Middle age presents a lot of changes for most women. Children get older and potentially move out. Aging parents need more help. Job responsibilities get heavier. And a new list of possible health challenges appears.
Between their late 30s and early 50s, women can face a wide range of hormonal, mental health, pelvic, cardiac, and musculoskeletal hurdles. If you’re in this age group, protecting your well-being means paying attention to changes in your body.
In a recent webinar, women’s health experts from The Christ Hospital Health Network shared some key takeaway messages that can help you safeguard your long-term health. Together, Valerie Bullock, MD, an integrative medicine specialist with AIM for Wellbeing; Aruna Puthota, DO, a primary care provider and psychiatrist; Jim Wendel, MD, an obstetrician-gynecologist; Anne Stachowicz, MD, a urogynecologist; Shree Lata Radhakrishnan, MD, a preventive cardiologist; and Jennifer Chung, MD, a physical medicine and rehabilitation specialist, discussed the most important middle-age health concerns for women.
Here's what they want you to know:
Prioritize yourself and manage behaviors
Women in middle age often overlook doctor’s appointments or screening tests because they’re busy with professional and personal responsibilities. But putting your health on the back burner may mean you don’t find health issues early when they’re easier to treat. For example, delayed treatment of chronic inflammation can result in a higher risk of:
Cancer
Cardiovascular disease
Metabolic diseases like diabetes, insulin resistance, and fatty liver
Neurodegenerative conditions like Alzheimer’s disease or other types of dementia
However, changing some of your lifestyle behaviors can reduce your inflammation and set you up for better long-term health. Dr. Bullock recommends adopting these healthy behaviors:
Devote time to relationships: Loneliness can be as dangerous to your health as smoking, inactivity, or a poor diet. You don’t have to accept every social invitation, but investing time in relationship-building benefits your overall well-being.
Eat clean: Avoid processed foods and chemicals by choosing whole foods. If your body responds poorly to certain foods, eliminate them from your diet.
Exercise consistently: Make physical activity a regular part of your routine. A 10-minute daily walk is better than a 1-hour gym circuit you rarely complete. Eventually, try to get at least 30 minutes of exercise five days a week.
Focus on sleep: Get at least eight hours of sleep every night. Set a routine bedtime and wake time. Turn all screens off 30 minutes to one hour before bed.
Pick a relaxation technique: Choose a relaxation technique that works for you and practice it for five to ten minutes a day. Meditation, mindful breathing, or yoga are good options.
Stress and anxiety
Stress and anxiety can peak during middle age, Dr. Puthota says. The reasons are complex. Physical, psychological, and social changes can boost your stress level. Over time, high stress and anxiety can affect your cognitive, heart, and mental health.
You may have increased stress and anxiety when you experience two types of hormonal shifts:
Cortisol: When stressed, your body produces more of this hormone. It’s a necessary part of your fight-or-flight response. But having too much cortisol can disrupt your sleep, making you tired and anxious. High cortisol levels also change how your body stores fat, leading to weight gain in your abdomen.
Estrogen and progesterone: Estrogen is a building block for serotonin and dopamine, the brain chemicals that help you feel calm, content, and happy. Progesterone is also a key component of another brain chemical called GABA [gamma-aminobutyric acid] that controls anxiety. Your levels of estrogen and progesterone start to fall at 35, increasing your risk of major depressive disorder and anxiety up to five times.
Midlife also presents a complicated web of psychological and social changes that can have an equally strong impact on your stress and anxiety, Dr. Puthota says. For example, financial struggles, taking on too many roles, major life events, and other pressures can create a swirl of symptoms that can damage your health. Talk to your primary care provider or obstetrician-gynecologist if you experience any of these problems:
Cognitive: Repetitive thoughts about negative experiences, indecisiveness, forgetfulness
Emotional: Feeling overwhelmed, hopelessness, irritability
Physical: Fatigue, headaches, pain, sleep issues, stomach problems
To reduce stress, Dr. Puthota recommends the same lifestyle behaviors as Dr. Bullock. If your symptoms don’t improve within two weeks, talk with your doctor about therapy or medication.
