As their careers mature and their roles in the family evolve, women aged 51+ are leveraging their lived experience to be fully engaged and intentional about this next chapter.
Women in menopause are thriving through it and redefining what vitality looks like. This can be a time of empowerment, not confusion or fear. That means understanding the changes in your body—your hormones, heart, head, and everything in between.
In a recent webinar, women’s health experts from The Christ Hospital Health Network shared key messages that can help you safeguard your long-term health. Together, these physicians discussed the most important health concerns for women 51+:
Sarah Bartlett, MD, a gynecologist specializing in care for non-pregnant women
Todd Kelley, MD, an orthopedic surgeon specializing in hip and knee replacements
Odayme Quesada, MD, a cardiologist specializing in women's cardiovascular disease
Rodger Rothenberger, MD, a urogynecologist specializing in female pelvic medicine, gynecology, obstetrics, and reconstructive surgery
Rita Schlanger, MD, a primary care physician specializing in internal medicine
Colleen Swayze, MD, an obstetrician/gynecologist specializing in integrative medicine at AIM for Wellbeing
Here's what they want you to know.
Perimenopause vs. menopause
One thing in particular marks the difference between perimenopause and menopause. Perimenopause is about transition, when your periods may become irregular and you start having symptoms like mood swings and hot flashes. Perimenopause can begin in the years leading up to menopause and signals the beginning of menopausal symptoms and menstrual changes. According to Dr. Bartlett, symptoms may start up to seven years before menopause, often in the mid-to-late 40s, but the timing varies widely.
She describes perimenopause as “… a time of hormone flux—ups and downs in your own hormones, which leads to symptoms and irregularities.” Symptoms may begin during perimenopause and well into menopause. Just a few of the associated symptoms include:
Hot flashes
Night sweats
Poor sleep
Vaginal dryness
Mood changes
Poor concentration
While perimenopause is a transition time, menopause is a single point in time. Menopause is the 12 months following a woman’s last menstrual period, after which she is considered postmenopausal. This stage typically occurs around age 51–52 in the U.S., though it can be as early as 40 or as late as 58.
Dr. Bartlett points out that the language around perimenopause and menopause can be confusing. “But,” she says, “the language isn’t all that important because we treat the symptoms.” She goes on to say, “Just to be clear, menopause is normal. It’s a normal part of aging and nobody needs to treat it at all. However, you can choose to treat it for quality of life and potential health benefits.”
Hormone replacement therapy (HRT) for menopause
In postmenopausal women, their body’s hormones are low and stay low, and are even absent in some cases. While a woman may choose not to be treated with hormones, for those who do, there are several options.
Estrogen: This hormone does the heavy lifting to ease hot flashes and night sweats, and to boost bone health and potentially heart health. It’s available in several forms, such as patches and pills.
Progestogens: They come in different varieties, including synthetic and natural. These hormones are primarily intended to protect the uterus of a woman who hasn’t had a hysterectomy. They are sometimes used “off-label” to help improve sleep and ease anxiety. Your doctor could also prescribe a combination of estrogen and progestogen in one patch or pill.
Testosterone: Many medical organizations believe this hormone is helpful for women throughout their lives, and especially at perimenopause and menopause. However, since it’s not approved for women, Dr. Bartlett and many other physicians have gotten creative and are using men’s products. She’s careful to point out that she prescribes testosterone products that are FDA-approved for men and are at a lower dose, and that she checks the patient’s serum levels regularly to ensure they’re at a safe dosage.
Other HRT benefits
Along with controlling your menopause symptoms, HRT can also help:
Decrease the risk of bone fracture
Improve genital-urinary problems such as vaginal irritation and dryness, painful sex, and frequent UTIs (urinary tract infections)
Lower the risk of heart attack or heart failure
Nonhormonal prescription options and lifestyle changes
For women who can’t or don’t want to take hormones, there are effective nonhormonal prescription options as well. Dr. Bartlett reports that there are currently three FDA-approved oral treatments (one will be on the market soon). They each work a little differently, so to learn more about them, reach out to your doctor.
