— Bahá'u'lláh Authors Roza Olyai MS MICOG FICMCH FICOG National Chairperson, Adolescent Health Committee FOGSI Member, Governing Council Indian College of Obstetricians and Gynecologists WHO Consultant Expert Panel ASRH, WHO-Geneva Honorary Secretary, Family Planning Association of India, Gwalior Founder Secretary, Indian Menopause Society, Gwalior Director, Olyai Hospital, Gwalior, Madhya Pradesh, India Email: email@example.com Krishna Kavita Ramavath MD FICOG Visiting Clinician Department of Gynecology Gynecological Surgery, Phoenix Arizona, USA Email: firstname.lastname@example.org
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Smart Life @ 40 Plus
First Edition: 2012
Printed atSmart Life @ 40 Plus
The book provides an update on advances made in the management of women's health and lays significant emphasis on preventive care.Message
Women's health has been a neglected aspect of the healthcare system, especially in low-resource countries. Efforts have been progressing over the past few decades to promote women's health as an essential health and development strategy.
The International Federation of Gynecology and Obstetrics (FIGO) has a vision that women of the world achieve the highest possible standards of physical, mental, reproductive and sexual health and well-being throughout their lives. FIGO encourages its member associations and obstetricians and gynecologists throughout the world to work towards the promotion of preventive and curative healthcare for women.
Smart Life @ 40 Plus is a superb contribution to the promotion of women's health-topics, include all major pertinent issues related to the preventive health of women in this important age category. The suggested measures will help women to achieve and maintain sound health with confidence for the rest of their lives.
I would like to congratulate the authors on this extremely valuable addition to the field of women's health promotion. It deserves to be widely disseminated to women and healthcare providers to achieve its vital objectives.
Professor Hamid Rushwan
International Federation of Gynecology and Obstetrics
Smart Life @ 40 Plus is an exceptionally magnificent contribution to women's health all over the world. Drs Roza Olyai and Krishna Kavita Ramavath deserve our sincere congratulations and thank you for bringing out this volume that tackles every need of women from healthy living by proper eating, sleeping and exercise to the public health aspects of screening to management of medical problems of incontinence, utero-vaginal prolapse and the issues related to menopause. The volume provides the information on issues related to general health that gets affected with age such as diabetes, heart disease and cancer. Every woman can get their perfect health by following the advice provided. This volume is highly recommended reading for healthcare professionals and women—a true compendium rich with valuable information.
Sir Sabaratnam Arulkumaran
Professor of Obstetrics and Gynecology
Deputy Head of Clinical Sciences
St George's University of London
Former President, RCOG
President Elect, International Federation of Gynecology and Obstetrics
Good health and education are two important pillars on which life of individual progresses. Since longevity of human life has doubled from 40–50 years to 80–90 years in the last century, sustenance of health for these many years is essential to be able to enjoy the extra lease of life which is not just 4 to 5 years but 30–40 years.
Smart Life @ 40 Plus covers very well the needs and means a woman should be following to fully enjoy the postmenopausal life. To impart right knowledge and create awareness in a woman, covering all different aspects of health is an art very few authors have, which is well-appreciated in the book.
India is a multilingual large country with a large population. This book will have a better coverage if published in many languages.
I congratulate the authors for their effort and deep commitment to educate and empower the present-day women to enjoy a healthy post-menopausal life.
Padmashree Dr Rustom P Soonawala
Professor of Obstetric and Gynecology
When I went through the book Smart Life @ 40 Plus written by Dr Roza Olyai and Dr Krishna Kavita Ramavath, I felt the book was most appropriate for the Indian women.
In the years of my experience with Indian women, I feel the single most important factor which is lacking in their lives is the awareness of theirself. Women are today in the forefront. I personally felt that they should know how to take charge of their lives and cannot afford to neglect their health. Awareness in a woman will bring about awareness in the whole family and likewise in the whole community.
To the casual reader, this book will be impressive because of its sheer size and the opportunity to get to know new details about health and health maintenance. Practitioners and women of substance will be happily surprised by the book's depth of detail in every chapter and yet its simple smart ways of dealing with the complexities the subject necessarily must have.
