If you've hit 40, like many women, you may have noticed changes to your overall health. By making some simple adjustments and prioritizing routine care, screenings and prevention, you can stay healthy for years to come.
In a recent webinar, Sarah Bartlett, MD; Dena Costa, MD; and Laura Van Wyck, DO, discussed what women can do to stay well throughout midlife and beyond.
Here are six things to remember to stay healthy after 40.
1. Don't skip your annual gynecological exam
The annual gynecological exam is a vital part of preventive care for all women, especially women over 40.
“It's a time when you and your gynecologist can review your overall health and discuss any current problems," Dr. Van Wyck says.
What you can expect during your annual exam:
- Conversations about current concerns like contraception, hot flashes or urinary incontinence
- Discussions about your medical, surgical, obstetrical and gynecological history
- Physical examinations, including a breast exam and pelvic exam
- Review of your family history for certain conditions like breast, ovarian or colon cancer
2. Screenings take center stage
You're probably familiar with cervical cancer screenings. Doctors recommend starting these screenings — via a Pap smear — beginning in your early 20s. But many other recommended screenings start at or after 40.
Breast cancer screenings are first on the list. The American College of Obstetricians and Gynecologists recommends yearly screening mammograms beginning at age 40.
“Unfortunately, just by having breasts, you have a one in eight chance of getting breast cancer in your life, even if nobody else in your family has ever been diagnosed," says Dr. Van Wyck.
You should get a colonoscopy to screen for colon cancer starting at age 45. And experts recommend a bone scan to look for signs of osteoporosis at 65.
Dr. Van Wyck says women should also talk with their doctor and screen for mental health conditions like depression.
“The prevalence of mental illness in women in the U.S. is 27.2 percent, which is very high."
Risk factors for mental illness include genetic predisposition and social factors like:
- Alcohol or drug use
- Discrimination
- Family conflicts
- Homelessness
- Stressful life events
Talk with your doctor about which screenings are right for you. Your doctor may recommend earlier, or more frequent, screenings based on your personal or family history.
3. Preventive care should be a priority
Women can make simple lifestyle changes to prevent many health conditions often associated with aging.
Take care of your mental health
Taking time to decompress can improve your mood. And, Dr. Van Wyck says, studies have shown that practicing gratitude through activities like journaling can have a positive emotional effect on people with depression.
Social connection is also critical for mental health.
“Social media and TikTok are not substitutes for social interaction," Dr. Van Wyck says. “Our brains crave in-person connection."
Exercise is also important for mental health. The Centers for Disease Control and Prevention (CDC) recommends 150 minutes per week of moderate-intensity activity.
Physical activity raises your level of feel-good hormones called endorphins. These hormones can improve your mood, which is especially helpful throughout the stages of menopause.
Manage your weight
“Unfortunately, another cruel aspect of aging is the fact that we need fewer and fewer calories to survive and to maintain our body," says Dr. Van Wyck. “All those extra calories we consume are often stored as fat."
Exercise can help to burn those excess calories. But proper nutrition is also key to weight management.
“We recommended limited snacking between meals and being mindful of food choices," Dr. Van Wyck says.
Dr. Bartlett recommends decreasing processed foods and sugar and following a Mediterranean diet.
You can also manage weight through:
- Better sleep
- Decreased alcohol consumption
- Increased fiber
- Reduced stress.
Keep your bones strong
Bone loss is common as we age. Getting the right amount of calcium and vitamin D can help to prevent bone loss.
Talk with your doctor before starting any calcium or vitamin D supplements to be sure you aren't getting more than you need.
4. Menopause doesn't have to be miserable
You may notice menstrual cycle changes in your early, mid and late 40s. These changes could be due to perimenopause, also called “pre-menopause."
Perimenopause is the years leading up to menopause. Doctors diagnose menopause after 12 consecutive months without a period. The average age of menopause is 52.
During perimenopause and menopause, your hormones fluctuate, resulting in menstrual cycle abnormalities and other symptoms like:
- Anxiety, irritability and depression
- Brain fog, poor concentration
- Decreased sex drive (low libido)
- Frequent urination
- Hot flashes and night sweats
- Joint pain
- Skin, hair and nail changes
- Sleep disturbances
- Vaginal dryness and discomfort
You may also experience bone weakening, decreased muscle mass, increased risk for cardiovascular disease and weight gain.
During perimenopause, menopause and even post-menopause, you may feel a variety of symptoms. But your doctor can offer treatments so the stages don't have to feel miserable.
Menopause treatments
Many treatments can address the symptoms of menopause. Hormone replacement therapy (HRT) is an excellent option for many women.
HRT may involve estrogen, progestogen, a combination of estrogen and progestogen, or testosterone.
“There are good, safe and inexpensive hormone options," Dr. Bartlett says.
But she cautions that each has pros and cons, and timing is essential, so you should discuss all options with your doctor.
“It's very dependent upon you, your family history and your health status," Dr. Bartlett says.
