A Women's Health Expert Shares Six Healthcare Tips if You're Over 40
Women’s health care is more than contraception, pregnancy, Pap smears, menopause, or breast cancer. It’s heart health and diabetes care. It’s sexual health. It’s addressing Alzheimer’s, stroke, and cancer risk, and addressing mental health issues like depression and anxiety (which affect more women than men). It’s improving care of women after cancer. It’s helping women understand the importance of healthy lifestyle, diet, exercise, and weight management and their impact on future disease risk and empowering them to take steps to prioritize their own health habits as they age. It’s helping empower women to use their voice to speak up and actively engage in their own health care.
Women have unique, gender-specific, and often complex healthcare needs. Women’s health extends far beyond the gynecologist’s office and is more than “bikini medicine.” Women are fundamentally different than men, down to the DNA of every single cell. Women have a completely different hormonal milieu than men. Women have diseases that are unique to them (endometriosis, fibroids, polycystic ovary syndrome), and diseases that present in both men and women are completely different in women. When it comes down to it, gender and biology make a big difference in how diseases manifest and need to be treated. We only now understand that the centuries-old approach that women are simply “little men” is simply wrong. Women need gender-specific care.
As a woman, it is important for you to advocate for yourself, particularly in the following areas:
- Menopause is often a challenging time. Don’t suffer alone, and don’t exclude hormone therapy.
- Your “lady parts” - including your labia, vulva, and vagina - come in all shapes and sizes. There’s a tremendous range of what’s “normal.” Don’t be ashamed of yours!
- Diet is even more important as we age.
- Mammograms are important. But knowing your individual risk of developing breast cancer is even more powerful and can help prevent the development of the disease.
- Heart disease is the number-one killer of women.
Let's dig into all of these lifesaving health care tips for every midlife woman.
1. Menopause is often a challenging time. Don’t suffer alone, and don’t exclude hormone therapy.
For many women, menopause is a difficult stage of life. Although it is a “natural” phase, the dramatic change in hormones that occurs results in symptoms and body changes that impact many women’s quality of life. The classic menopause symptoms - hot flashes and night sweats - are often severe, but there are many others that women often do not realize are also associated with menopause. Anxiety and depression, brain fog, weight gain, hair loss, sexual symptoms, palpitations, and fatigue are all common symptoms that negatively impact women. We know that many women suffer unnecessarily at this time of life due to misinformation and their own fear of hormones, and also the reluctance of clinicians to address their symptoms due to short visits and lack of provider education in menopause management. Women need and deserve better menopause care.
Let’s say it together: hormones are not all bad! The large study - the Women’s Health Initiative - and data first published in 2002 may be the reason you have the perception that hormones are “bad” – that they cause cancer, heart disease, and strokes. Based on that study, many providers stopped prescribing hormone therapy to menopausal women. Fast forward to 2021. Today we know that the Women’s Health Initiative data is not completely applicable to younger women in their 50s – when many women are struggling with menopause’s changes. The average age in the study was 63 years old, and many women were over 70 - 20 years beyond the onset of menopause. Seventy-year-old women have different health issues than 50-year-old women. Now we understand that hormone therapy impacts younger women differently and is often the best option for the vast majority of women close to menopause.
Despite our newer understanding of hormone therapy’s safety, only 30 percent of symptomatic menopausal women are appropriately treated with hormone therapy today. We can do so much better.
If you’re a menopausal woman with symptoms, educate and advocate for yourself. I suggest three important things:
- If your clinician is not knowledgeable about menopause management and the pros and cons of hormones and other treatment options, find a clinician who is. The North American Menopause Society is a good place to find a menopause clinician. Look for one who’s certified as an NCMP (a menopause practitioner).
- If you’re having menopause symptoms, don’t automatically exclude hormone therapy – it may just be the best option for you. There are many FDA-approved oral, gel, and patch hormone options in various doses available, including FDA-approved bio-identical hormone therapy.
- Compounded hormone therapy, marketed as bio-identical hormone therapy, is not a better or safer option. Compounded pellets, while often touted as being safer, have not been proven as such. And because they are not regulated by the FDA, dosing is often higher than needed and there are concerns about impurities. There are FDA-approved bio-identical options.
2. Your “lady parts” - including your labia, vulva, and vagina - come in all shapes and sizes. There’s a tremendous range of what’s “normal.” Don’t be ashamed of yours!
