Women jumping
It’s a great time to be a woman in her 40s: as barriers continue to be broken in the workplace, men share more childcare responsibilities, and opportunities for physical and intellectual enrichment abound. While overall health and lifestyle have improved significantly for women compared to their mothers’ and grandmothers’ generations, there are still screenings, exams, and aspects of health to be mindful of while crossing that marathon finish line or having a baby.
Seeing the Future
If you’ve made it through your 30s without so much as a pair of reading glasses, you’re lucky. By 40, most people have an increased risk of certain diseases like glaucoma, cataracts, age-related macular degeneration, and diabetic retinopathy. Elizabeth A. Davis, MD, FACS, partner at Minnesota Eye Consultants, recommends those with no personal family history of ocular disease begin eye exams at age 40. “That’s when age-related eye diseases begin to manifest,” she says. “If problems are caught early, treatment can be successful.”
Woman on tablet
If you’ve been avoiding a visit to an ophthalmologist but you’re struggling to read books, holding them at arm’s length, or squinting to read a computer screen that used to be completely visible, make an appointment. This is most likely presbyopia, the normal loss of near focusing ability that occurs with age. Presbyopia is typically treated with eyeglasses. However, any vision loss that also includes shadowy areas in your central field of vision or unusually fuzzy or distorted vision could be something more serious, like age-related macular degeneration.
But you don’t have to settle for glasses; many people are candidates for alternative therapies, depending on the disease.
According to Davis, there are many new elective eye treatments now available to reduce or eliminate the need for distance glasses, reading glasses, and contact lenses: “[These are] procedures that improve the quality of life immensely, so seeing an eye care provider can be educational in that regard.”
You can start or continue to protect your eyes ahead of your 50s through a healthy lifestyle. Wear the correct protective sunglasses and eyewear with UV protection when outdoors, even on cloudy days; eat a diet rich in vegetables, leafy greens, and omega-3 fatty acids; avoid smoking; maintain healthy blood pressure and cholesterol levels; and exercise regularly.
Smart Screening
To stay in optimal health in your 40s, doctors recommend a variety of annual exams and screenings. For women, especially those approaching perimenopause or menopause, typically mid- to late-40s, it’s important to have your thyroid checked to ensure hormone levels are normal. A simple blood test can reveal thyroid changes, which can affect how the body’s organs function—including the brain, an obvious asset while earning a degree or climbing the corporate ladder.
“This hormonal decline and transition usually begins in a woman’s 40s,” says Susan Halloran, APRN, CNP, women’s health nurse practitioner at Menopause Center of Minnesota, “which often coincides with increasing career responsibilities, raising children, relationships, having elderly parents, disrupted sleep from hot flashes, mood changes, and vaginal dryness.” Typically, thisis perimenopause.
Perimenopause occurs when a woman’s eggs are depleting, which means all women—except those who’ve had hysterectomies where eggs are removed—will go through perimenopause before menopause sets in and all eggs are gone.
The symptoms of perimenopause and menopause are very similar: hot flashes, vaginal dryness, insomnia, emotional lability, low sex drive, low energy, focus or attention issues, and memory issues. However, in perimenopause, women experience irregular vaginal bleeding, and by menopause there’s no bleeding.
While some women experience extreme hot flashes, others won’t. “Not all women will have perimenopause symptoms or experience them with the same severity,” says Dr. Melvin Ashford, executive and medical director at Minnesota Women’s Care.
The good news is that many clinics in the Twin Cities area offer hormone treatment to offset the effects of menopause on the body, and potentially alleviate some of the symptoms you’re experiencing. Pellet therapy has gained popularity in the Twin Cities in recent years. A pellet the size of birdseed is injected into the body to release hormones on a 24-hour cycle, constantly giving your body what it needs to function optimally.
“Over the years, women have demanded relief for perimenopause symptoms and they seek out providers who will understand and help them,” says Halloran. “A woman cannot fulfill self-actualization when she is trying to just feel well. So, ask for help, demand help, and get help so you feel well.”
Women live with menopausal symptoms on average one to 10 years, so finding ways to combat symptoms or alleviate them is critical.
“I always bring up sexual health . . . there are many studies that say women don’t bring up sexual questions or concerns at appointments unless they’re asked, but there are things we can do to help them.”
—Dr. Margaret Hildebrand, Park Nicollet
Two women running
Preventive Measures
Although bleeding is a symptom of perimenopause, it can also signal other medical issues. How do you know if bleeding is part of menopause, perimenopause, or something else—like cancer or other diseases?
“I tell my patients: If you have irregular bleeding, I want to know about it,” says Dr. Rachel Harris, physician at Southdale OBGYN.
