WHO - Women / people with a cervix AND been sexually active between the ages of 25 to 74 years are invited to have a Cervical Screening Test every 5 years by the National Cervical Cancer Screening Program [ NSCP].  

WHEN - This starts once you have turned 25 years of age. It is repeated every 5 years if it is a normal or low risk result. The last would be at the age of 74 years. Can be stopped if done once after 70 years. 

This test checks for the presence of human papillomavirus [HPV] which is the main causative factor of cervical cancer. The presence of HPV does not mean that they have cervical cancer, but it is an early detection and take early action to prevent cervical cancer. If HPV is positive, they need to see a gynecologist for a further assessment like colposcopy to check cervix more closely and a biopsy of cervix is needed. 

Methods of collection;  

• Collection by your health care professional / GP; 

It is a simple and low risk procedure. Sometimes there is a mild discomfort especially in post-menopausal women. Involves inserting a speculum into your vagina and taking a swab directly from the cervix. 

• Self-collection; 

Self-collection for cervical cancer screening is a relatively new and empowering option  

In Australia it is becoming more accessible. Women and people with a cervix aged 25 to 74 years can choose self-collection. You'll be given a swab and instructions by your healthcare provider. When you collect the samples, it would be from your vagina. When your GP does it, the samples are taken from your cervix. If the samples are unsatisfactory, you will be notified to see your GP and repeat the collection by your GP. 

A breast examination is a crucial part of women's health care for early detection of  

breast cancer and other conditions. Breast cancers are detected after women presented to their GP with an abnormal feeling / lump/ pain/ discharge in breasts or through the breast screening program / mammogram. So self-breast examination, clinical examination by your GP as well as participating regular mammogram are crucial parts of detecting breast cancers.  

Symptoms and signs of breast cancer.  

You do not always get symptoms or signs of breast cancer. But it can present pain, sore spots in the breast, nipple or skin changes, nipple discharge or breast lump. 

Self-breast examination. 

WHO - Adult women in any age are advised to perform self-breast examination once a month. Women with menstrual periods, usually advised to do few days after the periods. Women in post-menopausal age advised to do same day each month. 

HOW -  

Visual examination;  

Look for changes in breast size, shape, skin texture and changes, nipple changes and discharge. 

Physical examination; Use the pads of your fingers to feel for lumps or thickening in the breast tissue and  

Underarm. 

This allowed you to familiarize yourself with how you look and feel your breasts, normally called self-breast awareness. This can be done while in the shower, in front of a mirror or lying down on a couch or a bed, If you detect something unusual in appearance or feeling [ breast lump, pain, sore spot, nipple discharge or abnormal appearance in breast skin or nipples], you need to make an appointment with your GP to examine your breast ASAP. 

Normal breast examination does not mean that you do not have to attend your 2 yearly mammograms. Abnormal finding in self-breast examination does not mean you got breast cancer, but it prompts you to seek early medical attention and exclude cancer. 

Clinical breast Examination; 

This is done by your GP who is trained to do clinical breast examinations and detect any abnormalities. This involves visual examinations as well as a physical breast examination.  

If your GP detects any abnormal findings, you will be directed to do further investigations like a mammogram, a breast ultrasound and also could be breast MRI scans. Any abnormal lumps in further investigations need to be biopsied. 

Mammogram 

The Breast Screening Australia program is a national program to reduce death from breast cancer by early detection. This is a free program.  

WHO – All Australian women  

WHEN – Age between 50 – 74 years, every 2 years  

WHERE – You can find a breast screening Australia location in your nearest town. (No 7-9, Wellington Street, Mackay. Call 132050 to make a booking.) 

ABNORMAL results detected OR any concerns – You will be directed to your GP or health care professionals for further investigations and management.  

A breast examination is a crucial part of women's health care for early detection of  

breast cancer and other conditions. Breast cancers are detected after women presented to their GP with an abnormal feeling / lump/ pain/ discharge in breasts or through the breast screening program / mammogram. So self-breast examination, clinical examination by your GP as well as participating regular mammogram are crucial parts of detecting breast cancers.  

