Reflecting on the Women’s Sexual Health Course for NPs

NPWH and the International Society for the Study of Women’s Sexual Health (ISSWSH) hosted the fifth annual Women’s Sexual Health Course for NPs in June. Samantha Tojino, NP-C, FNP, DNP-s, first attended the course in 2013 and returned this year as a faculty member. She reflects on this year’s program and the need to have a course specifically focused on women’s sexual health.

Q: Why is the Women’s Sexual Health Course so important?

Before NPWH and ISSWSH developed the Sexual Health Course, there were no post-graduate education or training programs designed to keep nurse practitioners up to date on the latest practices and standards of care in women’s sexual health. Sexual health is critical to overall health and wellness throughout a woman’s life – from sexual debut and STD prevention through the childbearing years and continuing on through menopause and beyond. Unfortunately, few educational programs spend adequate time on this essential topic.

Q: Who can benefit from the Sexual Health Course?

NPs are the ideal practitioners to address sexual health needs. With their ability to have intimate conversations with patients about sometimes taboo and difficult subjects and their clinical experience with women of all ages, NPs offer a knowledgeable and caring approach to sexual health. But the Sexual Health Course isn’t just for women’s health NPs. It is a valuable complement for all nurse practitioners who deal with women’s health, including FNP, AGNPs, and CNMs.

Q: What’s unique about the instruction offered by the Women’s Sexual Health Course?

The Sexual Health Course was created by NPs recognized as sexual health experts for NPs wanting to enhance their competence in women’s sexual health. With input from both NPs and physicians, the course focuses on the knowledge and skills advanced practice nurses can include in daily practice to enhance women’s sexual health as well as specialty knowledge geared to identifying and treating women with sexual dysfunction.  The course includes content on hormone therapy specifically geared to nurse practitioner management of sexual function and dysfunction as well as training in detailed vulvar, vaginal, and pelvic examination. The vulvoscopy workshop provides a hands-on approach for providers, enabling them to evaluate epithelial dermatologic conditions during the vaginal exam. Participants are guided by experts in the field.

Q: Has interest in the Sexual Health Course changed over the years?

Yes, course offerings – and the number of participants – have grown significantly since 2013. As our program grows, more providers are taking advantage of this opportunity to better serve our patients.

Q: What were the key takeaways for participants this year?

  1. Women’s sexual health is a complex subject! Nurse practitioner education and experience lead to better patient outcomes.
  2. Sexual health is a basic human right and a vital component of overall lifelong wellness.
  3. Female sexual dysfunction can affect quality of life for a woman and her partner – but nurse practitioners can help.
  4. With the knowledge gained from this course, nurse practitioners are more confident in their ability to address, diagnose, and treat their patients’ sexual health concerns.

Spotlight on Caregivers

U.S. longevity trends are thrusting more women into caregiving roles. NPWH recently led discussions at two national summits on women’s health spotlighting how women’s health advocates must be and are increasingly focused on the roles and needs of women caregivers. For too long, caregiving has been a social and health challenge in the shadows, but as more of us age and take on the role of caregiver, there are many things to know.

Diana Drake, DNP, MSN, APRN, WHNP-BC, reflects on these efforts to put caregiving needs front and center, and shares caregiving trends health care providers should know.

Did you know? The numbers tell us we need many hands on deck and thoughtful planning.

  • The U.S. 65-and-older population is projected to nearly double over the next three decades, ballooning from 48 million, to 88 million by 2050.
  • The nation’s first wave of Baby Boomers will turn 85 twelve years from now in 2030.
  • 85 –year olds are twice as likely as 75-year-olds to need help getting through the day.
  • Increased longevity has already resulted in more than 34 million “informal” caregivers to support our aging population.
  • Family caregivers have been described as America’s other Social Security. The nation’s healthcare system would go broke if it had to pay for their work, valued at $470 billion a year in free care.2

Who are these caregivers? Many of them are our patients

  • The average caregiver is female, 49 years old and providing care for her mother that is the equivalent of a part-time job.2
  • Compared with other demographic groups, women, along with low-income workers and minorities, are more likely to reduce their work hours or leave the workforce because of their caregiving role.2
  • Female caregivers are less likely than male caregivers to see health care providers for their own preventive healthcare needs.
  • Female caregivers face increased risks for::
    • Depression and anxiety
    • A weak immune system
    • Obesity
    • Chronic disease (including heart disease)
    • Problems with short-term memory or paying attention

NPWH is pushing the issue front and center.

Through our leadership role in two coalitions, NPWH is helping drive national conversations around caregiving to increase awareness of, and support for, the female caregiver.

