Aging doesn’t have to be uncomfortable. Keeping up with routine wellness exams and asking the right questions can put you on a path to thriving beyond 40.
In a recent webinar,
Jennifer Demos-Bertrand, DO,
Mable Roberts, MD,
Jessica Scholey, MD, and
Beth Taylor, PT, discussed women’s wellness after 40, including annual screenings and well checks, menopause, sexual health and pelvic floor care.
Here’s what you should know to thrive after 40.
Make your annual exam and routine screenings a priority
Midlife isn’t a time to slack off on routine wellness exams and screenings—especially your well-woman yearly exam.
Dr. Scholey says this yearly visit includes important discussions with your provider about your health history. It’s also a great time to ensure you’re current on certain health screenings, including breast and pelvic exams.
Breast exams, or breast cancer screening, begin annually at age 40.
If you’re healthy, every three to five years, your pelvic exam will include a Pap smear. This test looks for signs of cervical cancer.
Other necessary screening tests after 40 include:
Keep moving and be mindful of your diet
“Experts recommend that women get 150 minutes of moderate-intensity exercise or activity weekly to optimize cardiovascular health,” Dr. Scholey says. “Calcium and vitamin D supplements are also recommended to optimize bone health.”
Shoot for 600 international units (IUs) of vitamin D daily. IUs are a way of measuring the potency of supplements like vitamin D.
Recommendations for calcium vary by age. If you are 50 or younger, aim for 1,000 milligrams (mg) of calcium daily. You can get this through a healthy diet or supplements. If you are over 50, up your calcium to 1,200 mg daily.
Pay attention to abnormal bleeding
“Women over the age of 40 may be experiencing their perimenopausal transition, and along with that often comes some irregular or abnormal bleeding,” Dr. Scholey says.
It’s important to talk with your doctor about
abnormal bleeding to rule out other health concerns, including adenomyosis (abnormal tissue in the uterus), cancer or pre-cancerous conditions, bleeding or blood-clotting disorders,
fibroids, infection or polyps.
Some medications and hormone therapy can also cause abnormal bleeding.
Dr. Scholey says to watch for:
Bleeding after sex or between periods
Bleeding more frequently than every 21 days (three weeks)
Bleeding that lasts longer than usual
Postmenopausal bleeding
Very heavy bleeding
Ease your way through menopause
Menopause is the time in a woman’s life when their ovaries stop producing estrogen. The average age of menopause is 52 years old.
The years leading up to menopause are known as perimenopause. Perimenopause typically begins in your mid-40s.
When it comes to menopause and perimenopause, everyone’s symptoms are different.
“Some people have severe symptoms, and some have very mild symptoms,” Dr. Roberts says. “I’ll have patients who say, ‘I can’t sleep. I have hot flashes. I wake up sweaty at night. My kids tell me I’m moody. I can’t focus. I can’t concentrate.’ Everyone’s different. But it’s a natural process all women go through, and it’s very important.”
Some conditions and health habits can increase menopause symptoms. Obesity, stress, smoking and excessive alcohol consumption can all play a role in how you feel.
It’s best to talk with your doctor about your specific symptoms, which can also include sleep disruptions, vaginal dryness, urinary problems, painful intercourse, anxiety, depression and brain fog. Many treatment options can help you find relief.
Hormone therapy for menopause
Hormone therapy is one treatment option for menopause symptoms.
“As your hormones fluctuate or you lose the ability to produce hormones, it only makes sense that replacing hormones might help with some of the symptoms,” Dr. Roberts says.
Hormone therapy isn’t for everyone, especially women with certain health conditions, like a history of breast cancer, blood clots, heart attack or stroke. But, for many women, hormone therapy is safe and effective.
Hormone therapy uses estrogen and progesterone to treat menopause symptoms. Estrogen can help with symptoms like mood swings, hot flashes and sleep disturbances. It can also decrease your risk of osteoporosis.
Progesterone can prevent uterine cancer in menopausal women who still have their uterus.
“There’s a lot of scary information out there about hormone therapy,” Dr. Roberts says. “But studies currently suggest that it’s safe for people with no cardiovascular disease risk factors.”
