Health for Life: Changes After 40

Not long ago, a fortysomething friend of ours stopped at a convenience store to pick up a sports drink for her 13-year-old son. As she was about to pay, she felt a sensation of intense heat throughout her body and became nauseated and dizzy. The alarmed cashier asked if she needed help. Our friend shook her head and quickly made her way outside. But when she and her son got back in the car, she panicked and told him to call 911 on her cell phone because she was sure she was having a heart attack. Within minutes, she heard sirens coming closer. It was only then, as the heat dissipated and she began to sweat, that our friend realized what all these symptoms meant. She'd had her first hot flash! The emergency medical technicians, all in their early 20s, seemed bewildered as she explained her mistake. But one thing was clear: the only thing our friend was dying of was embarrassment.

Stories like this are growing more common as baby-boomer women hit menopause. Nearly a third of all American women are now between 40 and 60--and that means they are somewhere along the transition from regular menstrual cycles to a full year without any periods (the technical definition of menopause). That's more than 37 million women and many of them, like our friend, have only a limited understanding of what's happening to their bodies. Although this is the best-educated generation of women in human history, menopause remains a mystery for most of us. We tend to know very little about how changing hormone levels affect our brains, our bones, our hearts and our vulnerability to many diseases—and what we should be doing about it. As science provides new insights into women's health, menopause is coming out of the shadows--a result, we believe, of the boomer culture of openness and the nation's growing awareness of the importance of good health at every stage of life. Ignoring menopause and hoping it goes away won't make the transition any easier. In fact, research indicates that women who know what to expect navigate their way through midlife the most successfully.

When boomers were toddlers, menopause was seen as the end of a woman's vital years. But scientists now understand that this is a critical juncture, and what you do during menopause can shape your physical and emotional lives for years to come.

Women who make smart choices in menopause are more likely to live longer, healthier lives. Becoming more physically active, for example, can strengthen your bones, protect you against heart disease, boost your mood and reduce hot flashes, and may even lower your risk of dementia. You can start slowly, adding a 10-minute walk to your daily routine, taking the stairs instead of the elevator or starting the day with a gentle jog around the block. Small changes add up over time. We know many women who began with a few extra steps and now run miles. So it's important to keep at it and not give up.

Learning about menopause will help you weigh some of the health choices you'll have to make. Many questions have no clear answer because what's right for one person may be wrong for another. You have to familiarize yourself with the issues so that you can be an active partner with your clinician in deciding what's best for you. That's certainly true of menopausal hormone therapy, the subject of contentious debate in the medical community and among women themselves.

A decade ago, women were routinely urged to take hormones as a way to protect against heart disease and to keep their brains sharp and their bones strong. That all changed in 2002, when the National Institutes of Health abruptly halted a major study of hormone therapy called the Women's Health Initiative (WHI). Early results showed that women taking estrogen and a progestin were at higher risk of breast cancer, stroke, blood clots and heart attacks. The news shocked millions of women who were taking hormones.

After the WHI, hormone use dropped dramatically. Some women lost faith in conventional medicine and turned to so-called natural remedies for menopausal symptoms. But the safety and effectiveness of many of these alternative therapies have not been closely studied. You should assume that they carry the same risks as FDA-approved hormone therapy. For women who continue to take conventional hormone therapy, a recent study that seemed to link the drop in hormone use to an unexpected decline in breast-cancer rates raised even more questions about the drugs. Don't expect clear answers any time soon. There's still a lot researchers don't know about hormones, including potential benefits and risks for each woman.

Some physicians still believe that scientists will someday prove that estrogen (or some synthetic version of it) is indeed the elixir of youth. But for now, few think that hormones should be the first thing menopausal women try to relieve symptoms (the only exception might be women who reach menopause well before the average age of 51). Instead, doctors say women should make every effort to avoid medication by making lifestyle changes that have been shown to help—stepping up physical activity, reducing stress, losing weight, stopping smoking. If you choose hormones, the current recommendation is to take the lowest effective dose for the shortest possible time.

If you're like most women, you've probably spent much of your life up to this point focusing on the people who need you: your spouse or partner, your children, your aging parents, your friends, your co-workers. Meanwhile, you have a list of things you want to accomplish for yourself, like learning another language or starting a new career. Whatever your goals, chances are you've put them off until tomorrow. What have we learned from reporting about midlife? Tomorrow is here. Read on for answers to some of the most important health questions you'll face.