Coalition for Women’s Health Equity

More than three hundred women from across the country met in Washington, DC, for the Women’s Health Empowerment Summit, hosted in May by the Coalition for Women’s Health Equity.3 The summit spotlighted actions to address inequities that endanger women’s health and safety. As a member of the steering committee, NPWH helped organize a panel on Caregiving Across the Lifespan. Panel members explored the burdens and opportunities of caregiving and considered legislation to require the government to develop strategies that recognize and support family caregivers.

As a panel member, I was honored to speak as both a nurse practitioner who provides healthcare to many caregivers, and also as the daughter of two 96-year-old parents living in partially assisted care. I spoke directly to the impact of the female caregiver and the invisibility of the issue. With the profound impact that being a caregiver has on these women’s health, I also addressed the need for all health care providers to determine the caregiver status of their patients. The panel encouraged all caregivers in the room to lead by example, and to discuss their caregiver roles with their HCPs at health visits.

Healthy at Any Age Coalition

At NPWH’s second Healthy at Any Age Summit, we laid the groundwork for a coalition and began outlining the National Older Women’s Health Agenda. This agenda must include women caregivers and the adverse impact of long-term neglect of their own health.4 As we unite diverse sectors, share resources, and create strategies to advance the health and well-being of older women, NPWH will continue to draw attention to the vital role of caregivers and how to best meet their needs.

More conversations about caregiving must happen in living rooms, communities, government offices – and exam rooms. Let us know how you approach your patients to assess how caregiving may be impacting their physical health and psychological well-being.

Diana M. Drake is Clinical Associate Professor and Specialty Coordinator of the DNP WHNP Program at the University of Minnesota School of Nursing and Program Director for Integrative Women’s Health at the Women’s Health Specialists Clinic, both in Minneapolis. She is Chair of the NPWH Policy Committee and Chair Elect of the NPWH Board of Directors.

References

  1. United States Census Bureau. U.S. Population Aging Slower than Other Countries, Census Bureau Reports. March 28, 2016. gov/newsroom/press-releases/2016/cb16-54.html
  2. AARP Public Policy Institute. Understanding the Impact of Family Caregiving on Work. October 2012. org/content/dam/aarp/research/public_policy_institute/ltc/2012/understanding-impact-family-caregiving-work-AARP-ppi-ltc.pdf
  3. Coalition for Women’s Health Equity website. org/advocate/coalition-for-womens-health.html
  4. American Heart Association. Caregivers: Be Realistic, Think Positive. Last reviewed June 2017. org/HEARTORG/Support/Caregivers-Be-Realistic-Think-Positive_UCM_301771_Article.jsp#.WzlnWi2ZNhE

An Update on NPWH’s Efforts to Support Brain Health Initiatives

Julia Knox is NPWH’s Communications and Outreach Associate and represents NPWH at several legislative briefings per year. Below is information about one she attended in honor of Alzheimer’s and Brain Awareness Month and why brain health is important to NPWH and WHNPs. Julia has been at NPWH for close to two years and holds an M.S. in Public Relations and Corporate Communication. 

On Wednesday, June 20, NPWH attended an UsAgainstAlzheimer’s legislative briefing on the CHANGE Act of 2018. The CHANGE (Concentrating on High-Value Alzheimer’s Needs to Get to an End) Act is a bipartisan bill that “encourages timely and accurate assessment, detection and diagnosis of Alzheimer’s, supports innovative approaches to support family caregivers, and removes regulatory barriers to disease modifying treatments.” NPWH also signed on to an UsAgainstAlzheimer’s Congressional letter, urging all members to support the act.

IMG_8354

Sen. Shelley Moore Capito (R-WV), cosponsor of the CHANGE Act, addresses the audience

Alzheimer’s disproportionately affects women: of the approximately 5.5 million Americans with Alzheimer’s, nearly two-thirds are women[1]. In addition to the patients themselves, the disease also has a devastating effect on unpaid family caregivers, the majority of which (63%) are women. [2] NPWH believes WHNPs are an important resource for monitoring brain health. With greater awareness, knowledge and tools, providers can support earlier detection and treatment of Alzheimer’s, dementia, and other brain diseases.

Last year, NPWH partnered with WomenAgainstAlzheimer’s to survey WHNPs regarding their knowledge and treatment of brain health. The survey, Brain Health is Women’s Health, found that the vast majority of WHNPs want more knowledge, training, and tools to assess brain health. NPWH is working to provide this knowledge and training: brain health was the focus of a dedicated breakout session at the 2017 annual conference, and a topic of the second annual Healthy at Any Age Summit this April. We are also preparing to launch an updated version of our well-woman visit mobile app that includes a brain health section.

