Overview of Other Women’s Health Issues

Overview of Other Women’s Health Issues

Many women see their obstetrics and gynecology (OB/GYN) health care provider as their only health care provider. It is true that some health insurance carriers may allow women to choose an OB/GYN as a primary care provider (PCP). However, most providers in women’s health do not feel qualified to provide general health services, and many do not want to provide these services. In any case, it is important that those who work in women’s health have a basic understanding of some of the problems that, in general, are major health issues for women.

The inclusion of all health issues is beyond the scope of this book. Selected common concerns women may express at the time of their annual well-woman exam or during the course of another related telephone call are included. These topics are also important national health initiatives. They are as follows:

  • Anxiety

  • Cholesterol Screening

  • Depression (Depressive Disorders)

  • Domestic Violence (Intimate Partner Violence)

  • Hypertension

  • Smoking Cessation

  • Substance Misuse


Anxiety disorders occur when extreme anxiety interferes with normal activities. Most people experience occasional anxiety, but it is usually only a transient, uncomfortable feeling. Anxiety becomes a serious mental health issue when it impacts on physical as well as psychological well-being. It often goes hand-in-hand with depression. Contributing factors and common anxiety disorders are discussed in detail in Patient Education section of this protocol. Triage personnel are encouraged to familiarize themselves with this information to increase their knowledge of the often frightening presentation of anxiety disorders. This protocol is designed to help identify severe anxiety in women, which requires immediate attention, and ensure that women are given the opportunity to receive much-needed mental health care services. It is important to note that this section focuses on only the most common presentations of anxiety. A thorough discussion of the various manifestations of this disorder is beyond the scope of this book. An excellent website for patients and triage staff unfamiliar with anxiety can be found on the Office on Women’s Health website: www.womenshealth.gov/publications/our-publications/fact-sheet/anxiety-disorders.html#.

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STEP A: Recognition of a Panic Attack

Panic disorders are twice as common in women as in men. People with panic disorder have sudden attacks of terror when there is no actual danger. Panic attacks may cause a sense of unreality, a fear of impending doom, or a fear of losing control. A fear of one’s own unexplained physical symptoms is also a sign of panic disorder. People having panic attacks sometimes believe they are having heart attacks, losing their minds, or dying.

If the patient is experiencing uncontrolled fear and anxiety, coupled with physical symptoms, do the following:

  • Determine if there is anyone else present with the patient with whom she feels comfortable. It is particularly important to know if there is anyone nearby who is making the patient uncomfortable. Women with a history of abuse, sexual victimization, PTSD, or other trauma may experience symptoms related to panic when confronted by what they perceive as a threatening situation. It is not uncommon for others around the woman not to perceive the same level of threat or any threat at all. Have her remove herself from the situation if at all possible and align herself with someone with whom she feels safe.

Have her do the following for self-help*:

  • First, ask her to become aware of any tension that she may be feeling. Ask her to take a deep sigh and relax her shoulders.

  • Provide reassurance. (The triage personnel will be able to hear if she has taken a deep sigh. If not, repeat that command.) Instruct her to gently progressively tense and relax all the large muscle groups. For example, instruct her to tighten her right leg while taking a deep breath in. Then, have her hold the breath for a few seconds, release the tense leg, and let the breath out. Repeat this with muscle groups working back up to her shoulders.

  • Ask her to continue to slow down her breathing. Having her place a hand on her stomach may allow her to further control her symptoms by feeling her breathing slowing down.

  • If a patient has been diagnosed with any serious medical illness which may also present with similar physical symptoms, particularly cardiovascular disease, advise this patient to seek same-day treatment in an urgent care center, an emergency department, or with her regular health care provider. Home treatment may not be appropriate, even if this patient has experienced previous panic attacks. Certain medical conditions (notably heart disease and asthma) may be mimicked or worsened by panic. Depression, irritable bowel syndrome, and chronic pain may also be worse with severe anxiety.

  • If the patient cannot calm herself, make a same-day appointment with an appropriate mental health care provider and ensure that the patient is accompanied to the appointment by a friend, family member, or social services personnel.

  • Do not leave a high-risk patient alone. If it is necessary to call a family member or friend who is not at the patient’s house, have someone else call the contact person so primary triage personnel can remain on the line with the patient.

  • Per practice protocol, have emergency procedures in place for mobilizing community resources to get to the patient. This may involve a mobile mental health team or the police or fire department, based on your community. Immediately inform a provider in the practice that an emergency situation exists. Have someone else (other than the triage member engaged with the patient) call emergency services.

    • Keep the woman on the telephone and talking until emergency services arrive.

    • Reassure her that help is on the way.

  • If able to talk to a family member, ask him or her to make sure the patient is not left alone until she can see a mental health professional.

  • Make a same-day appointment with a mental health professional and ensure that she is accompanied by a family member or other responsible person with whom she is comfortable.

  • Keep the responsible health care providers informed about the problem and the actions taken.

  • Be certain to document accurately and completely.

STEP B: Treatment for Anxiety

The first steps in treating anxiety involve identifying preexisting contributing factors and symptoms of anxiety. Triage personnel are encouraged to thoroughly review the Patient Education section in the following text to enhance their skills in this area of assessment.

If the patient is experiencing anxiety without current symptoms of a panic attack, do the following:

Refer her for mental health counseling (either to a counselor she has seen before or to a new counselor).

Have her discuss her feelings with her partner, friends, and family.

Recommend she look to the community, friends, and family for support.