Treatments that don’t rely on hormones or other prescribed medicines include lifestyle changes such as:
Relaxation devices like massagers
Cooling blankets and mattress toppers
Cognitive behavioral therapy (CBT)
Hypnosis
Acupuncture
Then there are the tried-and-true methods that can help you with menopause symptoms:
Eat clean by avoiding processed foods and chemicals
Make physical activity a regular part of your daily routine
Turn off all screens 30 minutes to one hour before bed
See your gynecologist yearly even after menopause
Dr. Bartlett recommends that you see your gynecologist even after menopause. “Many women still need pap smears every 1 and 5 years,” she notes. “Depending on your risk factors, you should have one until at least age 65, and sometimes beyond that.” Other exams she recommends after menopause begins:
Yearly breast exam and a mammogram (typically yearly, based on the individual)
Colonoscopy
Routine screenings (cholesterol, blood pressure, etc., as the need indicates) are especially important because menopause can cause cardiovascular changes
Bone density testing starting at age 65
Any postmenopausal bleeding should be checked
Understand your body and your options
Your symptoms matter. If they’re interfering with your quality of life, don’t hesitate to seek solutions. What may be most important to understand about menopause is that it’s common. It’s normal. And a doctor you trust can help you no matter what.
Orthopedics: arthritis and joint replacements
What is arthritis? Dr. Kelley describes it this way. “If you break down the word, ‘itis’ means inflammation, and ‘arth’ means joint—so arthritis is simply inflammation of a joint.”
Arthritis most commonly affects weight-bearing joints, like the hip and knee. It’s mainly due to age-related wear and tear. But Dr. Kelley has the right idea when it comes to its relationship to aging: “I never tell someone they’re ‘getting older.’ I like to say you’re gaining life experience—and sometimes the knee or hip wears out along the way.”
There are a few other components related to arthritis:
Genetics
Previous injuries
Carrying extra weight
X-rays often tell the real story behind arthritis. In a normal X-ray of the knee, there’s a gap between the thigh bone and the shin bone. That gap is the cartilage. In an arthritic knee, that cushion of cartilage is gone, and the bones rub directly against each other. It’s essentially bone-on-bone. Hip arthritis is a little different. Most people feel hip arthritis in the front of the hip, deep in the groin area.
Arthritis symptoms
Symptoms can appear when you’re at rest, or when you’ve been sitting for long periods—for instance, at a restaurant, on the couch watching TV, or on an airplane. Those first steps after you stand up can be stiff. Other symptoms include:
Arthritis can make it hard to do daily activities, like taking short walks, tying your shoes (especially with hip arthritis), getting up from a chair, getting out of bed, or getting in and out of a car. Some people say they feel like the joint is going to give out, or that they just don’t feel stable.
Arthritis treatments
There are nonoperative and operative treatment options available. Experienced orthopedic surgeons will always try nonoperative treatments first. “If we can manage your symptoms without surgery,” says Dr. Kelley, “we don’t need to talk about surgery at all.”
Nonoperative arthritis treatments
These include lifestyle changes, ambulatory aids, and other options. None of these treatments cure arthritis, because there is no cure. But they can help manage symptoms. If something on this list works well enough to control your pain and restore your function, then you won’t need to discuss surgery with your doctor.
Switching from running to biking to reduce joint impact
Losing weight to help take pressure off the joints
Attending physical therapy to strengthen the muscles around the joint and teach your brain to control those muscles in a way that better supports the joint
Using ambulatory aids such as canes, walkers, or walking sticks
Icing to help with inflammation
Applying over-the-counter pain creams
Taking medications like ibuprofen or acetaminophen
Injecting steroids (cortisone) into the joint to take the edge off the pain
When the next option is surgery
If nonoperative treatments aren’t working, the next option is surgery; whether it’s a hip or knee replacement or replacing another joint. Total joint replacement is very successful. The goal is to reduce pain and improve your function and quality of life.
According to Dr. Kelley, “Hip replacements have even been called ‘the operation of the century’ because of their success rates. Patients tend to do extremely well.” Knee and shoulder replacements can take a little longer to recover from. But overall, notes Dr. Kelley, after physical therapy and healing, most patients report an 80–95 percent improvement and are happy with the results. Most implants last around 20 years.
Could you be a candidate for joint replacement surgery?
Being a candidate for joint replacement surgery depends on your pain and how you’re able to function day-to-day. If your hip or knee is interfering with your quality of life—for instance, you avoid restaurants, vacations, or activities because of pain—and nonoperative treatments aren’t helping, then it’s time to start discussing surgery.
Dr. Kelley stresses that it’s not based on age. “We operate on young people with arthritis and on seniors with arthritis. What matters is that X-rays show bone-on-bone arthritis. With mild arthritis, you’re not a candidate for replacement. You need X-ray evidence of advanced arthritis, and nonoperative treatments must have failed.”