To read more about the CHANGE Act, click here. To read the full report from Brain Health is Women’s Health, click here.

[1] https://alzheimersnewstoday.com/alzheimers-disease-statistics/

[2] https://www.usagainstalzheimers.org/networks/women

Pennies for Prevention: Preeclampsia, the Leading Cause of Maternal Death

By NPWH Board Member Jennifer Hawn, MSN, WHNP-BC

Preeclampsia; the masked evader.  When does it start?  Where does it start?  Who will it effect?  How do we stop it?  These are all difficult questions that clinical providers have yet to fully understand. One thing is for sure, the staggering effects of Preeclampsia on the outcome of pregnancies impact both maternal and fetal health.  But we are also beginning to understand that one of the best prevention strategies is not some NIH developed new intervention or new pharma R&D brainchild. It’s something in most patients’ medicine cabinets that costs only pennies: low-dose Aspirin.

The Dangers of Preeclampsia:

According to evidence collected by the United States Preventative Services Task Force (USPSTF):

  • Preeclampsia is the leading cause of maternal death, effecting 3.8% of pregnancies in the U.S.
  • Twelve percent of maternal deaths are due to effects of Preeclampsia
  • 97% of preeclampsia related deaths occur in the postpartum period
  • The morbidity and mortality of preeclampsia also affects neonates causing 15% of preterm births (<37 weeks gestation)
  • Prematurity alone is responsible for 70% of neonatal mortality and 75% of neonatal morbidity in developed countries

Due to the potential lifelong effects of prematurity, the cost associated with preterm birth and other maternal complications at the time of delivery and postpartum period, it is easy to see why Preeclampsia remains such a hot topic of discussion.

The Best-Known Prevention Strategy

As Advanced Practice Nurses, it is embedded in us that prevention is the key to minimizing disease and Preeclampsia is proving to be no different.  Educating our patients is key to recognizing preeclampsia at its earliest manifestation for effective management and treatment, however, additional evidence continues to support the use of low dose Aspirin (81mg) daily after 12 weeks gestation for the prevention of Preeclampsia.  While the evidence is unclear when the most benefit of this regimen occurs, it is widely accepted based on literature review that treatment of Aspirin 75 mg or greater, sometime in the late first trimester (>12 weeks) but before approximately 16 weeks has yielded the best results.  (There are no specific recommendations on when the Aspirin should be discontinued in the third trimester.)  This strategy is supported by further evidence that suggests preeclampsia is a combination of factors that begin in the first trimester related to unusual placental development that results in placental ischemia and the release of inflammatory and oxidative stress factors into the maternal blood stream – hence the use of an “anti-inflammatory” medication – Aspirin.

What does low dose Aspirin have to offer?  It does not magically prevent preeclampsia 100%.  The risk reduction for women who are at high risk for Preeclampsia is believed to be approximately 10% and a 20% reduction in perinatal mortality.  In studies, treatment with low dose Aspirin was associated with an absolute risk reduction of 2-5% for Preeclampsia, 1-5% for Intrauterine Growth Restriction (IUGR) and 2-4% for preterm birth.  IUGR also increases the risk of neonatal respiratory distress, seizures, sepsis and long-term disability even when born at term, so a small reduction in IUGR infants can have a remarkable impact on their quality of life.  Additionally, treatment has also been associated with an average birth weight increase of 130 grams.

Given that low dose Aspirin costs somewhere around a penny or so per pill and is conveniently obtained at any retail pharmacy, it is easy to see why we should be consistent in prescribing this for our patients who are at risk for Preeclampsia.

Knowing the Risks

So, what are the risks of treatment?  A question we should continually ask ourselves when it comes to treatment of disease, regardless of the seeming innocence of the treatment.   As an Antiplatelet Aggregate Inhibitor, Aspirin inherently carries the reputation of risk, especially in the face of potential surgery and blood loss associated with delivery, which is the only known intervention for initiating resolution of Preeclampsia.  Thus far, no known complications with the use of low dose Aspirin therapy for women who are at high risk for the development of preeclampsia have been identified.  Specifically, studies have not found any adverse effects related to increased risk of maternal hemorrhage, mean blood loss, placental abruption, neonatal intracranial hemorrhage or developmental milestones at age 18 months.

Who is a Candidate for Low-Dose Aspirin Therapy?

So, now that we know what to prescribe and why, Advanced Practice Nurses need to be experts in deciding who is a candidate for the use of low dose Aspirin therapy in pregnancy.  The USPSTF identifies that this treatment is best suited for women who are considered “high risk” for the development of preeclampsia.  Answering the question of “Who is this appropriate for” can be identified easily with a comprehensive health history.

