As women enter their 40s, a new chapter of health begins. The decade brings unique considerations, from changing hormones to life priorities. To help us navigate, we sat down with Dr. Katherine Sherif, a women’s health expert and professor of medicine at Thomas Jefferson University. In our Q&A, Dr. Sherif offers insight on turning 40 and the years incoming.
Femme Pharma: When a woman becomes 40, what is the top area she should consider when thinking about her health?
Dr. Sherif: The top area women should consider at the milestone of turning 40 is nutrition. What you eat will determine the trajectory of the next 40 years. We live in a world dominated by agribusiness marketing and have forgotten how and what to eat the way our grandparents and great-grandparents age. In order to eat well, you need to be intentional. It doesn’t happen by accident.
FemmePharma: What kinds of testing should women who turn 40 consider their first year at 40, and subsequent years after 40?
Dr. Sherif: At 40, we generally recommend a baseline mammogram to detect breast cancer. It may be earlier if you have a mother or sister with breast cancer, but 40 is the usual number. Most physicians recommend mammograms every 1-2 years. I usually recommend yearly on your birthday, so that it is easier to remember. At 40, PAP smears with HPV testing should continue every 5 years. At 45, we recommend your first colonoscopy to screen for colon cancer. The age for the first colonoscopy may drop due to the high incidence of colon cancer in young people, which is a consequence of our poor diet.
FemmePharma: What do you think are the most pressing issues from medical and emotional health standpoints for women during their life decade of 40-50?
Dr. Sherif: The most pressing issues for women ages 40-50 include:
- Mental health, especially anxiety and depression. The pressures of work and family may be compounded by hormonal changes during this time, termed the perimenopausal years. Since hormones begin to decline and fluctuate in the 30s, anxiety and depression may emerge for the first time, or may be exacerbated by hormonal changes. Not only do women have mental health challenges during this decade but they are magnified due to our poor mental health care infrastructure, which has been neglected by medical organizations dominated by surgeons and men, and gutted by insurance companies.
- Nutrition. It takes a large investment of time to learn to eat well. But, eating well will change the trajectory of your health for the rest of your life. Insurers often do not pay for dietician consults, except for the patients who already have diabetes or other very serious health conditions. Prevention is the key.
- Physical activity. We live in a world that makes it difficult to be physically active in a natural way, which then drives us to seek solutions such as going to the gym. We’re too busy to go to the gym and then feel bad about ourselves. The amount of physical activity we need to have a long, healthy life doesn’t add up to that much every day. It is more important to be consistent than to knock yourself out on Saturday at the gym. In the Blue Zones of the world, where a high proportion of people are healthy and active in their 90s and over 100, physical activity consists of everyday tasks, such as sweeping the sidewalk, working in the garden, and so on.
- Loneliness. It is difficult to make friends and requires an investment of time. Loneliness kills. Some studies estimate that loneliness is a greater factor in dying young than smoking.
FemmePharma: If you could give one piece of advice to women turning 40, what would it be?
Dr. Sherif: Make friendship and community building a priority.
FemmePharma: What kinds of conversations about perimenopause and menopause do you suggest women who turn 40 and progress through their 40s should involve themselves with?
Dr. Sherif: The medical establishment has done a poor job of explaining perimenopause and menopause, mainly due to gender- and sex-based biases against women. Fortunately, there has been an explosion of information about women’s health on social media. Women need to understand that just as adolescence is a process—not something that occurs overnight—perimenopause is a long process that begins in the 30s. Menopause is the term for one year after the last menstrual period, but this marker doesn’t explain much about our health in the preceding 15 years or so.
Then, there is the conversation about hormones. Women need to figure out the larger context—away from pharmaceutical marketing messages and aside from physicians who think hormones are either “good” or “bad.” The larger context is: conventional medicine regards hormones as a solution to treat a “problem.” Conventional medicine is disease-based, not health-based. We wait until you have a problem, then prescribe a solution. On the other hand, is taking hormones a way to prevent health problems, does it create problems, or is it just a waste of time if you are not taking it for hot flushes/vasomotor symptoms? Although studies are unclear about preventing health problems or promoting healthy aging, the science is murky since most studies used hormones foreign to the female body. Biology tells us that endogenous hormones maintain healthy functions. For example, estradiol releases nitric oxide in the arteries, causing the arteries to dilate and lowering blood pressure. Decreased estradiol contributes to the development of hypertension. Endogenous progesterone is a diuretic and its absence may also contribute to the development of hypertension. We need to ask ourselves: are we treating a “disease” or “deficiency,” or are we promoting healthy aging?