Let’s begin by saying, your labia, vulva, and vagina are perfect just the way they are. This part of your human body is well-designed, low-maintenance, and even able to adjust to changes in your body as you age.
So why do some wellness sites, many in the name of female empowerment, say it needs work? Even popular celebrities have begun recommending women try methods of vaginal “care” for various therapeutic and spiritual reasons.
From a medical standpoint, there are certainly specific medical conditions involving the labia, vulva, and vagina that should be treated – such as vaginal atrophy, known as genitourinary syndrome of menopause (GSM), and lichen sclerosus, a vulvar skin condition - but there are many treatments now being marketed that simply could cause more harm than good. Your vagina is a bit like a self-cleaning oven, perfectly capable of maintaining its pH-balanced environment on its own, thanks to the healthy balance of bacteria inside it. Introducing other substances could throw off your body’s ability to protect itself and make you susceptible to irritation, infection, or even chemical burn.
The vulvovaginal area is certainly an important one, but it doesn’t need any special tricks to stay healthy. Be informed. Be wary of clinics marketing aesthetic procedures for your “lady parts.” Your vagina does not require steaming or rejuvenation. Surgery to change the appearance of your labia does not improve sexual function. And jade eggs do not have any special benefit.
Don’t fall for marketing disguised as “science” or celebrity endorsements. Not only are the benefits questionable at best, they could be harmful. All you need to do is take care of yourself - see your healthcare provider regularly and get your recommended pelvic exams and pap smears.
3. Diet is even more important as we age.
A healthy diet is important at any age, but for midlife women, proper nutrition along with regular exercise is more important than ever.
Many women tend to gain weight as we age due to decreased activity and loss of muscle mass. More than half of American women in their 40s and 50s are overweight, and this number increases to more than 73 percent of women 60 or older.
Unfortunately, we find that the calorie counts that worked for us in our younger years are likely too high as we get older. And for menopausal women, the decrease in estrogen leads to a shift of fat to the mid-section. Obesity, especially this deeper “belly fat” obesity, has been linked to serious health conditions such as certain cancers, heart disease, and type 2 diabetes.
Following a Mediterranean-style diet that’s rich in fruits and vegetables, legumes, fish, and low-fat dairy – combined with regular physical activity - can help menopausal women maintain a healthy weight.
Additionally, as we age, our hormone levels drop, and we need more calcium to reduce risks of bone fractures. For women over 50, the recommended daily allowance for calcium is 1200 mg – about two to three servings of calcium-rich food. Be sure to talk with your doctor about your diet to determine if you need calcium and/or vitamin D (important for calcium absorption) supplements to support your bone health.
4. Mammograms are important. But knowing your individual risk of developing breast cancer is even more powerful and can help prevent the development of the disease.
From young adulthood, women worry about their risk of developing breast cancer; we understand that simply because we are female, we are at risk. Most of us know the statistic: “one in eight,” or 12 percent, of women will develop breast cancer over the course of their lifetime. What we also know is that many women are actually at much higher risk of developing breast cancer than the 12 percent risk of the general population – and they don’t know it.
Imaging with mammography, ultrasound, and breast MRI are tests that detect cancer. They are incredibly important, but they do not prevent cancer or help an individual woman understand her risk. And while early detection is critical, since survival rates are vastly improved for women in the early stages of the disease, it’s even more effective to prevent it. And we now know so much more that can help us do that.
Did you know that there are new tools that allow us to identify individuals at higher risk so providers can work with those women to establish more aggressive screening schedules and provide tools to help lower their risk through lifestyle changes and even medication? Breast cancer risk assessment tools also identify women who should consider genetic consultation and testing, and enhanced screening with breast MRI or ultrasound.
As a breast cancer survivor myself, my advice is to remember that you’re your own best advocate. Don’t be shy with your clinician! Know your family history and talk about whether a genetic cancer screening would be helpful. Ask your doctor to calculate your individual risk. Discuss your breast density and what it means. Ask about any lifestyle changes that might lower your risk.
5. Heart disease is the number-one killer of women.
For far too long, heart disease was considered a “men’s health” issue. That thinking has slowly shifted, thanks to more in-depth research and an increased awareness among women about their risk of heart disease.