Pap smears and guidelines for being checked have helped detect cervical cancers, making them more treatable in the past 50 years. Other reproductive cancers, like uterine, can be detected through biopsy and/or vaginal ultrasound. Unfortunately, ovarian cancer isn’t as easy to detect, and when symptoms present, the cancer is often beyond early stages. The key is keeping your doctor aware of any changes to your cycle, any pain or irregularities, and making an appointment each year with an OBGYN. Catching reproductive cancers early increases the odds of a good outcome.
“We can rule out uterine cancer easily with an endometrial biopsy,” says Harris. “Every patient with irregular bleeding should be evaluated—was it one time, was it spotting, so maybe we can ignore it, or does she have extra risk factors like obesity, family history of uterine cancer, extra hormones, or endometrial hyperplasia. Then I would say she needs that biopsy no matter what.”
In addition to being screened for reproductive cancers, staying on top of breast health by getting the right tests at the right time can save your life. Unless you have an elevated risk for breast cancer, your doctor will likely recommend that you start getting mammograms at age 40.
“Most OBGYNs are starting to recommend women get mammograms every year or every other year starting at 40,” says Dr. Margaret Hildebrand, OBGYN at Park Nicollet. “I recommend every year—and that’s someone with an average risk, not an increased risk.”
In general, it’s recommended that high-risk women start getting mammograms in their 30s, depending on the factors. For women with mothers, sisters, or other close family members with breast cancer, the recommendation is to get a mammogram several years before that family member’s age when she was diagnosed. So if your mother had breast cancer at 42, you’d want to talk to your doctor about getting a mammogram in your 30s. Technology is always evolving, and breast MRIs are an option for women who are high risk or who have very dense breast tissue and want a more detailed scan than what most mammograms can provide.
In addition to the annual exam, daily breast self-checks are suggested for everyone, whether or not you’re in menopause. If you notice any changes in breast tissue, tenderness, or abnormal spots or fluids, have them checked by a doctor.
The Heart of it All
Women are winning Olympic medals in their 40s and 50s, and they’re staying physically active well beyond that. Kristin Armstrong won the Olympic gold for cycling in Rio at 42; show jumper Beezie Madden, 53, has won several Olympic medals, including silver for team jumping in the 2016 games; and record-breaker Harriette Thompson is the oldest woman to run a half marathon—she is 94.
Chances are you’re not an Olympian, but you are likely juggling work-life balance and striving for your own personal wellness medals—running, walking, hitting the gym three times a week, or making time for that Saturday morning yoga class. No matter how you move, you’re doing your body right. A healthy heart is vital at any age, and for women in their 40s, it’s critical.
The number one killer for women in their 40s is heart disease, not cancer. “People get really worried about breast cancer at that age, but we actually get really worried about heart disease as people get closer to the age 50 mark,” says Harris. “And prevention starts in the 30s and 40s with diet, exercise, and regular screenings.” According to the American Heart Association, about 7.4 million women alive today have coronary heart disease, and 3.2 million of them have a history of heart attack.
When hormone levels change, it’s harder to lose weight, it’s harder for the body to metabolize calories, and it can lead to the risk of developing heart disease, and high cholesterol, blood sugar, or blood pressure. “As women approach menopause, the risk of cardiovascular disease increases,” says Hildebrand. “Starting at 40 we would recommend monitoring cholesterol, checking for diabetes, and talking about weight management.”
If you’ve gained weight, lost weight, or if you’ve gone through any hormone changes as a result of disease or menopause, you’ll want to discuss the potential for heart disease with your doctor, who can look at your medications, lifestyle, and activity level, and advise on nutrition. It’s also a good idea to meet with a nutritionist, who can teach you how to cut calories as your body’s metabolism slows down. Simple things like swapping a latte for a regular cup of coffee, or cutting out soda and drinking more water are ways to reduce a few hundred calories every day. Plus, a nutritionist can talk to you about your goals, come up with a daily meal plan, and recommend exercises.
Handling it All
By a woman’s 40s, she may be reaching key points in her career and climbing the corporate ladder; juggling family changes with growing children and the relationship with her spouse; handling the responsibility of aging parents; and accepting lifestyle choices that can contribute to overall health and wellness.
“Women feel they’re supposed to be able to handle it all—it can be really overwhelming,” says Harris. Every woman who comes in for an annual exam gets screened for depression. The test doesn’t screen for anxiety, but that often comes up while talking about lifestyle and overall wellness during the appointment.
If a woman is diagnosed with depression and/or anxiety, doctors will talk her through any lifestyle changes that could make a positive impact, as well as recommend talk therapy and possibly medication.
“There are many times we’re continuing to monitor or try therapy as the first step, and then in a few months check in and see how the patient is doing and assess where to go from there,” adds Harris.
