Keeping ‘Well’ through Midlife.

As discussed in the February and March issues of Connector, attitudes towards women’s health and wellbeing are changing; the unique medical problems that women face are becoming more widely recognized, and more of them are treatable.

The three phases of a woman’s life have already been identified and discussed in these previous issues as being the reproductive phase, midlife phase and post-menopausal phase (as cited by Dr Rihab Awad, consultant obstetrician/gynecologist at the American Hospital Dubai). The first phase, the reproductive phase, has already been examined in detail, and in this issue we will be concentrating on the midlife phase.

Midlife is the period of time in a woman’s life between the reproductive phase and menopause, between the ages of 40 and 60. During this phase women’s bodies undergo many changes as they prepare for the menopause and beyond, it is also an important time to be thinking about lifestyle changes to help prevent illness in old age.

Midlife is the stage of a woman’s life which has the greatest impact on her psychological state. When the children leave home, women often feel that their life is empty and they are left to re evaluate the relationship with their partners. There is also the fear of the unknown, and the psychological implications of middle life and ageing. At the same time, women are experiencing physical changes as their energy levels are decreasing and their metabolism is changing, so more lifestyle changes need to be made to compensate for this.

Mid-Lifestyles
In midlife, a woman should continue with the good habits formed during the reproductive phase, regarding self assessment of health and prevention of illness, as well as regular checkups with a doctor. Her lifestyle is as important now as it was in earlier years as she prepares herself for the menopause and old age, in particular in terms of exercise, diet, exposure to the sun, smoking, hair and complexion care and continued health awareness.

Generally, a woman’s physical activity levels decrease with age as her energy levels decrease, but it is important that a woman tries to keep exercising regularly as this can affect her health in later life. It is still recommended that she aims for twenty minutes of physical activity, three times a week, even if the type of exercise/activity changes. As energy levels and metabolism change, a woman should be carefully monitoring weight and BMI (Body Mass Index) regularly so that she is aware of the gradual changes in her body as she experiences them.

Her diet at this stage of her life will also affect how she experiences the menopause and how healthy she is during old age. Metabolism will be decreasing so it is important to keep calorie intake low to prevent excessive weight gain, vitamin and mineral intake should be maintained from the reproductive phase to help prevent illnesses, and calcium and iron/folic acid are of particular significance at this age to help prevent against osteoporosis following the menopause.

Women at his age are more at risk of developing breast cancer, and some studies have shown that a diet high in phyto-oestrogens can lower the chance of developing the disease. Phyto-oestrgoens are also particularly important at this time as women have decreasing levels of oestrogen, leading up to and through the menopause, and naturally-occurring phyto-oestrogens (found in grains, seeds, legumes, medicinal plants and other vegetables) can help to regulate the menstrual cycle before menopause, and help to reduce some of the symptoms of menopause.

Keeping Check
All through a woman’s life she should take some responsibility for her health and prevention of illness, through her lifestyle choices and self education as well as though regular self examination, and at this age self examination of the breasts is particularly important for early indications of medical abnormalities.

Regular check-ups by a doctor are recommended for all women in midlife to look after the skeleton, the psychological state, and to manage menopausal symptoms and ensure that the body is in a healthy state and able to help prevent against illnesses in old age. A doctor can run prevention tests- these tests and regular check-ups can help prevent breast cancer, cervical cancer, and colon cancer, as well as diabetes, osteoporosis and high cholesterol leading to atherosclerosis.

If a woman is aware of her body and state of health and is examining herself, she may notice abnormalities which lead her to consult a doctor outside of the normal routine check-ups The abnormalities that can occur at this age can include; a lump in the breast, palpitations or recurrent dizziness, any sign of urinary or genital infection, any sign or symptom of diabetes, any bone or joint pain, and any post-menopausal bleeding, and in these instances a doctor should be consulted immediately.

Screening for a Well Woman
As detailed in the previous issue of Connector, there are several different tests and screenings that the American Hospital Dubai recommends for all women:
• Monthly breast self examination (particularly important at this age), regular height, weight and BMI monitoring, as well as regular eye tests (which become more and more important with age).
• An annual pap smear, which takes a smear of cells from the cervix and can detect abnormal cervical cells which can lead to cervical cancer. Cervical cancer is found at the neck of the womb, and is one of the three major cancers with high mortality rates for women; early detection of this cancer relies on regular pap smears.
• CBC (Complete Blood Count) blood screening which can detect dehydration, blood loss or anemia, or blood abnormalities, infections, and allergies.
• Lipid profile, which is blood screening to check the body fat, represented in cholesterol and Triglycerides, which are indicators of heart disease.
• Urinalysis which is urine screening to check overall kidney function, and detect urinary tract infections, diabetes, or any other kidney disease.

There are also three other tests that are recommended for all women over the age of 40, these are the bilateral breast mammogram, the pulmonary function test, and occult blood-faeces colon screening.

• The bilateral breast mammogram is an x-ray picture of the breast- an internal picture of the breast, which is used to detect tumors and also to differentiate between benign (non-cancerous) and malignant (cancerous) tumors. For women between the ages of 40-49 this is recommended every two years, and for women over 50 this becomes every 12 months.
• A pulmonary function test is a test to measure how well the lungs take in air, the volume of air the lungs hold, and how well the lungs exhale air. The test diagnoses for lung diseases- asthma, bronchitis, and shortness of breath.
• The occult blood-faeces screening is a test which can detect cancer in the bowel. The earlier the cancer is detected, the better the chances are to cure.

The midlife phase is the time of a woman’s life where she suffers much anxiety and change, both physically and psychologically, and it is important to try to manage these impacts on her life in order to keep her a ‘Well Woman’.