Because everyone’s body reacts differently to menopause, finding the right hormones at the correct dose and delivering them the right way can take time.
“There are patches, pills, sprays, foams and gels,” Dr. Roberts says. “There are a lot of different combinations.”
Talk with your doctor about the pros and cons of hormone therapy. And, if you are on hormone therapy, be sure to tell them how you’re feeling and report any side effects you experience.
Non-hormonal menopause treatments
Many non-hormonal treatments can also help with hot flashes and night sweats. The Food and Drug Administration (FDA) has approved several medications that can help, including gabapentin, bupropion and oxybutynin, to name a few.
Dr. Roberts says some over-the-counter herbal products and supplements may also offer relief. She recommends talking with your doctor before taking any medication to be sure it’s safe and won’t interact with your other prescriptions.
Other ways to reduce menopause symptoms include stress-reducing activities like acupuncture, behavioral therapy, hypnotherapy and yoga.
Eating a healthier diet, exercising and losing weight can also help with menopause symptoms.
Dr. Roberts and Dr. Demos warn you to be cautious about trying products or remedies you’ve seen on social media sites like Instagram and TikTok.
“A lot of people out there want to prey on the ‘very miserable’ perimenopausal woman and offer things like saliva testing for your hormones, injections or pellets,” Dr. Demos says. “Those aren’t safe or recommended by any of the medical societies we use to make our recommendations.”
Postmenopausal sex drive changes
The biological changes that cause menopause can also affect your sex drive.
“Menopause is the end of fertility,” Dr. Roberts says. “You are no longer ovulating. There’s nothing in your body that’s saying, ‘I have to have sex now because I’m ovulating.’”
But that doesn’t have to mean the end of a healthy sex life. You can take steps to impact your desire. Dr. Roberts recommends:
Increasing foreplay
Planning more date nights with your partner
Reducing painful intercourse with vaginal estrogen, lubricants and moisturizers
Seeking sex therapy
The bottom line with menopause, Dr. Roberts says, “Your symptoms matter. If they interfere with your quality of life, we should do something about it.”
She recommends making a special appointment outside of your annual exam to discuss menopause symptoms.
Get support for your pelvic floor
Your pelvic floor is at the bottom of your abdomen. It has different muscles that support the organs inside your body. But there are also parts of your pelvic floor that you can feel—like the muscles you tighten when you try to hold your pee.
“This area can get weaker over time, and this weakness can start to affect your daily life,” Dr. Demos says. “If you’re constantly planning your day around the nearest restroom, we want to know about it.”
Pelvic floor problems, including uterine or pelvic floor prolapse—a slipping or bulging of the uterus or other pelvic organs—can be uncomfortable or painful. Problems with your pelvic floor can also cause you to leak urine or stool or make intercourse painful. Over the long term, pelvic floor problems can lead to hip and knee pain.
Those most at risk of pelvic floor problems include:
Treatments like pelvic floor therapy, certain medications, devices and even surgery can help.
Taylor, a pelvic floor physical therapist, works with women to help them strengthen their pelvic floor and adjust daily activities to treat pelvic floor conditions.
“Kegel exercises are a wonderful way to strengthen your pelvic floor,” Taylor says. “The challenge is that often people are doing them incorrectly. We teach proper breathing mechanics and positioning and discuss reps and hold times.”
Taylor and a team of pelvic floor physical and occupational therapists assist with pelvic floor issues, creating an individualized plan for each patient, including a home program incorporating stretching, strengthening exercises and breathing techniques. They also train patients and caregivers on manual interventions like wands, dilators and vaginal weights. Sometimes, Taylor and the team use ultrasound, biofeedback and electrical stimulation to promote muscle contractions and relaxation.
“It’s such a personal and hard topic to discuss,” Taylor says. “But we’re all getting older and have pelvic floors. I want everybody to feel the best they can feel.”
Make your midlife health a priority
You can thrive after 40. Focus on your health with yearly wellness exams, routine screenings and regular check-ins with your provider. It’s also important to find support for menopause relief and pelvic floor strength.
We can help you feel your best. For help finding a gynecologic expert at The Christ Hospital Health Network, call our ezCare Concierge nurse navigator at
513-647-1460.