Staying healthy as a woman over age 40 starts with asking the right questions, doctors say.
Females in this age group face new health challenges and can sometimes get lost in the shuffle of the traditional health care system, according to Dr. Alexa Fiffick, a family medicine physician and menopause practitioner at Concierge Medicine of Westlake in Cleveland, Ohio.
As menopause is often viewed as a “taboo topic,” Fiffick — also a clinical fellow at Cleveland Clinic — is working to empower this group of women to take control of their health proactively.
“To do that, they need to ask their doctors the right potentially life-saving questions,” she said.
In a conversation with Fox News Digital, Fiffick shared the top 9 questions women should be asking — along with her answers.
1. ‘Am I at risk for heart disease?’
Women have a 50% greater chance of having a misdiagnosed heart attack than men, data shows.
It wasn’t until 2020 that the American Heart Association identified menopause as an individual risk factor for heart disease.
“This giant, stressful health event wasn’t taken seriously for a long time,” Fiffick said.
“Finally, the science supports that menopause is a risk factor for heart disease. Women absolutely must ask their doctors about their individual risks based on this information, coupled with their medical history.”
2. ‘What types of exercise will keep my heart and brain healthy?’
For adults up to 65 years of age, experts recommend getting 150 minutes per week of exercise, combining moderate-to-vigorous aerobic workouts and strength training sessions.
For women in their 40s, lifting weights becomes particularly important, according to Fiffick.
“There is a lot of emerging evidence of the benefits of weightlifting — especially lifting weights that are considered heavy,” she said.
“It’s been difficult for this age group in the past to lift heavier, because we were all raised to think that weightlifting builds a more masculine structure,” she said.
“But it’s really important for bone health and to prevent falls — and it also helps the brain stay cognizant of changes, which can be really helpful to stave off dementia.”
When choosing a weight, it should be heavy enough that it can’t be lifted repetitively with ease.
“It should be a challenge to do the motions with the weight, so you can continue to keep challenging yourself,” Fiffick said.
“That sort of heavy weightlifting is associated with maintaining bone density.”
“Weight loss is more about your food consumption and less about cardiovascular exercise.”
Cardiovascular exercise is also important for keeping the heart healthy, Fiffick said.
“People tend to think of cardio for weight loss because that’s what we used to teach in the 80s, 90s and early 2000s — but realistically, weight loss is more about your food consumption and less about cardiovascular exercise,” she said.
“So it’s really pertinent to staying fit and keeping your cardiovascular system nice and strong.”
3. ‘What am I doing now that could hurt my bone density?’
By the time women enter their 40s, most have already reached their peak bone density, as it begins to decrease in the years surrounding menopause, according to experts.
Many of Fiffick’s patients are surprised to learn that certain over-the-counter medications can contribute to bone loss.
Those include proton pump inhibitors, or PPIs, a type of medication that prevents acid reflux.
“They can help degrade bone if you’re on them for a very long time,” Fiffick warned.
Some studies have suggested that metformin, a medication that is used to help lower blood sugar levels in people with type 2 diabetes, could also impact bone density, according to the doctor.
Other threats to bone health include significant alcohol or tobacco consumption, she said.
“If you’re having more than around one drink every evening, that’s probably a bit too much for bone health,” she noted.
“As far as tobacco goes, no amount is a good amount. Those sorts of things are actively hurting your bones.”
4. ‘Which supplements are effective and worth the money?’
With so many female-focused supplements on the market, it can be tough to determine which are essential and which can be skipped.
“My two go-to supplements are vitamin D and magnesium,” Fiffick told Fox News Digital.
“Getting enough vitamin D is important to help keep our bones healthy, but it can be difficult to get only through food, so most people need to take a supplem
ent.”
Magnesium is also important for women in their 40s due to its impact on bone health, heart health, hormonal balance and mood regulation, according to experts.
“Additionally, magnesium is said to help with the constipation that happens in perimenopause and menopause, as well as helping people sleep a little bit better,” Fiffick said.
For calcium, the doctor advises women to get it through diet rather than supplements.
“Most people who eat a more American diet get more than enough calcium through foods,” she said.
To help determine whether you need a supplement, Fiffick recommends going to the National Osteoporosis Foundation website, which provides a list of foods containing calcium and vitamin D to help you calculate your own intake.
5. ‘A clinician told me I’m too young for perimenopause or menopause — is this true?’
Fiffick often hears from patients who assume they’re too young to transition into this next phase of life.
“‘Normal’ menopause can happen anywhere between ages 45 and 55 — but sometimes it happens” at a younger age, she told Fox News Digital.
