibility, and balance and prevent joint stiffness, weakness, and falls.

Ideally, all your body systems are as healthy as they can possibly be. Occasional setbacks or flare-ups of problems are part of life, but if they do not take you out of exercise for more than one week, they should be easy to recover from. When you experience serious illness or surgeries that require more than one week of rest, recovery can sometimes take longer than the illness. Anesthesia can also contribute to feeling tired and weak for anywhere from several days to several weeks. If you are weak or limited by illness, try basic yoga moves, light weight lifting exercises, or toning exercises or classes. Advance to walking a few times a week, then add cycling or swimming. Gradually, you should be able to return to your previous level of activity.

Do not hesitate to see a doctor if you have concerns about unusual symptoms or feel unhealthy. Make an appointment, as this is the best way to get correct and appropriate answers to your questions. The earlier a problem is diagnosed and treated, the earlier it will be resolved and the more likely it will be fully healed. If you do not feel comfortable speaking with your doctor, find another one.

Your exercise program should make you feel stronger and healthier. Your nutrition program should provide you with fuel for life and exercise. By taking care of yourself, you will need no (or fewer) medications and avoid illness and injury. Each day will feel great. Staying active will keep you looking and feeling young and healthy. Remember, your health is your greatest resource.