Osteoporosis: What women need to know

Women’s Health Information EveningDr Katie Wood, GP Registrar

Osteoporosis

• What is osteoporosis?

• What increases my chances of getting osteoporosis?

• How can I find out if I have osteoporosis?

• How can I prevent it?

• How is it treated?

• More information on osteoporosis

What is osteoporosis?

• A condition which makes the bones fragile, and more likely to break

• There are usually no warnings you've developed osteoporosis and it's often only diagnosed when a bone is fractured after even minor falls

• Affects the whole skeleton but fractures most commonly occur to the wrist, hip and spine

The effects of osteoporosis on bone

Each year in the UK there are around 70,000 hip, 120,000 spine and 50,000 wrist fractures that are linked to osteoporosis.

What increases my chances of getting

osteoporosis? • Osteoporosis affects both sexes but being female puts you at

increased risk:

• Women tend to have smaller, thinner bones than men

• Oestrogen, a hormone in women that protects bones, decreases sharply when women reach menopause, which can cause bone loss. This is why the chance of developing osteoporosis increases as women reach menopause

• You’re also at greater risk of developed osteoporosis if you:

• Have needed steroid treatment for more than three months

• Have a family history of osteoporosis

• Don’t do much weight-bearing exercise

• Are a heavy drinker or smoker

• Have a conditions affecting bone metabolism, e.g. inflammatory conditions, coeliac disease

• Have a poor diet, and/or are very underweight

How can I find out if I have osteoporosis?

• There’s no good evidence that screening the whole population for osteoporosis would be helpful

• However, you should speak with your GP about having a DEXA scan to assess for osteoporosis if:

• You’ve already had a low-impact fracture

• You need steroid treatments for three months or more

• You had your menopause before the age of 45• Either of your parents has had a hip fracture• You have another condition which can affect the

bones

How can I prevent osteoporosis?

• Get plenty of calcium and vitamin D as part of a well-balanced diet

• Exercise regularly, especially weight-bearing or resistance exercises

• Stop smoking

• Don’t drink too much alcohol

Calcium and Vitamin D

• Calcium:• Adults need 700mg a day, which you should be

able to get from your diet• As well as dairy products, other calcium-rich foods

include leafy green vegetables, dried fruit, certain fish, and tofu

• Vitamin D:• Helps your body absorb calcium• Eggs, milk and oily fish• Sunlight exposure: Short exposure to sunlight (10

mins twice a day) throughout Summer should provide you with enough Vit D for whole year

How is osteoporosis treated?

• First-line treatments:

• Calcium and Vitamin D supplements• Bisphosphonates

• Works by slowing bone loss

• Other treatments include:

• HRT• Not recommended as 1st choice treatment for

women >60 years as linked with increased risk of breast cancer, blood clots and heart attack

• Denosumab• Block the cells that break down bone, leading to

increased bone mass

Where can I find out more?

• Arthritis Research UK Copeman HouseSt Mary’s CourtSt Mary’s Gate, Chesterfield Derbyshire S41 7TDPhone: 0300 790 0400 www.arthritisresearchuk.org

• National Osteoporosis Society CamertonBath BA2 0PJPhone: 01761 471771Helpline: 0845 450 0230Helpline email: nurses@nos.org.uk www.nos.org.uk

• NHS Choices The NHS Choices website has a useful overview of Osteoporosiswww.nhs.uk/conditions/osteoporosis/pages/introduction.aspx

Pelvic Organ Prolapse

Women’s Health Information EveningDr Katie Wood, GP Registrar

Pelvic Organ Prolapse

• Why pelvic organ prolapse happens

• The different types of prolapse

• When to see your GP

• What are the options for treatment?

• Can prolapse be prevented?

• More information on pelvic organ prolapse

Why pelvic organ prolapse happens

• The organs within a woman’s pelvis (uterus, bladder and rectum) are normally held in place by ligaments and muscles known as the pelvic floor

• If these support structures are weakened by overstretching, the pelvic organs can bulge (prolapse) from their natural position into the vagina

Why pelvic organ prolapse happens

The different types of prolapse

• A prolapse may arise:• In the front wall of the vagina (from the

bladder bulging into the vagina)• In the back wall of the vagina (from the

rectum bulging into the vagina)• At the top of the vagina (from the

uterus hanging down into the vagina)

• Many women have more than one type of prolapse at the same time

When to see your GP

• Pelvic organ prolapse isn't life-threatening, but it can affect your quality of life

• See your GP if you have any of the symptoms of a prolapse• a sensation of a bulge or something coming down or out of

the vagina, which sometimes needs to be pushed back• discomfort during sex• problems passing urine – such as slow stream, a feeling of

not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise

• Problems passing stools – such as having to strain to pass stools, a feeling that your bowels have not emptied fully, the need to push on, or around, your vagina to enable stools to pass

When to see your GP

• If prolapse is suspected, your doctor will carry out a vaginal examination. This will usually involve passing a speculum into the vagina to see exactly which organ(s) are prolapsing

• This only takes a few minutes and is similar to having a smear test

What are the options for treatment?

1. Lifestyle changes• Most women with mild prolapse don’t need

treatment, as the problem doesn’t seriously interfere with their normal activities

• Lifestyle changes such as weight loss and pelvic floor exercises may stop the prolapse from getting any worse

2. A vaginal pessary • A plastic or silicone device that fits into the vagina to

help support the pelvic organs and hold up the uterus • Many GPs are able to insert these• Particularly helpful for prolapse affecting the front

and top walls of the vagina

What are the options for treatment?

3. Surgery• The decision will depend on how severe

your symptoms are and how your prolapse affects your daily life

• You may want to consider surgery if other options have not adequately helped

Can prolapse be prevented?

• Regular pelvic floor exercises, especially if you are planning to get pregnant, are pregnant, or have given birth

• Good guide for pelvic floor exercises available here:http://www.guysandstthomas.nhs.uk/resources/patient-information/maternity/pelvic-floor-exercises-for-women.pdf

• If you are overweight, try to lose weight

• Eat a high-fibre diet and drink plenty of water to avoid constipation

Where can I find out more?

• Royal College of Obstetricians and GynaecologistsTheir website has a useful patient information leaflet on pelvic organ prolapse, and links to further informationwww.rcog.org.uk

• Bladder and Bowel FoundationHelpline – 08453450165www.bladderandbowelfoundation.org

• Patient.co.ukA good patient information leaflet titled ‘genitourinary prolapse’