Symptoms and signs of breast cancer.  

You do not always get symptoms or signs of breast cancer. But it can present pain, sore spots in the breast, nipple or skin changes, nipple discharge or breast lump. 

Self-breast examination. 

WHO - Adult women in any age are advised to perform self-breast examination once a month. Women with menstrual periods, usually advised to do few days after the periods. Women in post-menopausal age advised to do same day each month. 

HOW -  

Visual examination;  

Look for changes in breast size, shape, skin texture and changes, nipple changes and discharge. 

Physical examination; Use the pads of your fingers to feel for lumps or thickening in the breast tissue and  

Underarm. 

This allowed you to familiarize yourself with how you look and feel your breasts, normally called self-breast awareness. This can be done while in the shower, in front of a mirror or lying down on a couch or a bed, If you detect something unusual in appearance or feeling [ breast lump, pain, sore spot, nipple discharge or abnormal appearance in breast skin or nipples], you need to make an appointment with your GP to examine your breast ASAP. 

Normal breast examination does not mean that you do not have to attend your 2 yearly mammograms. Abnormal finding in self-breast examination does not mean you got breast cancer, but it prompts you to seek early medical attention and exclude cancer. 

Clinical breast Examination; 

This is done by your GP who is trained to do clinical breast examinations and detect any abnormalities. This involves visual examinations as well as a physical breast examination.  

If your GP detects any abnormal findings, you will be directed to do further investigations like a mammogram, a breast ultrasound and also could be breast MRI scans. Any abnormal lumps in further investigations need to be biopsied. 

Mammogram 

The Breast Screening Australia program is a national program to reduce death from breast cancer by early detection. This is a free program.  

WHO – All Australian women  

WHEN – Age between 50 – 74 years, every 2 years  

WHERE – You can find a breast screening Australia location in your nearest town. (No 7-9, Wellington Street, Mackay. Call 132050 to make a booking.) 

ABNORMAL results detected OR any concerns – You will be directed to your GP or health care professionals for further investigations and management.  

Women who are sexually active are better to have a regular STI check especially at the start of a new relationship. This commonly included a urine test for chlamydia, gonorrhea and mycoplasma genitalium. In high-risk individuals need to do blood tests for HIV, Hepatitis B &C and syphilis. 

In addition to that, it is better to see your GP if you had an intimate relationship (casual or regular) with someone with either STI symptoms or diagnosed with STI OR if you have suspected STI symptoms. 

Birth control is a method or device used to prevent pregnancy. The mode of action is interfering with the normal process of sperm meeting egg and fertilizing. Birth control is used just to prevent the fertilization as well for medical reasons like endometriosis, periods pain and heavy bleeding. 

There are various types of birth control, each with its own advantages and disadvantages.  As some birth control methods are contradicted for some women depend on their medical issues, drug interactions and side effects, your doctor will help you to choose a suitable method. Lifestyle and social factors need to be considered when choosing your contraceptive method.   

The types of birth control  

They divided into natural methods, hormonal methods and surgical/sterilization. 

Natural method; 

This is the only 100% effective method in not getting pregnant and attracting sexually transmitted diseases. This method is not having sexual intercourse at all.  

Barrier methods; 

This creates a physical barrier between sperm and egg to prevent pregnancy. It also gives some sort of prevention to sexually transmitted infection. Ex; male condoms. 

There are no side effects of this method.  

This includes;  

• Condoms for both males and females  

• Diaphragms and cervical caps – insert into vagina to cover the cervix to prevent sperms contacting egg. 

Hormonal methods; 

Few different types of hormonal methods; oral contraceptive pills [combined and progesterone only pills], injections, intra uterine devices, implants [‘bar’] and vaginal rings.  

There is no protection for STIs in hormonal methods.  

Benefits; 

• They are highly effective when used correctly and regularly, they are effective in preventing pregnancy. 