He adds, “You also need to be medically optimized before surgery. That means your diabetes is controlled, your heart is in good shape, you’ve quit smoking, and your weight is improved. You have to be healthy enough to undergo the procedure safely.”
Heart disease in women
Unfortunately, heart disease remains the number one cause of death in all women. As Dr. Quesada notes, “It’s important to realize that heart disease kills more women than all cancers combined. The Time magazine headline from the early 2000s that says one out of three women will die from heart disease is still true in 2025.”
The traditional risks for heart disease
There are well-known risks for heart disease that apply to both men and women. They include:
High blood pressure
High cholesterol
Nicotine exposure and smoking
Diabetes and high blood sugar
Being overweight
Not being physically active
Poor diet
Not getting enough sleep
Knowing your blood pressure, blood sugar, and cholesterol numbers means you can get treated when any of these numbers are higher than the normal range. That plays a big role in lowering your cardiovascular risk.
Women have unique risks for heart disease
Certain risks are specific to women or affect them more than men. These include:
PCOS (polycystic ovary syndrome) and endometriosis
Pregnancy complications, including preeclampsia and gestational high blood pressure
Gestational diabetes, which raises a later risk of both diabetes and heart disease
Autoimmune diseases, which are more common in women
Early menopause, which is linked to higher long-term cardiovascular risk
Hormone replacement therapy (HRT) is not dangerous in and of itself. But women with moderate or high cardiovascular risk, or those with known coronary artery disease, should be assessed carefully before starting or continuing HRT.
It’s crucial to monitor women treated for breast cancer. Treatments such as radiation therapy and certain older cancer treatments can raise the risk of heart failure or long-term heart disease.
Heart attack symptoms in women are often more subtle
An important difference between men and women is the way heart attacks show up in women. Men are more likely to have “classic” chest pain—sudden, intense, radiating to the jaw, along with nausea or shortness of breath. But women often have more subtle symptoms:
Nausea or vomiting
Jaw, neck, or upper-back pain
Unexplained fatigue
Shortness of breath
Chest discomfort not easily identified as cardiac
Women, and even emergency rooms, may overlook these symptoms. Many women are sent home without a diagnosis and have to return many times before a heart attack is identified. Dr. Quesada emphasizes, “If you don’t feel well, get checked—and go back if symptoms persist.”
Understanding microvascular and vasomotor dysfunction
There is a form of heart disease in women that does not involve blocked arteries. This set of conditions is known as coronary microvascular and vasomotor dysfunction. What’s important to note about this disease is that women can have coronary arteries that appear completely normal.
With this condition, traditional angiograms and stress tests may be “normal.” Yet the small vessels, which are invisible on standard imaging, may not be working as they should. Dr. Quesada’s program specializes in diagnosing these conditions and is especially valuable for women whose symptoms don’t match typical patterns.
Take steps to protect your heart
Being proactive is a big part of protecting your heart and preventing heart disease. Dr. Quesada suggests these steps to keep track of your heart health and catch signs of disease early:
Follow a Mediterranean or DASH (low-sodium) diet
Avoid foods high in salt, sugar, saturated fats, and processed ingredients
Know your personal risk factors, including family history, BMI, stress levels, and activity levels
Always have a primary care doctor who monitors your numbers
The most important message: know your numbers
Dr. Quesada can’t stress it enough: “Women must know their numbers and understand their ASCVD risk score. That’s a calculation used to determine whether someone should be on cholesterol-lowering medication (such as statins) and to guide decisions around therapies like HRT.” Along with those approaches, she suggests tools such as coronary calcium scoring and lab tests like lipoprotein(a) to help detect hidden risk and guide earlier intervention.
Pelvic floor problems
Dr. Rothenberger wants women to know one thing up front. “You are not alone,” he says. “Pelvic floor disorders are incredibly common, especially after age 50. But they’re not something women need to quietly endure or assume are a ‘normal’ part of aging.”
Pelvic floor problems are common
Nearly half of women over 50 experience a pelvic floor issue in their lifetime. Still, despite how common these conditions are, women often don’t discuss them in the doctor’s office because they may feel embarrassed or simply believe nothing can be done because “this is just life after kids or menopause.” Dr. Rothenberger stresses that these are normal health problems and not personal failures. “Effective treatments exist,” he says.