Perimenopause and menopause
Perimenopause typically begins in your 40s when your estrogen and progesterone levels start to rise and fall. Ovulation is inconsistent, so you may have irregular periods. Menopause happens when you don’t have a period for at least 12 months. On average, most women experience menopause in their 50s.
It’s important to remember that perimenopause and menopause affect all women differently, Dr. Wendel says. The symptoms you experience can depend on your ethnicity, genetics, and other health conditions. These factors will also help your doctor recommend the right treatment for you.
Common symptoms
Most women experience these symptoms during perimenopause and menopause:
Hot flashes: Also called a vasomotor symptom, a hot flash feels like a temporary spike in heat in your face, neck, and chest. Caused by a drop in estrogen, hot flashes happen, on average, for seven years. During a hot flash, you can also experience:
Anxiety
Chills
Heart palpitations
Sleep disturbances
Sweating
Roughly 90 percent of women have at least one hot flash a day. A third can have up to 10 daily episodes. The most common risk factors for hot flashes include:
Being African American
Obesity
Smoking
Mood disorders
Low socioeconomic status
Vaginal tissue changes: Less estrogen also makes the lining of your vagina thinner. Up to 40 percent of women experience this problem. It can cause these vaginal symptoms:
Treatment
If you’re experiencing symptoms, a discussion with your doctor is an important first step, Dr. Wendel says. They can assess your health history, risk factors, and other characteristics to identify the best treatment option.
Hormone replacement therapy (HRT) is the most common treatment. It can increase your estrogen levels only or bump up your estrogen and progesterone. In addition to controlling your menopause symptoms, HRT benefits include:
Decreased risk of bone fracture
Less weight gain around your abdomen
Lower risk of heart attack or heart failure
For some women, the previously mentioned lifestyle modifications may be enough to control or reduce symptoms. Other women may benefit from medications that treat anxiety, hot flashes, and night sweats.
Screenings for other health conditions
Dr. Wendel says it’s important to stay current with your preventive health during menopause. He recommends these services:
Pelvic floor
Your pelvic floor is the group of muscles that support the organs in your pelvis. That includes your bladder, large intestines, and reproductive organs. Early in life, these muscles are strong and keep your core stable.
When your estrogen and progesterone levels decline, your pelvic floor muscles and supporting tissues weaken as well, Dr. Stachowicz says. As a result, you can develop a pelvic floor disorder. These conditions include:
Weight gain is also common after a drop in estrogen and progesterone. Being overweight or having obesity puts more pressure on your pelvic muscles and increases your risk of prolapse by 40 to 50 percent.
Pelvic floor disorders are very treatable, and conservative steps you can take on your own are often successful to reduce symptoms. Dr. Stachowicz suggests that you:
Limit strain on your pelvic muscles, including eating more fiber to reduce constipation.
Maintain a healthy weight and lose weight if your doctor recommends it.
Pay attention to other health problems. For example, uncontrolled diabetes increases your risk of urinary incontinence.
Try aerobic exercise, pelvic physical therapy, Pilates, strength training, and yoga to strengthen your pelvic muscles.
Heart health
Heart disease is the No. 1 cause of death among women. According to the American Heart Association, it kills more women than all cancers combined. So, it’s important to know your risk factors, possible symptoms, and how you can control them.
Risk factors
Two types of heart health risk factors exist—traditional ones that affect everyone and unique ones that impact women. The American Heart Association outlines traditional risk factors, like smoking, inadequate sleep, poor diet, high cholesterol, and high blood pressure, in its Life’s Essential 8™. Women also face these additional contributing factors:
Autoimmune diseases (for example, lupus raises your risk of coronary artery disease)
Breast cancer treatment
Endometriosis and polycystic ovary syndrome (PCOS)
Hormone replacement therapy (HRT) *(in high-risk individuals)
Menopause
Pregnancy complications (pre-eclampsia and pregnancy-related diabetes)
Symptoms
Women can also experience different symptoms of heart conditions.