The percentage of women who have high blood pressure jumps from 33 percent among ages 45-54 to almost 66 percent of women 65-74. That risk climbs even higher as we keep aging: it’s estimated that 81.2 percent of women age 75 and older have high blood pressure. As we get older, we’re also more likely to have high blood pressure than men.
The American Heart Association issued new guidelines for healthy blood pressure readings in the past few years:
- Normal: less than 120/less than 80
- Elevated: 120-129/less than 80
- Hypertension (stage 1): 130-139/80-89
- Hypertension (stage 2): 140 or higher/90 or higher
- Hypertensive crisis: 180/120
These guidelines can help you and your doctor assess your health and identify the right approach to helping you manage your blood pressure. Your doctor should be looking at much more than these two numbers, including whether you’re pre-menopausal, perimenopausal, or menopausal; pregnant; thinking about becoming pregnant; or using certain types of birth control.
In addition, heart disease itself often shows up differently for women than men. Women often describe the typical “chest pain” as being more like pressure or tightness. We’re also more likely to have symptoms like neck, jaw, shoulder, upper back, and abdominal discomfort; shortness of breath; pain in one or both arms; nausea; sweating; lightheadedness; unusual fatigue; and indigestion. And we’re more likely to have symptoms while resting than men are. One theory is that this stems from the fact that women often have blockages not only in main arteries but also in the smaller ones. The end result is that women aren’t diagnosed as early or as often as men, nor are we treated as aggressively.
6. Sexual health IS health.
Sexual health of women has long been neglected despite the fact that an estimated 41 percent of women experience sexual dysfunction. In contrast, men’s sexual health is commonly addressed as part of their regular health care, as evidenced by the fact that there are currently 26 FDA-approved medications to treat sexual dysfunction in men, compared to only two for women - both of which were just approved in the last four years.
Why? There are two primary reasons: the investment and research into erectile dysfunction (which only affects 19 percent of men) far outpaces research into women’s sexual dysfunction. Women’s sexual dysfunction is also much more complex to treat, thanks to a wide range of causes and our changing biology as we age.
Sexual disorders among women include hypoactive sexual desire disorder (HSDD), inability to become aroused, lack of orgasm, and painful intercourse. Each of these disorders can be caused by many different conditions – from cancer to diabetes, to falling estrogen levels to sexually transmitted diseases and many, many others.
Menopause is also a big culprit. Those hormonal changes lead to “genitourinary syndrome of menopause” – GSM for short – vaginal pain and dryness leading to painful sex. About 80 percent of women 10 years beyond menopause will experience GSM, but only seven percent will get treatment. The good news is, there’s a whole new school of thought around menopause treatment, and it extends to this.
Add to that the challenge that many women – and providers - are not comfortable discussing sexual health, and women suffer in silence.
Remember that your sexual health is an important part of your overall health. In fact, sex has been found to have a positive effect on relationships, your immune system, sleep, stress, and more.
Again, advocate for yourself! If your doctor doesn’t listen, find one who’s comfortable with sexual medicine. There is no reason your sex life should decline as you age – and it doesn’t have to. Your health care provider should create an open, honest, and comfortable space for you to bring any health concern you’re facing, whether it’s physical, mental, emotional, or sexual.
Trained at Yale, and the University of Chicago, Dr. Lisa Larkin is a board-certified internist, business owner, and entrepreneur practicing internal medicine and women’s health in Cincinnati, Ohio, since 1991. She is Founder and CEO of Ms.Medicine, an innovative healthcare organization of women’s healthcare specialists seeking to raise the standard of care for women through its concierge primary care model and its education arm, Ms.MedEd, which provides evidence-based information to clinicians and consumers on the complex health needs of women. She is also Owner and President of Lisa Larkin, MD, and Associates, an independent, multispecialty internal medicine and women’s health practice offering Direct Primary Care and concierge medicine. Additionally, she serves as Director of Women’s Corporate Health for TriHealth, and she is the Founder and Executive Director of the nonprofit, Cincinnati Sexual Health Consortium.
A breast cancer survivor herself, Dr. Larkin is passionate about raising the standard of care of women and advancing evidence-based women’s healthcare. Considered a national expert in menopause management, sexual medicine and breast cancer risk assessment and prevention, Dr. Larkin is also well-known as a clinician and community educator, publisher, lecturer, expert media resource. She serves on the Board of Directors of ISSWSH (International Society or the Study of Women’s Sexual Health), and on the Board of Trustees of NAMS (North American Menopause Society).