It may be beneficial to create a screening tool for your practice that can be used in the process of interviewing new patients so the opportunity to initiate low dose Aspirin at the appropriate time in pregnancy is not overlooked.

While it is impossible to predict which women will have severe features of Preeclampsia and those who will not (a topic for another blog entry), it is widely accepted that women with the following are at increased risk:

  • Histories of Preeclampsia
  • Autoimmune disease (Lupus and Antiphospholipid Syndrome)
  • Diabetes
  • Chronic Hypertension
  • Renal disease
  • Those carrying multiples

However, other moderate risk factors also include women who are nulliparous, advanced maternal age (>40 years), between pregnancy interval >10 years, Body Mass Index (BMI) >35 and a family history of preeclampsia (mother or sister).

What Does this Mean for Advanced Practice Nurses?

Given that we usually see patients several weeks before they visit a Maternal Fetal Medicine specialist, it’s important for all Advanced Practice Nurses caring for child bearing women to screen for Preeclampsia and recommend low-dose Aspirin for the appropriate patients. This simple step – for pennies on the dollar – can make a priceless difference in maternal and fetal health.

References:

  1. ACOG: Hypertension in Pregnancy (2013)
  2. USPSTF: Low-Dose Aspirin use for the Prevention of Morbidity and Mortality from Preeclampsia

Resources:

  1. ACOG Low Dose Aspirin Practice Advisory (2016)
  2. Preeclampsia Registry
  3. Preeclampsia Foundation
  4. California Maternal Quality Care Collaborative – Preeclampsia Toolkit

STD Awareness Month: I don’t think this is what they meant by ‘everything old is new again’

This month, Melanie Deal, MS, FNP-BC, WHNP-BC writes how WHNPs can teach and treat their patients for STDs. Melanie has worked as a nurse practitioner for over 20 years.  She received her Master of Science in Nursing at the University of California in San Francisco.  Melanie currently practices at UC Berkeley Health Center and is clinical faculty for the California STD Prevention Training Center.  She is a regular presenter at Contemporary Forum’s Contraceptive Technology conferences. She has served on the Board of Directors for the National Association of Nurse Practitioners in Women’s Health (NPWH). 

April is STD awareness month. We as women’s health nurse practitioners have been front and center in the fight to keep our patient’s safe from these all too common infections.

We know that:

Chlamydia and gonorrhea rates have continued to rise. We must seek all opportunities to screen our female patients < 26 years old at least on an annual basis.

Antibiotic-resistant gonorrhea remains a major concern. In the U.S., we have one remaining class of drugs that will adequately treat this infection, cephalosporins.  Around the globe, countries are reporting cases of gonorrhea with decreased susceptibility and resistance to cephalosporins.  We must be vigilant for potential antibiotic-resistant cases and know how to treat them.

But one STD has made a significant comeback in the past decade: syphilis.

I think back to a conversation I had with my mother-in-law over dinner many years ago.  We were having one of our girls’ nights.  At the time, I was directing a CDC STD program, so it was not surprising that our conversation drifted to the topic of STDs.  Cocktail in hand, she leaned in and said, “So, tell me about the herpes”.  She wanted to hear about what was new with STDs because in “my day, we only knew about syphilis.”

At the time of this conversation, syphilis was a waning concern, especially in women’s health.  Syphilis rates in the country were so low, the CDC launched a program called The Syphilis Elimination Project” through which they hoped they could rid the U.S. of syphilis completely.

Here we are 20 years later, and syphilis is once again a growing threat.  Rates of syphilis have increased 67% between 2011 and 20151; and increased another almost 18% since 20152.  While the greatest surge has been among men who have male sexual partners, rates are also increasing among heterosexual men and women.  “Rates have increased in every region, in a majority of age groups, and across almost every race/ethnicity.”3 The U.S. is also seeing a concerning growth in cases of congenital syphilis, which should be absolutely preventable.

As women’s health nurse practitioners we must prepare ourselves to address this growing epidemic in a way we have not needed to in many years.

In response, the CDC has developed many clinician resources.

To put it simply the CDC challenges us to: Talk. Test. Treat.4

Talk.

Take a complete sexual history. We as women’s health nurse practitioners are familiar with taking sexual histories.  We must redouble our efforts especially with our prenatal patients.

Test.

Screen all prenatal patients at their first visit, and for higher risk patients, rescreen in 3rd trimester and at delivery.

Treat.