• Reduce menstrual cramps, painful periods and heavy bleeding. 

• Regular and lighter bleeding. [possible irregular periods in first couple of months after starting and then become regular]  

• Manage symptoms of Premenstrual syndrome [PMS] such as mood swings, irritability, headaches, fatigue before periods.  

• Hormonal contraceptive methods can reduce risk of ovarian cancer and endometriosis when use them regular and long term. 

• As a treatment of other medical issues like endometriosis, polycystic ovarian syndrome, acne. 

Side effects; 

Though they are an effective way of preventing pregnancies, they are not without side effects. You will not experience all these side effects, and some are not experiencing any side effects.  

Common side effects are nausea, mood changes, breast tenderness, headaches, weight gain and irregular bleeding or spotting in between periods which can occur especially in the first few months after starting.  

Risks associated with hormonal contraception 

Long term use of hormonal methods can lead to these risk issues. These risks are mainly with combined oral contraceptive pills. Your doctor will discuss before starting pills. 

• Blood clots – DVT. There is increased risk of DVTs when use long term compared to women who are not using them. 

• Slight increased risk of breast and cervical cancers. 

• Risk of increased blood pressure, cardiovascular diseases. 

You are advised to have a regular general checkup, blood pressure monitoring, blood sugar/cholesterol check and attending screening methods like cervical cancer screening / mammograms as indicated.

Oral contraceptive pills 

Combined oral contraceptive pills [‘pill’];  

This is a highly effective around 99% and daily tablet. Helpful in conditions like endometriosis, PCOS, acne and irregular periods. You can experience side effects such as nausea, headaches, mood swings, weight gain and increased risk of blood clots. 

Contact your doctor if you missed or delayed a pill. 

Progesterone only pill [‘Mini pill’];  

This is an alternative to combined oral contraceptive pills to the women who cannot take estrogen due to side effects, severe migraine and breast feeding. There is a lower risk of blood clots. 

This is a daily pill, and missing pill or delayed pill can reduce the effectiveness.  

Contact your doctor if you missed or delayed a pill. 

Injectable contraceptive methods 

Effectiveness is around 99% and it is a 3 monthly intramuscular injection usually in your upper arm. It is convenience for the women who are not good in remembering to take daily pills as well as who cannot take estrogen. 

Side effects; can cause irregular bleeding at the beginning, weight gain and reduced bone density leading to osteoporosis if used for a long term. 

Intra uterine device [IUD] 

They are small T-shaped devices. Effectiveness around 99% and long lasting.  Inserted and removed by health professionals.   

There are 2 types – Copper IUD and hormonal IUD.  

Copper IUDs are a good alternative for those who prefer non-hormonal methods. Copper IUDs last for 5-10 years while hormonal IUDs last for 5 years. 

There are 2 types of hormonal IUDs are available in Australia. They are called Mirena and Kyleena. Kyleena contains relatively low dose of progesterone.   

Common side effects are initial discomfort and spotting after insertion, irregular periods in the first couple of months. Sometimes it can cause heavy and irregular periods. 

Implants [‘Bar’] 

It’s a small, flexible rod inserted under the skin of your non dominant upper arm. Effectiveness is around 99% and long lasting for 3 years. Insertion and removal done by your doctor under local anesthesia.  

Possible side effects are irregular periods in the first few months, headaches, breast tenderness and weight gain. 

In any form of contraceptive methods, you are strongly advised to have regular check up with your GP [blood pressure, weight, BMI, blood sugar, cholesterol, regular breast examinations] and attend regular screenings [cervical cancer screening, mammogram]. 

In long term contraceptive methods – Injections, IUDs and implants- your doctor or the nurse will inform you when it is due next and also will send you reminders.   