As one goes through the chapters of the book, they let us quietly weigh the evidence for ourselves. Smart Life @ 40 Plus is a moving piece about women's health.
I highly recommend this book to the Indian women, who are not only above 40 but are careful about their health.
I congratulate the authors for bringing out an excellent publication which brings out the smartness in the lives of women and gives them the road to productive decades ahead!
Mrs Zia Mody
BA (Law) Cantab, UK; LLM (Harvard), USA
Senior Partner, AZB and Partners, IndiaForeword
With so many thousands of centenarian women presently in the world and a higher number predicted for the future, Dr Roza Olyai and Dr Krishna Kavita Ramavath are telling us in their book that life for women starts after 40. The information is geared to provide a healthy life after 40, following the saying of a centenarian woman from Jaipur: “If you treat your body well, the body treats you well, too.”
There is excellent advice not only for a healthy body but also for a healthy mind. As St Thomas Aquinas wrote in the 1200s: “Healthy mind in a healthy body.” One could also say nowadays as a result of the increased life stresses: “Healthy body in a healthy mind.” Prevention of cancer and other diseases, nutrition, adequate sleep, and exercise are all important and well detailed. A most important advice, very unique and original in a book of this type, is the awakening and developing of the inner resources of control instead of depending on medication, such as relaxation and meditation. The consequences of pregnancy and delivery, typically appearing late in life, are well addressed with excellent medical and surgical advice. Diseases of advanced life, such as osteoporosis, diabetes, and heart disease, are well covered with practical advice also on prevention, in particular emphasizing prevention of obesity, more important than its correction.
The book ends on an important subject usually neglected in most health books, having a smart life with a positive and spiritual attitude.
I congratulate Dr Roza Olyai and Dr Krishna Kavita Ramavath on their efforts to bring a positive look to women's life after 40, and for encouraging them to maintain a healthy mind and a healthy body in such important period of their lives.
Javier F Magrina MD
Professor of Obstetrics and Gynecology
Director, Gynecologic Oncology
Barbara Woodward Lips Professor
Mayo Clinic, Scottsdale
Phoenix, Arizona, USAPreface
Blow the 40th birthday candle and wish for a forty more!
These days a woman over forty faces middle years with confidence. Medical science has changed her “over forty years” and have added years to her life making her feel completely a changed and different person.
Fortieth birthdays are the milestones for women. Today women know that first forty years are the years of getting and reaching there and thinking about how to deal with the world. They are multitasking from taking new jobs, changing carriers, marrying and even having children. Days have changed and modern medicine has invested so much in women's health that today's women know that they can handle their lives in a much better way.
It is interesting to know that men who appreciate women over forty see in her as a fascinating person. This is partly, because she has the wisdom of her years and partly, because she knows how to deal with a man and treat him better. On the whole, she is transformed, mature with self-confidence, knows how to carry herself and can listen to other person with care and compassion. Hence, during this prime age of life women need to take care of themselves and invest in healthy lifestyle for a better future.
We are happy to share our knowledge and vision with you in this book. As the title suggests, you will find many answers to your health concerns. We have brought out smart choices which will help you in decision-making and taking right steps towards your health.
Smart Life@ 40 Plus in a class by itself provides chapters related to smart talk with your doctor, smart life of centenearians, eat smart, exercise and energize, smart skin care, positive health and so on. We have included certain websites for additional information about few important topics. Our aim is to empower women to take charge of their lives during forties and beyond.
Our attempt is to convey the important message that the small steps taken now towards a preventive care at the age of 40 or beyond make a huge difference in the coming years to come because we are gifted to live many more years happy and healthy. This book will definitely be useful not only to the clinicians but to undergraduate and postgraduate students, all public health specialists and NGOs.
Leave behind the tensions and worries of youth, blow the fortieth birthday candle and wish for a forty more! It is a time to pause and celebrate you for the vibrant years ahead.
Wish you all a happy reading!
Krishna Kavita RamavathAbout the Authors
MS MICOG FICMCH FICOG
Dr Roza Olyai has a brilliant academic background being honored for securing distinctions and ten gold medals during her medical schooling. Awarded Dr Mrs C Khare Award by the Indian Medical Association, Madhya Pradesh State Branch, for having secured highest marks in Gynecology in MBBS in the state of Madhya Pradesh India.