There are also many non-hormonal menopause treatments for women who want to avoid hormone therapy or can't take it because of certain other health conditions. These options include a combination of:
- Acupuncture
- Cognitive behavioral therapy
- Exercise
- Hypnotherapy
- Over-the-counter options
- Prescription medications
- Weight loss
- Yoga.
Dr. Bartlett reminds women they can still get pregnant until they are through menopause.
“Even if you are perimenopausal, you still need to be concerned about pregnancy. You may not be as fertile as before, but it's a bit of a high-stakes game. I've seen women get pregnant as late as 55."
She also stresses that you don't have to wait until your annual exam to talk about your menopause symptoms.
“If your symptoms are bothering you, you don't have to wait for some benchmark to seek treatment," Dr. Bartlett says. “Make an appointment with your provider."
5. 'The change' isn't always to blame
Dr. Bartlett says it's important to talk to your doctor about menopause symptoms. It's also important to know that menopause isn't always to blame for some symptoms, including bleeding changes.
Inconsistent ovulation due to hormone changes can alter the frequency and pattern of your periods. However, other conditions can cause abnormal uterine bleeding, which can be mistaken for a symptom of menopause.
“You should work with your provider to figure out what's going on so you can rule out problems and improve symptoms and quality of life," Dr. Bartlett says. “It could be a whole list of things, but it could also just be a normal expectation for perimenopause and bleeding patterns that change with age."
Some non-menopause causes for uterine bleeding include:
- Adenomyosis
- Bleeding disorders
- Cancer and pre-cancer
- Endometrial issues
- Hormone therapy
- Infections
- Ovulation disorders, including polycystic ovarian syndrome (PCOS)
- Polyps (uterine or cervical)
- Uterine fibroids.
Talk to your doctor if you have:
- Bleeding after sex or between periods
- Bleeding more often than every three weeks
- Bleeding that lasts longer than normal for you
- Postmenopausal bleeding (any bleeding after 12 months of absent periods)
- Very heavy bleeding.
To determine the cause of your bleeding, your doctor may use blood tests, menstrual tracking, ultrasound, biopsy or surgically removing part of the uterine lining.
A wide range of medical, surgical and minimally invasive treatments can address uterine bleeding. Your doctor will talk with you about the best treatment option for your specific condition.
6. Don't ignore your pelvic floor
Your pelvic floor is a group of muscles connected to your pelvic bone. Your pelvic floor muscles are like a hammock to support your pelvic organs (bladder, uterus, bowel and rectum).
Your pelvic floor muscles also:
- Help you control your urine flow, especially during times of stress like coughing, sneezing and jumping
- Help you hold stool and prevent you from passing gas
- Hold your tampon in during menstruation
- Keep your back and hips strong and pain-free
- Support sexual function and arousal
Dr. Costa says pelvic floor problems cause many conditions, including:
- Painful sex
- Pelvic, hip, low back and tailbone (coccyx) pain
- Urinary stress incontinence
- Stool incontinence.
Pelvic floor prolapse
Prolapse happens when a pelvic organ moves out of position and presses on the vagina.
“Women may come in and say their bladder has fallen or they feel a bulge there," Dr. Costa says.
The several types of prolapse include:
- Cystocele—When the bladder presses on the vagina
- Enterocele—When the small intestine pushes on the vagina
- Rectocele—When the rectum pushes on the vagina
- Uterine prolapse—When the uterus pushes on the vagina.
Who's affected by pelvic floor prolapse?
Women who have been pregnant are most at risk for pelvic floor prolapse.
Dr. Costa says you are at risk whether you deliver vaginally or have a C-section. Other risk factors for pelvic floor prolapse include:
- Age
- Being overweight
- Increased stress on the pelvic floor (chronic coughing, constipation, repetitive lifting)
Preventing and treating pelvic floor problems
You can prevent or treat pelvic floor problems in many ways.
- Kegels—These exercises help strengthen the pelvic floor muscles to prevent issues like urinary leakage and gas. You can perform a Kegel by squeezing the muscles you would contract to stop urine flow or hold in gas. If you do Kegel exercises, work on increasing the duration of contractions, but also focus on relaxing the muscles.
- Pelvic physical therapy—A pelvic physical therapist specializes in women's health and pelvic floor therapy, offering tailored exercises and treatments.
- Pessary use—A pessary is a small plastic device to help manage pelvic organ prolapse and urinary leakage by supporting a weakened pelvic floor. It's a viable option for women who prefer nonsurgical treatments and minimal downtime.
- Surgery—Surgery is an option for women who have exhausted nonsurgical treatments and desire a more permanent solution for pelvic floor issues such as prolapse or incontinence.
Dr. Costa says some pelvic floor problems need treatment by an urogynecology specialist. These obstetrician-gynecologists have additional training in pelvic floor disorders and reconstructive surgery. They manage a wide range of pelvic floor-related issues, including prolapse, incontinence, bladder pain and bowel dysfunction.
Make your gynecological health a priority
To maintain good gynecological health after 40, it's essential to prioritize routine care, screenings and prevention.
Need help finding the right gynecologist for you? Our ezCare Concierge Nurse Navigator can answer your questions and help you find the perfect match. Call 513-647-1460 - or - fill out this form to request a call back.