Provide a list of community resources with phone numbers and contacts. (This should be an important part of a practice or clinic’s protocol.)

Some people and facilities that may help a patient get treatment are:

Family doctors

Social workers


Family service, social service agencies, or clergy persons

Employee assistance programs (EAP)

Psychologists and psychiatrists

All practices should have a referral and follow-up system in place that includes the following, at a minimum:

  • A system that flags the patient’s record and outlines plans for continued contact with the patient identified at risk for severe anxiety.

  • Initiation of this practice-wide system that has as its goal the purpose of enhancing team communication and continuity of care by documenting all patient conversations, interventions, and referrals in the patient record per protocol.

  • All practices should have a mechanism for alerting other providers to patients experiencing symptoms of anxiety and depression. There should be open communication between practitioners providing patient care, such as psychological/psychiatric support and general family medicine.

Treatment for anxiety includes self-help methods for relaxation and reduction of tension, counseling (particularly cognitive behavioral therapy) and possibly medications
(benzodiazepines, selective serotonin reuptake inhibitors [SSRIs], beta blockers, among others). Often, a combination of all three is recommended.

» Patient Education

Although it is important to remember that anxiety does not “feel the same” to each person and may not present with the same symptoms in the same time frame for everyone, there are some known factors consistent across epidemiologic studies. Triage personnel should be familiar with the following factors which may predispose a patient to depression as well as the most common forms of anxiety.

Predisposing factors are very similar to factors contributing to depressive orders:

  • History of depression or mental health disorder

  • Physical or sexual abuse, including domestic violence

  • Family history of anxiety

  • Substance misuse

  • Increased situational or life factors that are stressful

  • Financial burdens

  • Recent death or loss of a family member or close friend

  • A lack of support from family and friends

  • Stressful life events

  • History of depression surrounding pregnancies

The major types of anxiety disorder are:

  • Generalized anxiety disorder (GAD). Women with GAD worry excessively about ordinary, day-to-day issues, such as health, money, work, and family. This disorder, as with some other disorders, impacts women more than men and is experienced disproportionally by ethnicity. Caucasian women, Hispanic women, and women of American Indian or Eskimo ethnicity experience GAD more often than African American women or Asian women. Women with GAD may be anxious about just getting through the day and may seem to others around them to fret over normal activities. They may have physically related stress symptoms, such as trouble sleeping or a variety of gastrointestinal presentations. At times, worrying keeps people with GAD from doing everyday tasks. Women with GAD have a higher risk of depression and other anxiety disorders than men with GAD. They also are more likely to have a family history of depression.

  • Panic disorder. Panic disorders, which are twice as common in women as in men, are extremely debilitating and frightening. People experiencing this disorder have sudden terrifying episodes when there is no actual danger. These attacks may cause a sense of unreality, a fear of impending doom, or a fear of losing control. Fearing one’s own changing physical symptoms is a very distressing manifestation. People having panic attacks sometimes believe they are experiencing a catastrophic health event.

  • Social phobia. Social phobia, also called social anxiety disorder, is diagnosed when people become very anxious and self-conscious in everyday social situations. People with social phobia have a strong fear of being watched and judged by others. They may get embarrassed easily and often have panic attack symptoms.

  • Specific phobia. A specific phobia is an intense fear of something that poses little or no actual danger. Specific phobias could be fears of closed-in spaces, heights, water, objects, animals, or specific situations. People with specific phobias often find that facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.

Here are other tips that may help a patient learning to cope with severe anxiety:

  • Try to be active and exercise.

  • Set realistic goals for yourself.

  • Try to spend time with other people and confide in a trusted friend or relative.

  • Try not to isolate yourself and let others help.

  • Expect your mood to improve gradually, not immediately.

  • Find activities that promote relaxation such as yoga, meditation, and mindfulness.

  • Continue to educate oneself about anxiety.

Depression (Depressive Disorders)

The subject of depression appears to be ever-evolving. Depression is generally found to be at least twice as common in women as in men. However, across diverse populations worldwide, statistics on prevalence and incidence vary among credible organizations. The National Alliance on Mental Illness (NAMI, 2017) states approximately 7% of the U.S. adult population experienced at least one major depressive episode in the past year, with women 70% more likely to experience depression than their male counterparts during their lifetime. This reliable organization states “young adults aged 18-25 are 60% more likely to have depression than people aged 50 or older” (NAMI, 2017, para. 3). However, Pratt and Brody (2014), authors of the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistic’s report on depression in the U.S. population, state that the age group of highest prevalence is the 40- to 59-year-old range. Despite confusion in this area, there is no disagreement that depression occurs more frequently in the female population and spans the reproductive years, a common time of hormonal change in women.

Depression impacts on physical as well as psychological symptoms. Contributing factors and presenting symptoms are discussed in detail in this protocol’s Patient Education section. Triage personnel are encouraged to familiarize themselves with this information to increase their knowledge of the often insidious presentation of depressive disorders. This protocol is designed to help identify severe depression in women, which requires immediate attention, and ensure that women are given the opportunity to receive much needed mental health care services. It is important to note that this section, as with all protocols in this book devoted to depression, focuses on unipolar depression. A discussion of the myriad of subsets and various manifestations of this disorder is beyond the scope of this book.

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STEP A: Refer to Mental Health Counselor

If the patient is experiencing uncontrolled mood swings, thoughts about harming herself or others, feeling out of control, or becoming excessively withdrawn, do the following:

May 8, 2019 | Posted by in OBSTETRICS | Comments Off on Overview of Other Women’s Health Issues
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