For almost all women, 40 will be the last decade of their menstrual life, a fact that can have far-reaching implications for the health risks they face in the decades to come.
Your 40s are also the time when cardiovascular and cancer risks begin to increase, making it a crucial decade to take stock of your current health and make the necessary changes to improve it as much as possible, says Stacey Rosen, cardiologist at Northwell Health in the United States.
“It’s an important time to optimize blood pressure, cholesterol, weight, physical activity… because, frankly, a lot of this becomes more difficult and the stakes are higher once you hit menopause,” she says. Rosen; “40 is the decade to really strengthen your preventive opportunities.”
Coronary heart disease is the leading cause of death among women in the United States, where eight in 10 women between the ages of 40 and 60 have at least one risk factor for heart disease. “The leading cause of death among women in Spain is cardiovascular complications, with stroke being the main cause of all of them,” states the Spanish Society of Atherosclerosis.
Exercise and a healthy diet are also ways to reduce cancer risk just as that risk begins to increase in women’s 40s. Get ready to add two new cancer screening tests to your health maintenance routine this decade.
The risk of cancer begins to gradually increase after age 40, so women should continue to undergo cervical cancer screening every three to five years, but they will also begin to undergo other screening. The United States Preventive Task Force (USPSTF), an independent, impartial panel that reviews all the evidence on health screenings, recommends that women start getting screened for two of the cancers that kill the most to women: colorectal cancer and breast cancer.
“Probably 90 percent of colorectal cancer deaths are preventable if we had been able to detect them early and perform a high-quality colonoscopy,” says Rajeev Jain, a gastroenterologist at Texas Digestive Consultants in Dallas, United States. This is because colonoscopies don’t just look for cancer, they also detect and remove polyps that can turn into cancer.
The latter may seem preferable, since they are non-invasive, while colonoscopy is invasive and requires prior preparation. But Jain tells his patients to compare bowel preparation with the alternative of undergoing chemotherapy and surgery if colorectal cancer develops. Non-invasive tests can only diagnose existing cancer, while colonoscopy can diagnose and prevent it. “If you want to prevent cancer, a high-quality colonoscopy with polyp removal is best,” says Jain.
Recommendations for when women should have their first mammogram, and how often, have changed many times over the years. The main reason is that recommendations change as more evidence accumulates, providing a clearer picture of the balance between the benefits and harms of screening.
Joann Elmore, an internist at the University of California who specializes in the study of cancer screening, says it’s important to understand that cancer screening has not only benefits, but also harms. Aside from the discomfort of the procedure itself, those harms include the risk of false positives, “where the test may say you have cancer, and you end up not having it, but it leads to a cascade of many additional tests,” Elmore says.
This is not intended to discourage women from undergoing screening, but it is suggested that it is important for women at average risk not to undergo more testing than they need and to be aware that false positives are a risk factor. frequent.
“With breast cancer, one in 10 mammograms will have an abnormality and the woman will be called back for additional testing,” says Elmore; “This is part of the screening process, and don’t be too surprised when they do it to you.”
One way to decrease the chance of false positives is to have a mammogram with 3D tomosynthesis if possible, because they provide much more information, Elmore says.
Although many women continue to have pregnancies and births into their 40s, most will have left motherhood behind by age 30. If you have managed to keep the same gynecologist all this time, hopefully you have established a solid patient-specialist relationship with him. That means you can ask her to help you optimize your overall health and prepare for what lies ahead with perimenopause, the period of time before menopause, during which your body gradually produces less estrogen and begins to have fewer periods. .
Hopefully you will also be regularly tested for depression, anxiety, excessive stress and intimate partner violence.
Your 40s are also the time to evaluate whether you have had any adverse pregnancy outcomes, such as gestational diabetes, preeclampsia or hypertensive disorders of pregnancy, preterm birth, pregnancy-related mood disorders (such as postpartum depression), or repeated fetal loss. . All of them can increase your cardiovascular risk, so you should monitor your blood pressure, blood glucose and cholesterol more.
Blood pressure should be measured at least every two years if it stays below 120/80, but should become annual if you develop hypertension. Likewise, cholesterol checks should only be done every five years, unless the numbers exceed normal values, in which case they will need to be done more frequently. Diabetes screenings should have started at age 30, and should continue.
Some women in their 40s can develop thyroid problems, sometimes unmasked by pregnancy, says Jill Rabin, an obstetrician-gynecologist at Northwell Health in the United States. Although no body officially recommends it, Rabin says it’s wise to consider baseline testing for TSH and free T4 levels. These hormones help regulate metabolism and other bodily functions, and their levels can be an indicator of thyroid function.
If you have symptoms of an overactive or underactive thyroid, talk to your doctor to find out if it is advisable to have your thyroid tested or consult an endocrinologist. Symptoms of an overactive thyroid, or hyperthyroidism, include unexplained weight loss, tachycardia, excessive sweating or heat intolerance, neck swelling, trembling hands, muscle weakness, difficulty sleeping, and nervousness or irritability. Hypothyroidism, an underactive thyroid, includes symptoms such as fatigue, weight gain, cold intolerance, joint or muscle pain, dry skin, thinning hair, symptoms of depression, and decreased heart rate.
Everyone should have a baseline eye exam at age 40 and repeat it later based on what it reveals, your family history, and your symptoms.
Continue to have your teeth cleaned twice a year, or possibly more often if you are lax about your oral health (for example, if you don’t floss regularly).
Many women begin to notice skin changes in their 40s, such as the appearance of fine, dynamic wrinkles, which are the result of repeated facial expressions, says April Armstrong, a dermatologist at the University of California.
“At 40 is when you start to notice a visible decrease in skin elasticity and hydration, so you’ll notice your skin is drier and starting to get a little thinner,” says Armstrong.
“There is no universal recommendation for everyone to be screened for skin cancer at age 40,” Armstrong says, but he advises being alert to those with skin cancer risk factors, such as a history of exposure. prolonged exposure to the sun or use of tanning beds, or to those who have a family history of melanoma or non-melanoma skin cancer. The doctor encourages women to self-monitor, following the ABCDE rule to detect any suspicious moles or discolorations.
Armstrong also recommends women incorporate a retinol or, ideally, a retinoid into their skin care routine starting at age 40 to mitigate the effects of sun damage on the skin. But, as always, the most important part of skin care is sun protection, including regular use of sunscreen. Even if foundation includes sun protection, it often contains filters that let in the rays, so Armstrong recommends applying regular sunscreen underneath and then applying makeup on top.
Finally, it is important not to miss the opportunity to avoid infectious diseases that can be prevented through timely vaccination. Continue getting vaccinated annually against flu and COVID-19 to reduce the risk of complications and hospitalization from these diseases. These vaccines are especially important for people with certain risk factors, such as obesity or hypertension, but even middle-aged people without health problems can end up hospitalized with flu or Covid infections.