Life in the 40s; changing Gynecological health

Women’s health is intricately related to changing ovarian function. Estrogens, produced by the ovaries, have effects in almost all the body organs.Circulating levels of estrogensdefine women’s health and lifestyle, from puberty to the menopause.

For the majority of women, the estrogen cycle remains optimal till the start of the fourth decade. Ovarian function is ever declining with age, but becomes more marked in the 40s. Menstrual patterns start to change, periods become heavier and irregular. By this time, fertility is appreciably declined. Less and less women will conceive, and they’ll have a higher risk of miscarriages. As if that is not enough, there is a higher risk of having a baby with birth defects, and the risk of pregnancy complications is higher. To be forewarned is to be forearmed.

Contraceptive choices in the 40s change as well, but declined fertility does not warrant less effective methods. Specific risk factors associated with estrogen-based contraceptives usually warrant review, more so in overweight women and smokers. Additional benefits of some contraceptive methods become desirable. An example is women experiencing heavy periods who may opt for a specific coil that reduces menstrual bleeding, on top of being contraceptive.

Even though expected, increasingly heavy periods in the 40s usually warrant Gynecological review. A minority of women may have abnormal changes on the lining of the uterus, warranting specific treatment. An ultrasound scan usually excludes potentially serious causes, sometimes combined with a biopsy of the uterine lining.

As the 4th decade advances, lower and lower estrogen levels lead to a condition called perimenopause. This is the period when signs of menopause begin to appear. Women may experience hot flushes and mood swings, increasing discomfort with sexual intercourse;and periods become infrequent and scanty. Dreadful perimenopausal symptoms can easily be managed with estrogen replacement, improving quality of life. Some women will transit into the menopause in their forties, but for the majority menopause comes in the 5th decade.

Health screening must be continued in the 40s, and well past the menopause. Cervical cancer screening should be continued with Pap smears every 3 years, provided the last smear was normal. More frequent screening is only applicable in selected risk groups, like women with HIV. Breast cancer screening should commence at 40, and no earlier unless specific risk factors for early onset breast cancer are present. Your Gynecologist may suggest additional non-routine screening tests depending on specific circumstances. Caution should be exercised, umpteen screening tests backed up by medical marketing hype and not science are commonplace, and often lead to unnecessary interventions and harm.

General health must not be ignored. Increasing sedentary lifestyles in the 40s often leads to increasing weight and consequent risks of heart disease and adult onset diabetes. Don’t smoke, drink less, eat healthily, do some exercises and don’t ignore unusual symptoms.