Awarded Dr Nawal Kishore Award for Best Paper Presentation during FOGSI, Catch'em young millennium conference at Agra 2001.
Awarded Certificate of Appreciation in recognition of laudable participation in cause of adolescent care through FOGSI—J and J School Health Program, organized by FOGSI, 2002.
Awarded certificate of appreciation for Emergency Obstetric Care Training by FOGSI, ICOG and Ministry of Health and Family Welfare, Government of India (2008).
She has been honored the Gwalior Ratan for Best Doctor of the year in 2010.
She is the Founder Secretary of the Indian Menopause Society Gwalior Chapter in India.
She is also the National Trainer Adolescent Health, FOGSI-IMA-IAP-WHO. She was invited as WHO Consultant in 2010 to represent the International Federation of Gynecology and Obstetrics at WHO, Geneva, Switzerland, for a meeting of experts on making guidelines for “Preventing early pregnancies and poor reproductive outcomes among adolescents in developing countries”.
She is the National Resource Person EmOC, FOGSI-ICOG, Mac Arthur Project, John Hopkins, USA.
At present, she is the National Chairperson of the Adolescent Health Committee (2009–12) of the Federation of Obstetric and Gynecological Society of India, Member Governing Council of Indian College of Obstetricians and Gynecologists of FOGSI (2012–15) and the Honorary Secretary of the Family Planning Association of India, Gwalior.
Her recent publication includes the book title Recent Advances in Adolescent Health which was edited by her in 2011, foreworded by Dr Hamid Rushwan, Chief Executive FIGO, a FOGSI Publication by Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India.
She is also the editor of the Adolescence magazine apublication of the Adolescent Health Committee, FOGSI since 2010 till date.
Editor-In-Charge Menopause—A Reality Publication of the Indian Menopause Society and the Co-Chair Publication Screening Committee Indian Menopause Society (2011). She is also on the Board of Editors, POISE Magazine,a National Publication of the Indian Menopause Society.
She has coordinated various National School, College Health Projects and published various booklets for the adolescent girls like Protecting Young Girls and Challenges for Youth Today and Tomorrow—FOGSI Publications.
She has edited and published the FOGSI Guidelines in Establishing Adolescent Friendly Health Centers in consultation with WHO in accordance with the Government of India Guidelines (2010). She has also published many chapters in various Textbooks for postgraduate/undergraduate students and published many articles in various national and international journals.
Krishna Kavita Ramavath
Dr Krishna Kavita Ramavath had obtained her MD in Obstetrics and Gynecology from the prestigious Andhra Medical College, Vishakapatnam, India.
She started her illustrious career as an Assistant Professor of Obstetrics and Gynecology at the same medical college and King George Hospital in Visakhapatnam.
Presently, she is with Mayo Clinic, USA as a visiting clinician in Robotic Surgeries. As an internationally trained and highly skilled surgeon, Dr Kavita specializes in infertility, sonography, hysteroscopy and laparoscopic techniques. She holds a Diploma in Advanced Gynecological Endoscopic Surgery from the University Hospital, Schelswig-Hostein, Kiel, Germany.
During her 12 years career besides being a gregarious surgeon, she is an active academician, contributed many publications, delivered lectures and talks in several regional, national and international forums. A multifaceted personality, she was general secretary of Obstetrics and Gynecological Society of Visakhapatnam, an affiliate body of FOGSI, during 2009–2010.
Dr Kavita's contributions were widely recognized and she was bestowed with several awards including Best Doctor Award for Visakhapatnam District in 2003, and Academic Excellence Award by Obstetric and Gynecological Society of Visakhapatnam, in 2009 and Dr Kamini Rao Award-Yuva Fogsi Orator for the year 2010.
Dr Kavita had made the obstetrics and gynecological community of Andhra Pradesh proud, by being the first recipient of the International Fellowship Award of the International Federation of Gynecology and Obstetrics (FIGO) in 2009. She was awarded this fellowship for her research paper Cancer Cervix—A Revolutionary Therapeutic Approach Needed, which she had presented at the FIGO 19th world congress of Gynecology and Obstetrics, held in Cape Town, South Africa, in October 2009.
