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No matter what age you are, you want to feel your best and know you’re taking every step possible to be healthy. At Providence, we know age is just a number, and we can only feel as good as the care we give to our bodies. Melanie Santos, MD, FACOG, FPMRS, medical director of pelvic health for St. Jude Medical Center in Fullerton, California, and several Providence patients recently talked about the importance of women receiving the right care at the right time.
Conversations with your primary care provider
It happens more often than you might think: A middle-aged woman schedules an annual physical with her primary care provider, dutifully answers all of her provider’s questions, and completes the appropriate bloodwork. Then, a few months later, she’s struggling with a recurring issue that never came up in a routine exam. As a result, she may have to undergo more extensive medical treatment that could have been avoided if addressed earlier.
In some cases, women are too embarrassed to bring up personal concerns with their doctor, such as urine leakage or other pelvic issues. For others, they simply don’t feel they have the time to seek treatment.
For women who are past their childbearing years, it is especially important to be honest with their primary care doctor, because they may be experiencing treatable conditions related to menopause, heart health, bone health, or pelvic health.
Talk to your provider about heart disease
Heart disease is the leading cause of death for women in the United States. Yet, it’s rarely top of mind for them when they’re managing their everyday health. While women are much more likely than men to see their provider for preventive care visits, they may gloss over seemingly small issues that could indicate bigger heart problems.
“Some of my patients have had lower leg swelling which they attribute to their bladder issues, when in fact that swelling could reflect issues with their kidneys or heart,” says Santos. “They also discuss vague symptoms that they don’t feel are a concern. For instance, they may have been experiencing nausea and vomiting, but they assume their stomach is just getting sensitive as they grow older.”
In reality, nausea and vomiting could be a sign you are experiencing a heart attack.
Risk factors for heart disease
Several common risk factors for heart disease — such as high cholesterol, high blood pressure, and obesity — affect both women and men. But other factors may play a bigger role in the development of heart disease in women, says Santos.
Heart disease risk factors for women include:
- Diabetes – Women with diabetes are more likely to develop heart disease than men with diabetes. Also, because diabetes can change the way women feel pain, they have an increased risk of suffering a silent heart attack — a heart attack without symptoms.
- Emotional stress and depression – Stress and depression affect women’s hearts more than men’s. Depression may make it difficult for a woman to maintain a healthy lifestyle and follow the recommended treatments for other health conditions.
- Smoking – Smoking is a greater risk factor for heart disease in women than it is in men.
- Inactivity – A lack of physical activity is a major risk factor for heart disease.
- Menopause – Low levels of estrogen after menopause increase a woman’s risk of developing disease in smaller blood vessels, such as in the heart.
- Family history of early heart disease – Studies have indicated this is a greater risk factor in women than in men.
- Inflammatory diseases – Rheumatoid arthritis, lupus, and other inflammatory conditions may increase the risk of heart disease in both men and women.
How to stay healthy in your 40s
Dr. Santos recently answered several questions about how women in their 40s can stay on top of their health as part of a series about women at different ages.
How is a woman in her 40s different from a woman in her 30s, health-wise?
Santos: Women experience many changes as they transition to their 40s, especially as they enter the perimenopausal status (the time leading up to menopause). During this time, women’s estrogen levels decline, which can lead to:
- Memory issues
- Decreases in bone density
- Menstrual cycle irregularity
- Vaginal dryness (this is one of the first signs of lower hormone levels)
- Pelvic floor dysfunction
Aside from hormonal changes, women in their 40s can see other changes both mentally and physically that affect their overall health, including:
- Slowing of metabolism
- Decline in muscle mass
- Increased stress with worries about children, parents, health, career, finances
- Periods of depression
- Decreased sex drive, which is affected by both hormonal changes and stress levels
What are women most concerned about health-wise in their 40s?
Santos: As women age in general, their risk of developing disease increases. For women over 40, they can be at increased risk for the following:
- Heart disease
- Breast cancer
- Accidental pregnancy
- Blood clots
What’s great about being a woman in her 40s?
Santos: Women in their 40s tend to be more confident and know what they like, need, and want. They may have less dependence and self-criticism, and more decisiveness that can help them take proactive steps toward improving their health. They can promote good health by:
- Scheduling annual check-ups with their health care provider.
- Sleeping for seven to nine hours every night.
- Exercising regularly – Exercise should include cardio for heart health, weight training for bone health, and adequate stretching.
- Eating healthy foods and drinking plenty of fluids.
- Confronting vices and seeing the benefits of reversing bad habits.
- Meditating is important for the mind and body alike.
What are four topics women in their 40s can discuss with a primary care provider at an annual checkup?
Santos: During an annual checkup, here is a quick reference checklist to keep on hand:
- Weight management
- Signs and symptoms of perimenopause
- Sexually transmitted diseases
- Mental health including depression, anxiety, or stress
What are the most important screenings and checks women should undergo?
Santos: The following are the most important checks for women and general recommendations for frequency:
- Eye exam – every two to four years
- Blood pressure – every two years
- Pelvic examination and PAP smear – every one to three years
- Thyroid – every five years
- Skin mole checks – yearly
- Mammogram – every one to two years
- Blood glucose – every three years, starting at age 45
Don’t fear bowel and bladder conversations
Women are more likely to experience bladder incontinence than men, and some of the causes of bowel incontinence — like vaginal childbirth — only impact women. And because many people consider bladder and bowel issues an inevitable consequence of childbearing, hormone fluctuations and aging, many women tend to ignore them while trying to fulfill all of the other responsibilities of their busy lives.
But bladder and bowel problems often become more severe over time, especially with hormonal changes that happen after the age of 40, causing emotional and physical distress. The good news is that most incontinence issues are treatable and manageable. And even some of the most advanced treatments and procedures can be done quickly with minimal downtime, getting you on the way to feeling better faster.
Keep an eye on your bone health
When you think of estrogen, you probably first think of its impact on reproductive and sexual health. But did you know estrogen can also play an important role in your bone health?
As women begin to produce lower levels of estrogen as they age – and all together stop during menopause – they become at higher risk of developing osteoporosis, which is a condition that causes bones to become weak and brittle.
Fortunately, there are many steps women of any age can take to support bone health before it becomes a concern.
- Get plenty of calcium and vitamin D
- Stay active
- Put a priority on your good health
Many women feel they need to care for everyone else in their lives, but it’s important to care for yourself, too. Talk to your primary care provider about the above issues, and don’t be afraid to bring up any and all concerns — even if they’re a little embarrassing.
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This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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