Know how to identify the stage of syphilis for your patients in order to provide the appropriate treatment regimen.

Neurosyphilis can occur at any stage.  Screen all syphilis patients for signs of neurosyphilis, including ocular and otic syphilis.

Hopefully, with our vigilance, we can once again make syphilis seem like an old time disease; one for the history books.

References:

  1. CDC Call to Action: Let’s Work Together to Stem the Tide of Rising Syphilis in the United States
  2. CDC: The State of STDs
  3. The rising tide of syphilis: Coming to a patient near you
  4. Test. Treat.

Additional resources

  1. Syphilis: Pocket Guide for Clinicians
  2. Sexual Health and Your Patients: A provider’s guide
  3. Asking Essential Sexual Health Questions
  4. CDC STD Treatment Guidelines

It’s Endometriosis Awareness Month!

In honor of Endometriosis Awareness Month, NPWH Board Member Caroline Hewitt, DNS, RN, WHNP-BC, ANP-BC, explores the current standards of diagnosis and treatment.

Endometriosis is not a new condition to those of us who provide women’s health care, but it is woefully misunderstood by the public. However, it is getting increasing attention from the media and TV and film stars like Lena Dunham and women’s rights activities. This newfound attention means that our patients are learning about this condition from sources as diverse as fashion magazines, blog posts, and everywhere in between.

Occasionally, as clinicians, we can be blind-sided by what our patients are reading and hearing amongst their peers, so it helps to have an idea of what is being said outside the nurse practitioner’s office.

So, in observance of Endometriosis Awareness Month, I would like to use this occasion to briefly review the current standards of diagnosis and treatment as published by ACOG, The American Society for Reproductive Medicine (ASRM), The World Endometriosis Society (WES) as well as The Society of Obstetricians and Gynecologists of Canada.

Overview

Endometriosis affects 6 to 10 percent of women of reproductive age, and it is present in approximately 38 percent of women with infertility and in up to 87 percent of women with chronic pelvic pain. It is thought to develop from attachment and implantation of endometrial glands and stroma on the peritoneum as a result of retrograde men­struation. Endometrial lesions result from overproduction of prostaglandins and estro­gen, which leads to chronic inflammation. (AAFP, January 1, 2011 ◆ _Volume 83, Number 1)

Diagnosis

According to ASRM, “Diagnosis should be viewed as chronic disease requiring a lifelong management plan with the goal of maximizing use of medical treatment and avoiding repeated surgical procedures” (2014). Diagnosing endometriosis can take up to 10 years. This delayed diagnosis is due to the vague presenting symptoms that frequently overlap with other gynecologic and gastroenterologic processes, as well as the fact that the surgical diagnosis comes with risks.

Imaging studies like MRI and ultrasound do not provide reliable diagnosis nor does a pelvic exam adequately indicate the volume of endometriosis. There is also no positive correlation between patient symptoms and extent of disease.

Treatment

The definitive diagnosis of endometriosis can only be made by histologic examination of the lesions that have been surgically removed. That being said, initial medical treatment with combined oral contraceptive pills (OCPs) (or progesterone only pills) is the recommended first line treatment, even before a definitive diagnosis is made. If there is no response to OCPs/POPs (typically evaluated after 3 to 4 months), it is recommended to proceed with a diagnostic laparoscopy before using medications with higher risk of adverse effects (danazol or GnRH agonists).

If chronic pain doesn’t respond to medical therapy, surgery is the next option. But even after expert removal of endometriosis, recurrence is common; rates can be as high a 55%. The desire to preserve fertility will direct the extent of surgery and type (fertility preserving laparoscopy vs hysterectomy/bilateral salpingo-oophorectomy (BSO).  Laparoscopic surgical procedures require specialized training.

Link to Cancers

Endometriosis is associated with some epithelial ovarian cancers (EOC). The risk of developing an EOC is 1% for the premenopausal women with endometriosis and up to 2.5% for the post-menopausal women. It is important to note that endometriosis is not considered a pre-malignant lesion, screening for EOC is not recommended in women with endometriosis and there is no suggestion that prophylactic removal of endometriosis lesions will reduce the risk of EOC.

In summary, endometriosis is a chronic disease that can be difficult to diagnose. The first line treatment, as recommended by all the major women’s health/reproductive health organizations, remains medical. Surgical intervention, like laparoscopy and excision presents with its own risks and also requires the provider to have had specialized training. Decisions regarding extent of surgical intervention should also take into account the childbearing desires of the patient.

It’s great that more women are learning about Endometriosis. This often misunderstood and very personal condition deserves our attention. As Nurse Practitioners, we need to be prepared to listen to our patients and partner with them to ensure their diagnosis, and management, is evidence-based and safe.