She is also a recipient of Clinical Attachment in Robotic Endoscopic Surgeries at the world renowned Mayo Clinic, Phoenix, USA.Acknowledgements
We are grateful to Professor Javier F Magrina, a world renowned Robotics Surgeon, Department of Gynecology, Mayo Clinic, Scottsdale, Arizona, USA for writing the foreword for us.
We are thankful and specially honored by the messages received from Professor Hamid Rushwan, Chief Executive, FIGO; Sir Sabaratnam Arulkumaran, President Elect, FIGO; Padmashree Dr Rustom P Soonawala, President, FOGSI-1996, and Mrs Zia Mody, Senior Partner, AZB and Partners, India.
We are very grateful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for publishing this book and help spread the message.
We would like to thank Mr Narendra Katore, for designing the cover page, Dr Radha and Dr Tim Rost, for their inputs. We would also like to thank Professor Manika Debnath HOD, Department of Health Sciences and Yoga, Lakshmibai National University of Physical Education (LNUPE) and Mr KM Asthana, for the photographs.
I thank my Guru, Sri Sri Paramahansa Yogananda with deep reverence for being my inner strength and invisible inspiration to bring out this book.
I am especially thankful to my father, Professor RA Naik MD (Rtd.) Department of Medicine, King George Hospital, Visakhapatnam, India, a keen eyed editor of all my works. He provided a very sensitive, thoughtful and intelligent input at every phase in the evolution of the book.
Heartfelt appreciation goes to my mother Dr Srilakshmi MA Phd (Rtd.), HOD, Department of Sociology, Andhra University, Visakhapatnam, India, for not only providing intellectual guidance but also for her helpful comments on the entire manuscript.
Finally and most importantly, I thank my husband Srinivas Reddy Engagement Manager, Wipro, USA and my beloved son Neeraj Vasisht, for being so loving and supportive. They have been a constant source of contribution to my learning in an imperceptible way, from inception of the idea to the completion of the book.
Last but not the least, I am greatly indebted to my parents Mrs and Dr Moussa Ramezani Sarajari, my late father-in-law Mr Sohrab Rustom Olyai and my late mother-in-law late Professor Perin Olyai who have given me the courage to face challenges of the world by inculcating good attributes in me, to my loving and supportive husband Dr Nayson Olyai, for his constant support and being my best critic, my daughter Neda and my son Navid, for their tolerance and understanding of the time away from them during my career and in editing this book and being the backbone to my progress.Know Yourself: Smart Life @ 40 Plus-Health Assessment
Balance in life comes by adopting a healthy lifestyle. By knowing your limitations, you will perform your duties more powerfully. But when it comes to health you do better only when you know more about yourself. Being familiar with one's ownself and truly knowing about the basic health status is important to lead a pressure free smart life. Before attempting the book, we urge you to take this challenge on your health assessment, which will motivate you to focus on the efforts of prevention.
Most of the assessment can be completed in less than 3 minutes but it will help you to better understand the risk areas of your lifestyle to make proper changes. It just needs a pen or pencil to circle the numbers that you think are right. For the numbers, No. 1 stands for never and No. 5 stands for always. The middle numbers 2, 3 and 4 can be circled according to the intensity. Once you have circled the numbers, do the total of the score and check the result.
Let us take the assessment:
1. My diet is healthy and balanced.
2. I exercise regularly 4 to 5 times a week for 30 minutes
3. I have a stress free job and home environment
4. I have made financial future secure
5. I have my routine health checkups annually
6. I am aware of the diseases in my family
7. I feel connected to people and adopt well
8. In general, I would say that I feel healthy
9. I have a refreshing sleep every night
10. I am actively involved in social service
If your score is 0-10
You are heading towards your risk. Crisis may suddenly come to you—be aware. Take charge of your life!
If your score is 11-20
You are lacking a vision for health in long run. Try to make changes to embrace the quality of life you deserve. Take a life style leap!
If your score is 21-30
There are some areas of flaws in your lifestyle but some areas are flawless. Watch for the things out of control and strike a balance!