Menopause is a natural process of reproductive life marking the end of the reproductive life of a woman. This occurs as a result of lack of estrogen production secondary to loss of ovarian follicles and ovarian follicle development. Natural menopause confirms after 12 consecutive months without periods since the last period. This usually occurs between 45-55 years. Australian median age of menopause is around 51. Around the menopause time [perimenopausal period] women can experience various symptoms affecting day to day activities, social life and work.  

Menopause is av natural and a biological process however some women go though that’s earlier than expected due to removal of ovaries for another medical issue. 

Symptoms; 

Hot flushes, night sweats, irregular periods, mood changes, sleep disturbances, dry vagina, loss of vaginal lubricants and urinary tract infections are among the commonest symptoms. 

Furthermore because of menopause, women can experience weight gain, skin dryness, loss of bone density and loss of muscle mass.  There could be mood changes, heightened anxiety levels due to unbalanced hormone levels in the body.

Due to metabolic changes in menopause, they are high risk in developing cardiovascular health issues such as ischemic heart disease and strokes.   

Diagnosis 

Menopause is a clinical diagnosis.  

Symptoms scoring is a useful way to diagnose menopause. 

Blood tests/ FSH hormone levels are not recommended but sometimes can be used in women who had hysterectomy and women who have been on contraceptive methods in menopause age.  

Management 

Lifestyle modification plays a major role in menopause management. Eating healthy, regular exercise and managing weight are main aspects of management. 

Menopausal Hormone Therapy [MHT/HRT] 

MHT can be considered for women who are experiencing symptoms excessively. There are combined MHT as well as estrogen only MHT.  

Estrogen therapy – Used for the women who had hysterectomy in past. Comes in tablets, patches, creams and gel forms. Topical treatment has fewer side effects compared to oral forms.  

Combined estrogen and progesterone therapy – Used for the women who still have their uterus intact. 

Vaginal preparations – Estrogen cream, rings and tablets come in vaginal preparation to help dry vagina and pain. 

Risk of MHT 

Use of MHT is not without risk. They slightly increase the blood clots and breast cancer risk. But with newer MHT preparations side effects are less than what they were before. But still got a slightly higher risk than the women who are not on MHT.  

Dysfunctional Uterine bleeding is condition that you can get due to heavy, excessive, irregular, and prolonged uterine bleeding that is not related to an underlying condition in uterus such as pregnancy, polyps or cancers. But in this condition, we have to exclude other possible causes. 

Symptoms; Usual symptoms are irregular, prolonged, heavy bleeding, potting in between periods and lower abdominal pain or cramps. 

If you are experiencing these symptoms, your doctor will arrange for an ultrasound scan, blood test, STI check if there is a risk, and cervical screening test if it is not up to date.  

Management; Usually this can be treated with medical management, but in uncontrollable heavy bleeding you'll be referred to a gynecologist for a uterine biopsy, endometrial ablation and hysterectomy.   

This is a chronic and debilitating condition. Women usually can experience periodic lower abdominal pain, heavy monthly bleeding, pain with ball opening. Sometimes it can lead to subfertility. 

Investigations are blood tests and ultrasound scan management. It can be managed medically. If symptoms are not improved, you need to see a gynecologist for further assessment and management.  

The Bowel Cancer Screening Program in Australia [ NBCSP] aims to detect bowel cancer early and then to treat and reduce the death from bowel cancer. This is a free program. 

TEST – The screening test is called FOBT. You will receive 3 containers in the post to collect 3 stools samples and drop them in to the mail. If you are late for the test, you can call 1800627701 OR your GP can request a test. It is a simple noninvasive pain free procedure. 

WHO – For all Australians 

WHEN – Age between 50 – 74 years old. But from July 2024 people between 45 – 49 can participate in the program. It is done every 2 years. 

ABNORMAL results – If the stool samples are positive for blood, your doctor will discuss the possible causes and will arrange for a colonoscopy +/- endoscopy. 

Discussed in detail in chronic disease. 

Osteoporosis is a condition where bones become weaker, lighter and brittle, making them more prone to fractures. Specially women after menopause or men after 50 years of age more prone to get this.