Your Heart is a Lady Part

 February is Heart Health month. NPWH Chair Elect and Policy Chair, Diana Drake DNP, APRN, WHNP-BC, and Clinical Associate Professor, shares an update on the state of women’s heart health and resources for clinicians.

Connecting Heart Health and Reproductive Health, a Missed Opportunity

For many practitioners working in ob-gyn practices, you may be the only health care provider a patient sees this year.  But according to a national survey, only 13 percent of women report talking about heart health during their annual ob-gyn visit

That’s a problem, because heart disease is a leading killer of women, taking 400,000 lives in 2016. Contrary to popular belief, women have a higher risk for heart disease than men, because of higher obesity rates, rates of strokes.

The biological changes during pregnancy can also increase heart disease risk. But even in the cases of women with pregnancy complications like preeclampsia and gestational diabetes, 60 percent didn’t discuss heart health with their ob-gyn after pregnancy.

Many providers say they have limited training in assessing women’s risk for heart disease.

It’s time to change.

If we are going to do more to address the major threat that heart disease poses to women, we in the clinical community need to think of the heart as a lady part. 

Our role as a women’s health nurse practitioners is to assess and address needs of the whole woman from head to heart to toe. And good news: 80 percent of cardiovascular diseases may be prevented with education and action.

We have a huge opportunity to do more to educate ourselves and our patients.

In other words, the more we ask, the more lives we save.

8 Ways Clinicians Can Improve Heart Health:

Here are some key ways we can do more to address heart health:

  1. Start Upstream, Prevention is Key

Recommend patients get Well Woman annual visits and follow cardiovascular prevention screening guidelines.

  1. Improve Patient Education and Teach Self-Advocacy

Encourage patients to take charge of their own health. The most important personal action for the patient is to know their numbers: blood pressure, cholesterol, blood sugar and body mass index. Taking action to correct them can be lifesaving.

  1. Recognize Social Stigmas that Prevent Patient Conversation

Social stigma about body weight can keep women from discussing it with their providers, but body weight can have a profound effect on the heart. It’s up to us to ask in a way that will encourage dialogue and get our patients thinking.

  1. Utilize Risk Assessments and Recognize Health Care Disparities

Be aware that young women and ethnic minorities are often assigned a lower cardiovascular risk assessment than is appropriate for their lifelong risk.

  1. Get More Training: Use NPWH Training & Tools in Cardiovascular Assessments

NPWH provides professional continuing education for NPs and other clinicians caring for women. There are over 50 continuing education activities in our online E-Learning portal and these include heart health topics to improve your practice.

Check out the NPWH Well Woman App that includes a Cardiovascular Assessment Tool.

  1. Know the Heart Attack Signs in Women

Symptoms of heart attacks can also present differently in women. The most common heart attack symptom for women is still chest pain or discomfort. But women are more likely to experience some of the other common symptoms, including the following:

  • Uncomfortable pressure, squeezing, fullness or pain in the center of the chest that either lasts more than a few minutes or goes away and comes back.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
  1. Know the General Risk Factors for Heart Disease

High blood pressure, high LDL cholesterol, and smoking are key risk factors for heart disease. About half of Americans (49%) have at least one of these three risk factors. Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:

  • Diabetes
  • Being overweight or obese
  • Poor diet
  • Physical inactivity
  • Excessive alcohol use
  1. Advocate for Better Clinical Trials & More Research
  • When it comes to developing a research base, only one-third of heart research subjects are women even though women make up 51 percent of the population. NPWH encourages representation of women in clinical trials to help increase data for accurate clinical decision making that is gender specific.

Our mission is to ensure high quality health care to women by women’s health nurse practitioners and other nurse practitioners who focus on women’s health. And we know that’s your mission, too. We hope you will take advantage of our online resources or join us at our conferences this year!  And we remind you: your patient’s heart is a lady part!

Here are a few more great heart health resources for clinicians and patients:

American Heart Association (AHA)

Center for Disease Control and Prevention, Women’s Heart Health

US Department of Health and Human Services, Womenshealth.gov

Managing hyperlipidemia

2017 hypertension Clinical Practice Guidelines Released

2017 New Stroke Prevention Guidelines (AHA)

Patient Education

Cervical Cancer Update

As Cervical Health Awareness month comes to a close, NPWH Director of Education, Susan Rawlins, MS, WHNP-BC, NP, shares an update on the state of Cervical Cancer and new resources for clinicians.

How prevalent is cervical cancer and what do we know about it now?

