This introduction presents an overview on women's health. It also presents societal differences, inherent physical and medical differences between men and women. Much of the research on women's health concerns has emphasized women's genitourinary organs and diseases and childbearing diseases. Men and women often live different lives within society and the way they live affects their health. In caring for the woman with addiction, dealing with her individual circumstances is very important. Women are less likely to use smoking cessation programs, especially work-related programs, and are less likely to quit. Women are usually less likely to become infected (except with AIDS) and more likely to develop autoimmune diseases. Women are more likely to be caregivers, elderly, poor, alone and uninsured, making their health care needs and treatment different than those of men. Women's immunology, drug use and metabolism may differ and may affect the treatment of diseases.

Prevention for the older person includes maintaining quality of life, preserving function, preventing collapse of family support systems, and maintaining independence in the community. Older women often have substantial responsibilities caring for spouses, siblings, children, and grandchildren. Significant levels of depression are seen in caregivers of Alzheimer's patients. Women access the health care system more frequently than do men. They receive more health services and prescriptions, undergo more examinations, laboratory tests, and blood pressure checks than men. Depression is the most commonly diagnosed mental illness in older adults in the primary care setting, although it often goes unnoticed. Abuse is best correlated with the emotional and financial dependence of the caregivers on the geriatric victims. By attending to the differing risk factors of older women and following a systematic periodic evaluation, physicians can assist older women in maintaining their health and functional status.

The most important characteristic of a healthy diet is balance of food types, and of intake and output. Low protein intake is associated with a higher risk of bone fracture. There is controversy about whether high animal protein intake increases the risk of fractures in women. Menopausal women are at increased risk for osteoporosis, especially if they are Caucasian and/or thin. The best calcium source is dairy products. Three servings provide the recommended daily allowance of 1000 mg. With fewer women taking hormone replacement therapy, more women are looking for alternatives to control menopausal symptoms, particularly hot flashes. The type of natural product most commonly used for menopausal symptoms are phytoestrogens or plant estrogens. Eating disorders are most commonly associated with younger women: teenagers and young adults. The recommended diet for people with diabetes should contain carbohydrate, protein, and fat in reasonable proportions.

Regular physical activity and exercise result in positive improvements in health and fitness. Moderate amounts of physical activity can reduce the risk of certain types of cancer, heart disease, diabetes, and obesity. Burning approximately 150 kilocalories per day or 1,000 kilocalories per week leads to a reduction in the risk of coronary heart disease by 50% and of hypertension, diabetes, and colon cancer by 30%. The evidence for exercise providing a reduction in the risk of breast cancer is equivocal. Women who are physically active have higher resting metabolic rates and lower body fat, but similar fat-free mass, body mass index, and body weight compared to their sedentary counterparts. The type of exercise performed depends on the desired goal. If a woman wants to build muscular strength, then resistance training is appropriate. Exercise prescriptions for a female athlete are specific to the demands of her sport.

This chapter focuses on the psychosocial health care of women and suggests shifts in the paradigm of the approach in order to meet the needs of women that may be unique to them. Theories designed to describe normal psychological development of men resulted in description of women's development as aberrant or arrested. Relational theory sees women in a context broader than that assigned by their reproductive abilities or gender driven caretaking roles. Good psychosocial care of women respects relationships as fundamental and is capable of viewing the world through relational lenses. Providing humane, thoughtful psychosocial care to young women during the period of enormous transition and growth that marks adolescence is exciting and often very challenging for the provider. As women emerge from adolescence into adulthood, issues of relationship persist, but the complexities of attaining a livelihood, sustaining oneself, and possible partnering come more directly to the fore.

Normative changes occur in the sexual life of the individual. The onset of illness or chronic disease may have a significant impact on how and when a woman engages in sexual activity. Adolescence is a time of great physiological, emotional and psychological change. It is a time of exploration, emancipation, and a search for self-identity. For couples who want to continue sexual intimacy throughout pregnancy, the physician may recommend positional changes that are more comfortable for the woman and can accommodate the enlarging fetus. Pain, or the anticipation of experiencing pain, may have a negative effect on the woman's interest in sexual intimacy. Women in midlife, aged 40 to 65, can use guidance regarding the impact of chronic illness, hormonal changes, and medications on sexual functioning. Common sexual consequences of dementia include anhedonia, depression, impotence, incontinence, and anorgasmia.

