May 25, 2018

Women’s health per decade: How to age and live your best life after 50

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A primary care physician and a nutritionist create a checklist of cancer screenings, lifestyle changes and health conditions for women to be aware of during each decade after 50.

It is never too soon — or too late — to take steps to protect your health. However, many women are not aware of what they need to pay attention to for their health based on their age. Physicians and nutritionists at the University of Alabama at Birmingham break down what women need to know about their health per decade starting in their 50s.

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Menopause

Menopause is the largest change women will experience during their 50s. According to Erin Snyder, M.D., a primary care physician and the assistant program director of the Tinsley Harrison Internal Medicine Residency Program at UAB, 52 is the average age women go through menopause. Snyder says most women will begin having symptoms before their periods stop.

“I typically talk to women in their 50s about menopause symptoms,” she said. “Those include vaginal dryness, hot flashes and mood swings.”

Snyder says these symptoms can be distressing for many women, but there are treatment options available.

“Hormone replacement therapy is the most effective treatment for menopausal hot flashes, and is safe for many women, especially in their 50s,” Snyder said. “Topical estrogen is very effective for vaginal dryness and can be dosed low enough so that there is minimal systemic absorption.If hormonal treatment isn’t for you, there are non-hormonal options that can help control many peri-menopause symptoms.”

Cancer screenings

As for cancer screenings, women should begin colon cancer screenings at 50. Women can have an annual stool test or a colonoscopy.

“If the colonoscopy is normal, you do not need to have another one for another 10 years,” Snyder said. “However, if you have colon polyps, your doctor may bring you back for further tests, and that may impact the frequency of colonoscopies.”

Women should also continue cervical cancer screenings, which are done during their annual Pap smear. Annual screenings should continue through age 65.

Diabetes

Many women should be screened for diabetes earlier than their 50s, but this screening will continue regularly throughout middle age. “I try to check blood sugar and cholesterol levels at least once every five years for healthy patients,” Snyder said.

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Osteoporosis

All women should have a bone density screening starting at age 65. However, younger women who are post-menopausal and have at least one additional risk factor for osteoporosis, such as family history or a slim build, should have the test shortly after going through menopause. Beth Kitchin, Ph.D., RDN, assistant professor of nutrition sciences at UAB, recommends women talk to their doctors about their risks and bone health at the time of menopause. According to Kitchin, being a woman puts one at greater risk for the condition.

“When we start menopause, we lose estrogen,” Kitchin said. “It turns out that estrogen is good for keeping our bones strong, so when estrogen drops, bone density drops. Age is a big risk factor. As we get into our 50s and 60s, our bone density decreases.”

Aside from age, there are three other risk factors that women do not have much control over that make them more likely to develop osteoporosis: family history, weight and the medications.

“If you remember a parent or a grandparent shrinking, losing a lot of height, that’s a sign of broken bones in the spine caused by osteoporosis,” Kitchin said. “Genetics plays a strong role in how strong your bones get and how rapidly you lose your bone density.”

The medicines women may have to take for other conditions may also make them more prone to the condition.

“Medicines have possible side effects and the possible side effects of a few medicines is low bone density,” she said. “One of these medicines is Prednisone, and it can lower your bone density if you take it for longer than three months. Other medicines that may cause low bone density are Arimidex, Aromasin, Femara, Nexium, Prilosec, Prevacid and Dilantin.”

To find out more about osteoporosis, visit UAB’s Tone Your Bones website.

Incontinence

Urinary incontinence is one of the most common symptoms Snyder sees among her female patients, yet she says it is one of the least talked about.

“It is common after menopause and even more so as women get older,” Snyder explained. “It is caused by a lack of estrogen. Without estrogen, the tissue supporting the bladder gets flatter and thinner so the bladder isn’t supported as well. Women are more prone to leak urine.”

There are ways to prevent accidents from happening. Snyder recommends her patients with incontinence use the bathroom frequently to keep their bladders empty and avoid medicines or drinks that could cause bladder irritation, such as caffeine and alcohol.

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Ending screenings

Many women are able to stop cervical cancer screenings once they reach 70. Their physicians may also talk to them about ending other cancer screenings, but this is a case-by-case scenario and varies with each patient. Snyder says she lays out possible scenarios with her patients if they are diagnosed with a certain cancer after 70.

“I ask if they would be interested in having surgery or chemotherapy if cancer is found,” she said. “If they say yes, then they should continue with screenings. Some people are clear that they don’t want to have any more surgery or chemotherapy. If that’s the case, it makes sense to stop.”

Planning for the future

Another important conversation for women to have with their physician and their loved ones is about planning for the future. According to Snyder, they need to start thinking about what course of action they would like to take if they are unable to make decisions for themselves.

“If your heart stops, would you want doctors to restart it? Would you want to be on a ventilator? How long would you want to remain on life support? The most important thing I tell my patients is that it is crucial to have this conversation with their families before it is too late and they are unable to speak for themselves,” she said.

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Independence

Independent living is typically the most significant conversation that comes up between octogenarians and their primary care physicians.

“I start to talk about how people are doing in their homes if they are living independently,” Snyder said. “Are they still driving? Does that feel safe? It is helpful to talk to people around the patient in their 80s. How are they getting around their homes? How do they get the things they need, like getting to the grocery store and appointments?”

Another conversation that comes up is dementia. Snyder says many elderly patients begin showing signs of dementia or Alzheimer’s disease in their late 70s and into their 80s. It is important for their loved ones to be aware of signs of forgetfulness or mood swings and make sure their doctors are aware, too.