Cervical cancer remains a serious concern in the U.S. and around the world. While the death rate has decreased due to strides in preventing and diagnosing the disease, it is still the third most common cancer for women worldwide.[1] 13,000 cases of invasive cervical cancer were diagnosed in the US in 2017.[2]

We know that no one event causes cervical cancer. Some of the events or conditions known to increase the risk of cervical cancer are:

  • the HPV virus,
  • smoking tobacco,
  • having a family history of cervical cancer,
  • having had a chlamydia infection,
  • being overweight,
  • or having a diet low in fruits and vegetables.

We, as practitioners, take these and other risk factors into account when seeing patients and providing well women care.

How do we prevent and screen for cervical cancer?

The HPV vaccine is a critical first line defense against cervical cancer. Since 2006, when the FDA approved the first HPV vaccine, we have been recommending it for girls starting at age 11 or 12. The Advisory Committee on Immunization Practices expanded that recommendation 2011 to include boys.

The CDC estimates that increasing HPV vaccination rates from the current levels to 80% would prevent an additional 53,000 future cervical cancer cases among girls now aged 12 years or younger.

You can read our latest HPV position statement here.

In addition to prevention, improved screening tests have helped us diagnose sooner and fight cervical cancer more effectively. These tests can check for cervical cancer, the cell changes that lead to cervical cancer, or for the HPV infection.

The two most common screening tests are the cervical cytology test (Pap test) and the hrHPV test.  The current preferred method of screening for cervical cancer is with co-testing – collecting cervical cytology and HPV screening at the same time. We recommend co-testing because it can identify 70% of cervical cancers missed by screening with HPV alone.[3]

Recently, the U.S. Preventative Task Force came out with draft recommendations that could impact women’s access to co-testing. NPWH and many women’s health leaders are making our voices heard and trying to ensure women have access to the best health care information and services to live long, happy, and productive lives. Check back on our website for updates soon.

How can clinicians stay on the cutting edge of preventing, screening, and treating cervical cancer?

As the only national professional nurse practitioner organization focused on women’s health, NPWH provides professional continuing education for NPs and other clinicians caring for women. We presented an HPV vaccine update at our 2017 annual conference, and it can be accessed online now.

There are over 50 continuing education activities in our online E-Learning portal. Our mission is to ensure high quality health care to women by women’s health nurse practitioners and other nurse practitioners who focus on women’s health. We hope you will take advantage of our online resources or join us at our conferences this year!

[1] National Institutes of Health. NIH Fact Sheets: Cervical Cancer. https://www.report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76). Updated March
29, 2013. Accessed December 18, 2017

[2] American Cancer Society. “What Are the Key Statistics About Cervical Cancer?” https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html. Updated January 5, 2017. Accessed December 18, 2017

[3] Blatt AJ, et al. Comparison of cervical cancer screening results among 256,648 women in multiple clinical practices. Cancer Cytopathol. 2015;123(5):282-288. doi:10.1002/cncy.21544. (Study included ThinPrep, SurePath, Hybrid Capture 2 Assay)

 

2017 and Beyond at NPWH

A Look Back at 2017

2017 turned out to be an important year for women – both in terms of facing threats that limit access to quality healthcare and opening up new dialogues about sexual harassment and assault. As the year winds down, I wanted to share some perspective on the work we have done and will continue to do to help WHNPs provide the highest quality care to patients and to serve as respected voices for meeting the needs of women.

NPWH and our members continued to shine a light on women’s health issues this year, especially those that are often overlooked or not well understood. We promoted women’s health at any age, women’s sexual health, care for transgender and gender-nonconforming patients, and so much more through education, clinician resources, and participating in coalitions with ally organizations.

Here are some of the accomplishments from 2017 we are most proud of and key opportunities for you to note for 2018:

  • We are working to ensure our clinicians are getting state-of-the-science knowledge and training by bringing together experts from around the country at our Annual Premier Women’s Healthcare Conference. This year, our 20th conference, was our largest to date. More than 700 of you joined us in Seattle for learning and networking.

    For those who couldn’t make it, you can click here to view the sessions and earn CE credit. Click here to hear from women who attended the conference.  We hope to see everyone at next year’s conference, October 10-13 in San Antonio.