Contraception is an inherent part of good health care for women. Emergency contraception (EC) is birth control used to prevent pregnancy after known or suspected failure of contraception or unprotected intercourse, including sexual assault. Women who use EC should be given additional opportunities to consider whether a more permanent or better method of contraception is warranted. Once adolescents have had a sexual experience, they may be even more open to reconsidering abstinence and should be encouraged to consider abstinence as a potential choice. Certain types of condoms provide some protection against sexually transmitted infections. Oral contraceptive pills (OCPs) are hormonal methods of birth control. For most women, pregnancy and/or abortion are associated with a greater risk of mortality and morbidity than oral contraceptives. Male sterilization is the most cost-effective contraceptive method, with a failure rate of 0.1 to 4%. Many circumstances affect a woman's access to contraception.

Women's causes of infertility include ovarian and tubal or mechanical factors. Cervical and uterine factors can include an abnormally shaped uterus (bifid, bicornuate, or anatomy changed by fibroids) or inimical cervical mucus. Both partners should be examined and cultured for sexually transmitted disease, especially chlamydia. Counseling the couple about the normal menstrual and ovulation cycle, about the effects of medications and alcohol on fertility, and about expectations on becoming pregnant is important. The effect of the infertility depends on the age of the couple, their personality and coping styles, pre-existing psychopathology, medical causes, and motivations for pregnancy. Five percent of children born to unmarried mothers during the 1990s were placed in adoption. The family physician can often make a positive impact on a couple's quest for fertility, using simple office-based diagnosis and treatment. The physician can help couples through fertility treatment and also through the problems and concerns of adoption.

Incorporating preconception care into primary care of young women enhances the preventive aspects of care and may improve pregnancy outcomes. The preconception approach to medical care includes optimization of chronic health problems and risks that may impact negatively on pregnancy. Specific preconception issues regarding common chronic disorders are addressed along with antepartum medical care in this chapter. Preconception care of type I diabetic women results in earlier prenatal care, lower glycosylated hemoglobin levels, fewer antepartum hospitalizations and fewer hospital days, and decreased intensity and length of stay for newborns. Perinatal consultation may be helpful as a preconception event in a number of high risk medical conditions and in women with an unexplained history of poor reproductive outcomes. A growing list of metabolic problems and hematological disorders are associated with preeclampsia, growth retardation, abruption, and other complications in late pregnancy.

Normal menstruation is the end product of a complex interplay of health and hormones. This chapter discusses the etiology, treatment and evaluation of amenorrhea, polycystic ovary disease and abnormal menstrual bleeding. Many of the causes of amenorrhea can also cause oligomenorrhea, metrorrhagia, menorrhagia, and other irregularities of menstruation. Primary amenorrhea occurs in adolescents who have never had a menstrual period. Women with amenorrhea can be placed on ovulation inducing drugs. An ovulation inducing agent, such as clomiphene is needed. Metformin may be used in those women with polycystic ovarian syndrome (PCOS). Metformin improves the endocrine symptoms of PCOS, even in women who are not diabetic. It treats insulin sensitivity, induces normal ovulatory cycles, and causes weight loss, although this is an off-label use. Heavy menstrual bleeding (HMB) is an important cause of ill health in women.

The menstrual and urogenital changes associated with perimenopause can be very distressing. Seventy-five percent of postmenopausal women experience atrophic genital changes. Vasomotor symptoms are often the most disruptive perimenopausal symptoms that a woman experiences. These can occur even before she sees any change in her menstrual pattern. There is significant variation in an individual woman's response to these, and the symptoms can be distracting, cause insomnia, and lead to unpleasant social situations. Menstrual patterns are altered in many ways, including menorrhagia, menometrorrhagia, oligomenorrhea, intermenstrual bleeding, polymenorrhea, postcoital bleeding and postmenopausal bleeding. In one small survey, 93% of women reported one of these changes in the five years prior to menopause. Etiologies of abnormal menstrual bleeding include endocrine abnormalities, pregnancy related, infectious (genital and systemic), neoplasms (benign and malignant) of pelvic organs, uterine abnormalities, coagulation disorders, liver disease, medication (iatrogenic), and trauma. Women with life-threatening bleeding need immediate treatment.

This chapter discusses the etiology, diagnosis and treatment of certain sexually transmitted diseases (STDs), including gonococcal (GC) infections, chlamydia infections, syphilis, genital herpes, pelvic inflammatory disease, HIV/AIDS, and hepatitis B. Gonorrhea is frequently asymptomatic in both men and women. Patients with gonococcal infections need to be evaluated for other sexually transmitted diseases, including chlamydia, HIV, hepatitis B and/or syphilis when appropriate. Neurosyphilis can occur, with symptoms of central nervous system (CNS) changes such as tabes dorsalis or dementia. All patients with syphilis should be tested for hepatitis B and HIV infections. Sex partners of women with pelvic inflammatory disease (PID) should be treated, especially to cover chlamydia and gonorrhea. Testing for HIV should be offered to all women, not just those whose behaviors may put them at risk of transmission, but to all women with an STD, including HPV.