[Preventive activities in women: PAPPS 2024 update]

Abstract

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.

Keywords: Agentes anticonceptivos; Contraceptive agents; Embarazo; Osteoporosis posmenopáusica; Postmenopausal osteoporosis; Pregnancy; Preventive health service; Servicios de salud preventiva.