Causes of pelvic floor problems
The pelvic floor is a network of muscles and connective tissues that support the bladder, uterus, vagina, and rectum. There are many reasons why, over time, the muscles and tissues can weaken. Among them: childbirth, menopause, surgery, or simply living life.
A weakened pelvic floor can cause problems such as:
Pelvic organ prolapse (a bulge or heaviness in the vagina)
Urinary leakage, either with coughing or sneezing, or with sudden urgency
Bowel leakage, including trouble controlling gas or stool
While they’re not dangerous, these symptoms can deeply affect a woman’s daily life, confidence, intimacy, and independence.
These issues are common, but they’re not normal. They’re not caused by doing Kegels incorrectly or “not being strong enough.” They result from real anatomical changes—and they are treatable.
Nonsurgical treatment options
Many women improve significantly with nonoperative therapies, which carry little to no risk. These include:
Pelvic floor physical therapy. A specialized physical therapist teaches patients how to:
Many women who think they’re doing Kegels correctly discover they actually need help relaxing overly tight muscles. Therapy can address this common issue.
Lifestyle and behavioral strategies. Therapists and clinicians may also help with:
Bladder training
Ways to control urgency
Managing constipation
Adjusting caffeine and fluid habits
Pessary devices, which are small, removable silicone objects inserted into the vagina. They can support a prolapse or help with leakage that’s triggered by laughing, coughing, or sneezing. Many women find substantial relief through the use of pessaries alone.
Medical and surgical treatments
When moderate approaches aren’t enough or don’t fit a woman’s lifestyle, there are safe, effective medical and surgical options. Every choice is personalized to the patient’s goals and comfort.
For stress urinary incontinence, which is leakage caused by laughing, coughing, or sneezing:
For urgency urinary incontinence caused by an overactive bladder:
There are many surgical options to treat pelvic organ prolapse, including vaginal and laparoscopic approaches. Your doctor can tailor them to:
Maintain sexual function
Avoid using mesh
Minimize recovery time
Pelvic floor problems are highly treatable
According to Dr. Rothenberger, improving pelvic floor disorders can dramatically restore quality of life. “Patients who once avoided walks, tennis, intimacy, or even leaving the house due to bulging or leakage often return to the activities they love after treatment,” he says. “You don’t need to feel embarrassed or alone in this. These are medical conditions that we can treat, so don’t wait for your doctor to ask. Bring it up. Specialists exist specifically to help women overcome these issues. You deserve to feel confident, comfortable, and free to live fully.”
How primary care keeps women 51+ thriving
Dr. Schlanger suggests that you think of your primary care physician (PCP) as your partner in navigating this stage of life. They help you:
Understand and lower your health risks
Stay on top of screening tests
Keep current on vaccines
Connect lifestyle, lab results, and symptoms into a clear plan
“PCPs see our role as our patients’ quarterback,” says Dr. Schlanger, “watching for risks, ordering the right screenings, guiding prevention, and referring you to specialists.”
PCPs focus on several health pillars, including:
Cardiovascular health
Bone health
Cancer screening
Vaccines
Lifestyle
Protect your bone health as estrogen declines
When menopause occurs, estrogen levels fall, and bones naturally lose density. To protect bone health, Dr. Schlanger recommends DEXA scans. “These usually start by age 65,” she says, “but they can start earlier, closer to age 50, if there are risks to bone health.” She notes that results fall into three categories:
Normal bone density: repeat scan every 2–5 years
Osteopenia: early bone loss, time to focus on prevention
Osteoporosis: higher fracture risk, may need medication
Core strategies for improving bone health include calcium and vitamin D for almost all postmenopausal women and weight-bearing exercises, like walking, strength training, and impact exercises.
If you have osteoporosis, we may recommend medicines. In more complex cases, your PCP may refer you to an endocrinologist who specializes in bone health.
Cancer screenings and staying ahead of risk
As women age, cancer risk increases, so staying on top of screenings is essential. Here are some guidelines for what kind and when.
Vaccines are still essential in midlife and beyond
Dr. Schlanger notes that vaccines remain a major part of prevention. She recommends:
A yearly flu shot
Pneumonia vaccine(s) after age 50
Shingles vaccine (two doses) to prevent painful shingles reactivation
Tetanus and pertussis booster every 10 years, especially important around babies and grandkids
RSV vaccine starting around age 60 for added respiratory protection
COVID vaccines as updated versions become available; especially important for older adults and those with other health conditions
Lifestyle and wellness questions to ask yourself (and your PCP)
“These are just some questions to ask yourself … food for thought,” says Dr. Schlanger.