If your score is 31-40
You are nearing the goal of smart life ahead. You need to have an open eye for good things in your life. Try to improve every other area by seeing things to the best of your judgment. Make more healthy choices!
If your score is 41-50
You are on your way. You are living in balance. Life gives you unbounded opportunities to express your unlimited potential. Make use and get going!Common Health Concerns After 40
Today, women think of menopause as a time in their lives when they are free to do all those things they have waited a lifetime to do. During the middle years, there are a number of physiological changes that take place in a woman's body. Some can be modified; some can be controlled; and some cannot be. However, the important thing is to realize which factors can be prevented and how to take care of one's health.
For many women, the change brings mild symptoms which may not bother them at all, and others find themselves suffering from a wide range of unpleasant symptoms. As the hormonal changes begin to occur, it is not unusual for a woman to see changes in her personality.
Most of the conditions have been discussed in the book in various chapters, but some are beyond the scope of this book. Smart Life @ 40 Plus brings you the common health concerns which women should know and be vigilant. A full evaluation with a gynecologist helps you to take care of yourself with timely interventions.
The greatest risk of a woman who has approached 40 is heart related ailments. This has been discussed in Heart health in detail. We know that the hormone estrogen protects women from risks related to heart disease. As estrogen decreases from 40's, women come under great risk of heart disease. Chest pain, nausea, vomiting, shoulder ache, shortness of breath are few symptoms of heart disease. Heredity, diabetes, obesity, blood pressure, high cholesterol, metabolic syndrome and physical inactiveness are the factors behind the disease. Smoking and alcohol have also been directly implicated.
Osteoporosis is the next most common concern. As calcium levels decrease in the body, the bone density decreases making bone structure brittle. This results in joint pains and frequent fractures. Calcium rich food like leafy vegetables, milk, and curd, etc. together with regular intake of calcium and vitamin D may prevent the disease. Regular exercise prevents osteoporosis. A detailed review is described in the next chapter on osteoporosis.
Breast cancer is another common problem around this age. It is the most common type of cancer among women. First degree relative genes BRCA 1 and 2, early onset of menstruation before the age 12 and late menopause after 55 years, nulliparous and not breastfeeding, continuous use of oral pills, etc. are some of the causes of breast cancer. Today mammograms are still the gold standard to screen for breast cancer because these cancers are picked up quickly by mammograms even before the woman or her doctor picks up the lump. Upgraded mammograms are computer aided detection (CAD) and digital mammography, which aid radiologist's ability to detect breast cancer early. For early detection of breast cancer get the mammogram done annually starting from 40. Discuss your risk factors with your gynecologist.
Hormonal changes around menopause may trigger problems like mood swings, excessive perspiration, insomnia and depression which are also important problems related to this age. A well-balanced life with regular exercise, yoga and meditation and nutritious diet helps to stay healthy and fit as age advances. One has to update with the latest health news and should aim for self-care.
Gone are the days when mothers agonized over kids leaving home, today's woman is more likely to wish them well and then take up new career or concentrate on putting the romance back into her marriage. Women who turn 40 today have a lot more waiting for them than those who reached that milestone a generation ago.
Reaching 40 is a great time for many women and for many others today; “mid-life crisis” is not even in their vocabulary. A positive health after 40 also aids in undoubtedly good sex life.
Estrogen replacement therapy (ERT) was found to ease the hot flashes and mood swing problems of menopausal women. Thirty years ago, estrogen replacement was a promising therapy for woman to be forever feminine. The euphoria quickly evaporated, when uterine cancers and breast cancers were increased in women who took HRT.
Currently, the pendulum has swung away from HRT. Women are not encouraged to take hormones unless approaches like lifestyle modifications with a well balanced low fat diet and regular exercise and nonhormone prescriptions do not help and the symptoms are debilitating.
It is important to remember that all the scientific research and data available are out there today, and that the information is likely to change often. This is certainly true with the health concerns. We have discussed here in this book for women who have entered their middle years — while some form of preventive medicine may still be necessary very early. The choices about care and treatment become part of an ongoing process between a woman and her doctor. Their effective communication brings good rapport and exchange of ideas which will lead to informed decisions.