Heart attack: Many signs of a heart attack appear in both women and men. Squeezing chest pain is the most common one. Other frequent symptoms include:
Back, jaw, or neck pain
Nausea and vomiting
Shortness of breath
But, as a woman, you can have a heart attack without chest pain. You may also experience these less obvious heart attack signs:
Dr. Radhakrishnan says you can have these symptoms even if you aren’t having a heart attack, which makes it hard to know when to seek attention. If they appear, pay attention to what you’re doing at that moment, if the symptoms feel different than what is usual for you, and how you feel overall. Seek medical attention if anything worries you.
Chest pain: Sometimes, chest pain isn’t related to a heart attack. Obstructive coronary artery disease—a buildup of plaque in your arteries that reduces blood flow, leading to blocked arteries—causes this pain for 20 to 40 percent of people. Doctors can see this condition on advanced imaging scans.
But between 60 and 80 percent of people who experience “cardiac” chest pain don’t have blocked arteries. Instead, they can have non-obstructive coronary artery disease that is harder to see with imaging exams. Several conditions can cause this type of chest pain. Men and women can experience these problems:
Myocardial bridge: A blood vessel passes through your heart muscle rather than lying on top of it
Myocarditis: Inflammation of your heart tissue
Pericarditis: Inflammation of the membrane that surrounds your heart
Some conditions that cause non-obstructive coronary artery disease are more common in women, including:
Coronary microvascular disease: Narrowing of the small blood vessels that feed the heart
Coronary vasospasm: Spontaneous, temporary narrowing of the coronary arteries that reduces blood flow
Spontaneous coronary artery dissection (SCAD): A tear in the wall of a heart artery
Takotsubo cardiomyopathy: Sudden chest pains and shortness of breath triggered by emotional stress, causing a sudden drop in heart function
A healthy diet for a healthy heart
Eating a healthy diet is one of the best ways to reduce your risk of heart disease. Dr. Radhakrishnan says heart-healthy nutrition includes:
Fruits and vegetables
Heart-friendly oils (avocado, canola, or olive)
Lean protein
Low-fat or fat-free dairy
Nuts and seeds
Whole grains
Limit alcohol, eggs, processed foods, saturated fats, sodium, sugary drinks, and sweets.
Steps to protect your heart
Being proactive is a big part of protecting your heart and preventing heart disease, Dr. Radhakrishnan says. She recommends these steps to keep track of your heart health and catch signs of disease early:
Schedule regular appointments with your primary care provider.
Know your risk factors.
Keep an eye out for symptoms.
Determine your numbers, including blood pressure, blood sugar, and cholesterol.
Ask your doctor for appropriate heart screening tests.
Musculoskeletal health
Joint pain and stiffness aren’t always signs of normal aging. Dr. Chung says they’re also treatable signs of menopause triggered by a drop in estrogen. Estrogen supports collagen, which strengthens your bones and joints. It also fights inflammation in every bone, ligament, muscle, and tendon. When estrogen levels drop, up to 70 percent of women develop musculoskeletal syndrome of menopause (MSM). This condition causes chronic inflammation and leads to more pain and less range of motion.
If you have MSM, you have a greater risk of injury and are more likely to develop:
Losing estrogen impacts your bones, muscles, and spine in specific ways:
Bone: Reduced estrogen leads to bone loss and weakness. In fact, women can lose between 15 and 20 percent of their bone density during menopause. Osteopenia is moderate bone loss. Osteoporosis is severe bone loss that increases your risk of fracture.
Muscles: Low estrogen can cause sarcopenia, a condition where you lose muscle and strength.
Spine: With reduced estrogen, you have less muscle mass and core strength to support your spine. In addition, weakened bones bend and curve under your body weight, and degenerative disc disease can cause stiffness.
Migraines
Dr. Chung says estrogen and progesterone changes are closely linked to migraines—even if you’ve never struggled with them before. These factors can make migraines more frequent and more severe:
Heavy menstrual bleeding
Hot flashes
Sleep pattern changes
Get the comprehensive care you need
Middle age presents a wide range of health concerns. “It is really important to have a supportive team behind you, to really listen to your symptoms, put all the pieces together and formulate a plan for you,” says Dr. Chung. “It is our job to empower you, to validate, to listen... If you’re not getting that from your health care team, you really need to find those who will.”
If you need help finding a provider, please call our free ezCare Concierge Service at 513-866-3851 or complete this form to request a call back.