  • We continued to fill the gap in post-education training on women’s sexual health at our Fourth Annual Women’s Sexual Health Course (WSHC) for NPs this past June in Baltimore. 200 NPs attended this important program and expanded their knowledge of evaluating, diagnosing, and managing Female Sexual Dysfunction.
    This program, along with the companion vulvoscopy workshop, regularly sells out – so be on the lookout for registration information for the Fifth Annual WSHC (being held June 7-10, 2018, in Phoenix, AZ) in early 2018. Curious about the WHSC? View highlights from 2017 here.
  • We kept our clinicians on the cutting edge of a variety of topics critical to women’s health and well-being. We partnered with Spire Learning to host the second annual Faces & Cases Seminar: Managing Women’s Healthcare Issues Across the Lifespan.
    This regional meeting was held in Dallas in November, and will be repeated in Atlanta (February 3), Chicago (March 10), and New York City (April 14). Registration information will be posted soon.
  • We published new position statements on human sex trafficking, hereditary breast and ovarian cancer risk assessment, HPV, and healthcare for  transgender and gender non-conforming individuals.

  • Our continuing education offerings expanded, giving clinicians a wealth of resources to stay current in practice. In addition to the aforementioned courses from the Annual Conference, we offered a free webinar series on preventing unintended teratogen exposure in in reproductive-aged women, a free newsletter series on cord blood banking, and several CE articles from Women’s Healthcare: A Clinical Journal for NPs.

    You can view all available courses here.

  • We continued to bring resources into the modern age and put them at our practitioner’s fingertips with our Well-Woman Visit mobile app. This year, we added sections on menopause and IBS assessment.

    Click here to download it on iOS devices and here for Android.

Looking forward to 2018

  • Women are living longer. We will not let our patients who have changing health needs as they age be pushed aside. To ensure their later years are healthy and happy, we will host the 2nd Healthy at Any Age Summit in the spring of 2018 and bring multiple organizations together to focus on the issues facing women as they age.
  • We will continue to represent WHNPs as active members of several coalitions and task forces, including the National Coalition for Sexual Health, Coalition for Women’s Health Equality, Council on Patient Safety in Women’s Healthcare, and the Women’s Preventive Services Initiative, among others. We will also continue to regularly attend Capitol Hill briefings to ensure the representation of WHNPs on key healthcare issues and keep your finger on the pulse of Washington. (You can view a list of Congressional letters we signed onto in 2017 here.)

We, and our members, are dedicated to having courageous conversations about women and all aspects of their health. In this era where women’s rights to quality healthcare is consistently under attack, we look forward to 2018 and continuing to build a future where women have equal access to the justice, respect, and healthcare they deserve. Thank you for your continued support of NPWH and women’s healthcare.

Best wishes for a happy and healthy 2018,

G Johnson

Gay Johnson

NPWH CEO

Genetic Testing and Hereditary Cancer: A Q & A with Kate McReynolds, APRN, MSc, MSN, ANP-BC, AGN-BC

Kate McReynolds is a Genetic Nurse Practitioner at Vanderbilt University Medical Center in Nashville, Tennessee. She will be speaking at our upcoming 2nd Annual Faces and Cases in Women’s Health Conference.

What is genetic testing and why is it so important?

Genetic testing for cancer susceptibility is a vital tool that can identify women who are at significantly increased risk for cancer. Nurse practitioners play an important role in identifying women who would benefit from genetic testing, referring them to providers with expertise in cancer genetics for testing, and ordering enhanced screening if a mutation is identified. About 5 to 10 percent of most cancers are hereditary, and patients who have a mutation in a gene associated with a hereditary cancer syndrome have cancer risks that are often much higher than in the general population. For many of these syndromes, we can now test for mutations in specific genes.

Genetic test results can guide clinical management including decisions about risk reducing measures such as risk reducing surgery, and screening to find cancer as early as possible. Genetic testing results can also help a woman’s family members better understand their own cancer risks and plan accordingly.

Should everyone get genetic testing?

Because only a small percentage of cancers are hereditary, not all women are good candidates for genetic testing. These tests can be expensive and are generally recommended only for women who have personal and/or family histories with certain red flags that are concerning for a hereditary cancer syndrome.

Examples of features concerning for a hereditary cancer syndrome include cancer diagnosed before age 50, an individual with multiple primary tumors, cancer of the same type in more than one person on the same side of the family and in different generations, cancers that may be related in a syndrome, rare cancers (e.g. male breast cancer) and certain ethnicities.

What should NPs know about genetic testing and genetic mutations?

When I talk to Nurse Practitioners, my goal is to help them understand the significance of taking a good cancer family history and to familiarize them with the red flags in order for them to make appropriate referrals for genetic counseling and testing. It is important that they understand the cancer risks associated with some of the more common hereditary cancer syndromes and where to find the relevant clinical management guidelines. In addition to playing a key role in enhanced screening, it is also important that that NPs understand the psychosocial impact of finding out they, or a loved one, has a hereditary cancer syndrome.