For women starting the process at between 40 and 45 years old, it’s considered “early menopause,” Fiffick said — but it’s not treated separately from “normal” menopause.
After 55, it is considered late menopause, she noted.
“The group that we treat really separately are the people who are under 40 when they start menopause — those are the ones we call ‘premature menopause,’” Fiffick said.
“As your body stops having estrogen, it stops being able to protect your brain, your bones and your heart.”
Starting menopause before the age of 40 can increase the risk of metabolic syndrome, Fiffick warned, which can contribute to the development of cardiovascular disease.
“That happens because as soon as your body stops having estrogen, it stops being able to protect your brain, your bones and your heart,” she said.
“So all of the ‘diseases of aging’ — meaning high blood pressure, cholesterol, heart attacks, type 2 diabetes, osteoporosis fractures — those all come on much quicker if you are menopausal earlier.”
A younger menopausal patient is treated differently than a menopausal woman in her 50s, Fiffick said.
“For the older patients, we’re mainly trying to make you feel better and maybe do some preventative things,” she said.
“For women under 40, we’re trying to get you at least enough estrogen and progesterone so it’s as if your ovaries didn’t close up shop. So it’s a very different approach than for someone who’s a little bit older.”
6. ‘How much protein should I be eating?’
Women’s nutritional requirements change as they age, Fiffick said.
A general rule of thumb is for women in their 40s to consume about 0.8 grams of protein per pound of body weight — and the large majority aren’t hitting that mark, the doctor noted.
“If a woman comes into my clinic and I have her walk me through an average day of eating, even if she’s a meat eater, she’s likely only getting around 50 grams,” Fiffick said.
“With the average body weight exceeding 130 or 140 pounds, that’s not nearly enough.”
Fiffick encourages her patients to start tracking their protein to get a baseline, and then look for ways to augment that.
An easy way to increase protein is to add powder to shakes, which usually have about 30 grams of protein, she advised.
“If you do that in addition to eating chicken, fish, legumes and other sources of protein, you’ll usually be much closer to the goal.”
7. ‘How much sleep do I need each night?’
Women in their 40s fall into what Fiffick calls the “sandwich generation,” which can make it challenging to get the appropriate amount of sleep.
“Some women have really young kids, others have teens, and some have kids in their 20s,” she said.
“Recent research found that these women tend to need upward of eight to 10 hours of sleep,” Fiffick noted.
While the longtime rule of thumb has been that seven hours is sufficient, “that is not necessarily good enough for women,” the doctor said.
Sleep plays an essential role in all aspects of wellness, according to Fiffick — including metabolism, heart health and brain function.
“We need to get good sleep to keep from getting dementia and to keep our hearts healthy,” she said.
“That requires a really good circadian rhythm, which starts with a good morning routine. I try to help people get as much natural light as possible.”
8. ‘How do I take care of my skin?’
Women should start taking care of their skin in their 20s, according to Fiffick — but it’s never too late to start prioritizing dermatological health.
For women in their 40s, Fiffick emphasizes the importance of a good moisturizing cream, a retinoid and a vitamin C serum to prevent further sun damage.
She also suggests adding a facial sunscreen to the daily skincare routine.
“The sooner you do it, the better you’ll feel,” she said. “Your face is the first thing you show people.”
A common mistake is over-moisturizing the skin to compensate for dryness.
“For someone who’s more oily and has breakouts, we tend to over-moisturize to try and compensate, but you should get a really good moisturizer and use it just at night and in the morning,” she said.
For facial cleansers, women should find something that is gentle and designed for daily use, the doctor said.
9. ‘How can I effectively manage my weight?’
Maintaining a healthy weight can be especially difficult for women in their 40s, due to hormonal changes and evolving metabolic needs.
“I get this question every single day — and the answer isn’t necessarily easy,” Fiffick said.
“The body composition changes drastically in your 40s. Hormones change. We’re no longer in peak childbearing years. Estrogen and progesterone levels fluctuate.”
For some women, intermittent fasting can be a useful way to manage weight, she said.
Cleveland Clinic’s Dr. Alexa Fiffick shared with Fox News Digital the most common questions her patients ask in her practice.
“A lot of women have success with intermittent fasting if it’s done with intention,” Fiffick said. “It’s not right for everyone, but for some, it can help them stay on track.”
In terms of diet, Fiffick said women in their 40s should focus on nutrient-dense foods.
“I like to help my patients get on a Mediterranean diet,” she said.
“The easiest way to think of it is ‘close to the vine,’ meaning things that are as natural as possible and as close to what you would find on a farm.”
Foods to focus on include fresh fruits and vegetables, whole grains, legumes, fish and nuts.