What do you eat in a day?
What is your activity level? How much do you exercise in a week?
How is your mood? How do you cope with stress?
Do you drink alcohol? How much?
Do you smoke tobacco?
What brings you joy? What do you do for yourself?
“If your answers concern you,” she adds, “talk with your PCP about them. That’s exactly what your doctor is there for.”
Caring for your brain as you age
During the 51+ stage of life, brain health is as vital as bone and heart health. Everyday choices can support your brain and benefit the rest of your body too. “After all,” Dr. Swayze says, “everything recommended for your brain also helps your heart and bones. They’re truly high-impact habits.”
Sleep is your brain’s nightly “clean-up crew”
Sleep and relaxation are the first foundation of healthy aging for the brain. Sleep is a powerful natural antioxidant and anti-inflammatory treatment. During deep sleep, our cells essentially “take out the trash,” meaning they clear waste and restore brain function. This cellular “cleaning” happens mainly during stage 3 deep sleep, which typically lasts for the first three to four hours after you fall asleep. That’s why it’s so important to:
Go to bed around the same time each night
Avoid disruptions during the early hours of sleep
Get consistent, deep sleep to protect long-term brain health
Exercise is brain medicine
The next brain-health pillar is exercise. Dr. Swayze reports that research from the Harvard Aging Brain Study has shown that even people with no outward symptoms of dementia can slow the progression by walking just 5,000 steps a day. “Movement doesn’t just help your heart and muscles,” Dr. Swayze notes, “it directly benefits your brain.”
Current government recommendations suggest exercising for 150 minutes every week. That could look like:
The format matters less than reaching the total time and choosing something you actually enjoy and can keep doing.
Food as information and medicine
According to Dr. Swayze, we can’t “outrun” a poor diet. Food is more than calories in and calories out. It serves as a source of information for the body by influencing inflammation. Studies have shown that high-quality food can help reverse disease. Here’s a practical starting point:
Challenge yourself to eat 35 different plants every week. “That’s actually more doable than it sounds,” Dr. Swayze says. For instance, buying other types of apples instead of a single variety adds to your count. And having 10-grain bread during the week means you’re 10 plants in. A variety of foods supports a healthier gut microbiome, which in turn supports brain health.
Food is also about making connections. Shared meals with family and friends build relationships and emotional well-being, which are crucial for a healthy brain.
Stress matters more than we think
Chronic stress isn’t just a feeling. It has measurable effects on the body, including hormones, the gut, the heart, and especially the brain. When we’re always stressed, the brain has less chance to merge our memories. This leads to brain fog and more trouble finding words as we age. Simple strategies to help avoid that include:
“Name it to tame it:” Labeling what you’re feeling goes a long way to cut the intensity of the feeling
Breath work: A few minutes of slow, deep breathing can reset how your brain and body feel
Movement: Helps burn off stress hormones, such as adrenaline
Spending time in nature: Being outdoors, often called “forest bathing,” is deeply calming. In some countries, doctors literally prescribe spending time in parks as part of treatment for anxiety and depression
Relationships help protect the brain
We’re living through an epidemic of loneliness, Dr. Swayze notes. “In 2023, the U.S. Surgeon General issued a formal advisory on its health risks. They found that chronic loneliness is associated with about a 50 percent increase in dementia risk as people age.”
According to Dr. Swayze, building and maintaining relationships isn’t just a “nice to have.” It’s a critical part of brain health. If finding new connections feels daunting, she suggests:
It’s never too late to improve your health
Change is possible at any age, as shown by the results of a large Canadian study that followed 51,000 people over 20 years. Among them, about 25 percent started with multiple chronic health issues. After making lifestyle changes over three years, this group improved its overall health. The factors most strongly linked with regaining well-being were:
“Chronic disease,” says Dr. Swayze, “isn’t a guaranteed downhill slope. With intentional changes such as sleep, movement, nutrition, stress management, and relationships, many people can move back toward greater health, resilience, and quality of life.”
Get the comprehensive care you need
Growing older presents a wide range of health concerns. Paying attention to your body’s changes can help reduce and manage menopause symptoms, and potentially improve your quality of life. If you need help finding a provider, please call our free ezCare Concierge Service at 513-654-2895 or complete this form to request a call back.