Whether you’re approaching your 40s, well into them, or well past them, it’s essential to keep yourself healthy, active, and accountable for annual wellness exams.
Mom with two kids
Bringing Up Baby
Having a baby after 40 brings a host of considerations, but it’s not impossible to conceive. With the rise in older women hoping to become mothers, the medical field has expanded, with lots of professionals working specifically to help women get pregnant or provide a treatment plan to increase fertility odds.
Ideally, a woman in her mid- to late-30s who isn’t planning to have children for a while yet should talk to her OBGYN, who may advise she get fertility testing and discuss egg preservation. These tests can reveal potential issues with fertility as well as an estimate of her remaining eggs.
“I always want to know if a woman—especially one in her early 40s—has had prior testing, like ovarian reserve testing,” says Dr. Colleen Casey, reproductive endocrinologist and fertility specialist at Center for Reproductive Medicine. Ovarian reserve testing, which is an ultrasound, checks how many follicles a woman recruits each monthly cycle to determine how fertile she is. Women need a lot of eggs to increase the odds of getting pregnant or to begin freezing eggs—and women’s fertility declines every year after 35.
In addition to ensuring there is a good egg supply, the environment of the fallopian tubes is important—especially if the woman is considering an intrauterine insemination (IUI), where sperm is injected into the uterus during anticipated ovulation. For women in heterosexual relationships, men would have their semen tested to determine their fertility. Ultrasounds are typically able to determine ovarian and uterine health for a potential pregnancy.
After the ovarian reserve test, doctors level with women who are over 40 about their realistic odds of conception using IVF or IUI, and provide information about donor egg or embryo, or adoption. Donor eggs and donor embryo transplants allow the woman to carry her own pregnancy using another woman’s eggs along with her partner’s (or donor’s) sperm.
Women considering an egg or embryo donation typically meet with a psychologist to check in on the mental and emotional state as the woman or couple have been going through the fertility process so far, then they’re put on a waiting list to be matched with a donor, which is then typically an eight-week process: The egg donor is stimulated and eggs are retrieved, then they are fertilized with the intended father’s sperm, and finally, the embryo is transferred into the woman five days later.
Age alone doesn’t mean a woman can’t get pregnant. “We have women up to their 51st birthday who get pregnant using donor eggs,” says Casey. “The success rate has more to do with the egg quality, so I don’t deter patients from carrying the pregnancy unless there’s something wrong, which most likely there’s not.” Increased age at pregnancy does come with risks like high blood pressure and diabetes.
Doctors keep a close eye on women who are considered high-risk or who are older at pregnancy (35 is considered a geriatric pregnancy!) by having frequent ultrasounds and offering testing for potential issues earlier in the pregnancy than younger women would. Pregnant women over age 34 are offered the noninvasive prenatal testing (NIPT), which tests a woman’s blood rather than the traditional testing—chorionic villus sampling (CVS), which involves the sampling of placental tissue or amniocentesis by penetrating the uterus to take a sample of amniotic fluid to test for certain chromosome abnormalities. “The test reveals the number of X and Y chromosomes, so it does more than check for the copies of chromosomes to find abnormalities,” says Dr. Rachel Harris, Southdale OBGYN. Since there are certain sex-linked chromosomal disorders, the test screens for those, but the fun part is you get to know the gender sooner.
Degree Of Success
More women than men are earning master’s, certificate, and doctorate degrees, according to the most recent data from the Council of Graduate Studies. In the 35 to 44 age group, more women than men hold bachelor’s degrees or higher, about 35 percent compared to30 percent, according to the Census Agency. And multiple studies show women are the majority of post-graduate degree-seekers since 2008.
A Common Issue
Genetics, childbirth, and age can leave a woman with less muscle control, which can result in bladder leakage or loss of control. It’s common, and it’s also treatable. “Urinary incontinence and loss of bladder support are common for women in their 40s,” says Dr. Melvin Ashford, executive and medical director at Minnesota Women’s Care. “Luckily we have many new and innovative options to help these women.” Some of these treatments include invasive or noninvasive surgeries and bladder slings.
Save Your Skin
Running with a view sure beats an indoor treadmill, and cross-country skiing around a crystal lake is an experience like no other. No matter what time of year you’re staying active, don’t skip the sunscreen. “Skin health in a woman’s 30s can really prevent a lot of cosmetic aging as we get older,” says Dr. Margaret Hildebrand, OBGYN at Park Nicollet. “A lot of evidence shows that regular dermatology checks and wearing sunscreen well into your 30s, especially 40s, will make a difference for long-term skin health.” Look for SPF 30 or higher, with broad spectrum to protect against aging UVA and penetrating UVB rays that damage skin.
