López García-Franco Alberto, Alonso-Coello Pablo, Pereira Iglesias Ana, González Fernádez Cristina, Romero Pineda Elisa, Landa Goñi Jacinta
Medicina Familiar y Comunitaria, Centro de Salud Dr. Mendiguchía Carriche, Leganés, Madrid, España.
Medicina Familiar y Comunitaria, Institut de Recerca Sant Pau, Barcelona, España.
Aten Primaria. 2024 Nov;56 Suppl 1(Suppl 1):103131. doi: 10.1016/j.aprim.2024.103131.
In the 2024 PAPPS update, we present preventive activities specific to women's health, except those related to cancer prevention (which are included in another document) and aspects related to differential morbidity of gender, which is a cross-cutting element for all working groups. Contraception is an essential preventive activity; the right to decide both the number of children that they will have and when to have them is considered basic. We must inform about contraceptive methods, guaranteeing in follow-up their safety, efficacy, and effectiveness (tables are included on changing from one method to another to preserve contraceptive protection). We must inform about emergency contraception and propose it in in the event of unprotected intercourse. We will use opportunistic screening to do this, without needing to screen for thrombophilia or dyslipidaemia, but we will screen for hypertension. Pregnancy is a major life experience and general practitioners should not ignore it. We should be competent at both preconception consultation (recommend folic acid intake, avoiding exposure to occupational and environmental hazards, screen for certain pathologies, and assess the intake of medication not indicated during pregnancy) and during follow-up of pregnancy. Whether or not we follow-up the pregnancy, we should not fail to monitor it, taking advantage of this period to promote healthy lifestyles and manage potential intercurrent events. Menopause in general and osteoporosis in particular exemplify the strategy of medicalising life events that has been followed by different bodies and organisations. In our update we address the prevention and treatment of symptoms secondary to oestrogen deprivation. We also propose osteoporosis prevention, including bone density scanning according to the fracture risk in the next 10 years, therefore, bone density screening is not recommended in women under 60 years of age. We recommend the FRAX tool for assessing risk, or better, measuring hip fracture risk with prevalence data from the Community of Madrid. The indication for treatment is linked to the Z-score (bone mineral density compared with women of the same age), since this is a condition associated with aging, and not the T-score, which is used to compare women of 20 years of age.
在2024年PAPPS更新中，我们介绍了针对女性健康的预防活动，但不包括与癌症预防相关的活动（已包含在另一份文件中）以及与性别差异发病率相关的方面，这是所有工作组的一个贯穿各领域的要素。避孕是一项基本的预防活动；决定生育子女数量和生育时间的权利被视为基本权利。我们必须宣传避孕方法，在后续过程中确保其安全性、有效性和实效性（包括从一种方法转换到另一种方法以维持避孕保护的表格）。我们必须宣传紧急避孕，并在发生无保护性行为时予以推荐。我们将通过机会性筛查来进行此项工作，无需筛查血栓形成倾向或血脂异常，但要筛查高血压。怀孕是一项重要的人生经历，全科医生不应忽视。我们应在孕前咨询（建议摄入叶酸、避免接触职业和环境危害、筛查某些疾病以及评估孕期禁用药物的摄入情况）和孕期随访方面具备能力。无论我们是否对孕期进行随访，都不应疏于监测，利用这段时间促进健康的生活方式并处理潜在的并发事件。一般的更年期，尤其是骨质疏松症，体现了不同机构和组织所遵循的将生活事件医学化的策略。在我们的更新中，我们讨论了雌激素缺乏继发症状的预防和治疗。我们还提出骨质疏松症的预防，包括根据未来10年的骨折风险进行骨密度扫描，因此，不建议对60岁以下女性进行骨密度筛查。我们推荐使用FRAX工具评估风险，或者更好的是，利用马德里自治区的患病率数据来测量髋部骨折风险。治疗指征与Z评分（与同龄女性相比的骨矿物质密度）相关，因为这是一种与衰老相关的病症，而不是用于与20岁女性进行比较的T评分。
