Maybe you don’t feel fabulous about turning 50, but if you want to stay fit and healthy at 50 and beyond, you need to take charge of your health. Hoda Kotb, who is hitting that big milestone on Aug. 9, got a medical exam with the help of NBC chief medical editor Dr. Nancy Snyderman. According to the TODAY "This is 50" series, 79 percent of people in their 50s get a physical at least once a year, up from 63 percent in their late 40s. But many women turning 50 haven't been to the doctor in years.
Cardiologist Dr. Nieca Goldberg and breast cancer surgeon Dr. Freya Schnabel of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center also helped Hoda with her medical tune-up. They offer a primer on the special medical needs of women as they turn 50, what should be part of your health regimen and how to prepare before your doctor's visit.
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For years you may have just been seen your gynecologist, but by 50 you should have a primary care doctor. Make sure you bring a list of questions to ask the doctor. You may want to have your best girlfriend or a family member join you for support and to help you remember things the doctor discussed.
One in three women will die of heart disease, the leading killer of women. Studies have shown that two-thirds of the women who suddenly die of heart attack do so without any warning sign at all. Ninety percent of those women had risk factors like high blood pressure, high cholesterol, obesity, lack of exercise and cigarette smoking. Risk factors if treated would lower risk of heart disease.
Your heart check-up at age 50 should include a thorough family health history. Family history of heart attack increases a woman’s risk, especially if her father or brother had a heart attack under the age of 50, or if she has a mother or sister who had a heart attack under the age of 60.
The initial testing for heart disease is low tech. The physical includes a blood pressure measurement. High blood pressure or hypertension is defined as a blood pressure of greater than 140/90. Hypertension increases heart attack risk by 25 percent and stroke risk by 35 percent. You can work on lowering your blood pressure, before the visit, by reducing your intake of salt and following the DASH (Dietary Approaches to Stop Hypertension) Eating Plan.
The initial test for heart disease is an electrocardiogram. The ECG is done in asymptomatic women at age 50 because heart disease risk increases as women get older.
Heart attack symptoms in women are more common ten years after menopause, but the risk starts much earlier. Although heart attack risk increases after menopause, menopause does not increase risk for heart disease.
If you have heart symptoms such as chest tightness and /or shortness of breath on exertion your doctor may order an exercise stress test. Make sure you let your doctor know if you are having the following symptoms:
- decreased endurance during your usual activities
- chest tightness or shortness of breath
- unexplained fatigue
- feeling faint or fainting
- If any of these symptoms occur at rest or awaken you from your sleep you need to call 911
You can lower your risk for heart disease with diet, exercise and smoking cessation. The American Heart Association recommends at least a half hour a day of moderate aerobic activity almost every day. If you are using exercising to lose weight, you need to increase your duration of exercise to 40-60 minutes. Your heart doesn’t care if your do a straight 40 minutes or break it up into 20 minute intervals, both options work to help you lose weight.
You can assess your own risk for heart disease by using the heart disease risk calculator on the CardioSmart web site.
Laboratory testing should include a lipid panel and glucose test. You may also get a thyroid test. Thyroid disease is common in perimenopause and menopause.
Checking Vitamin D levels is also important, as many women are vitamin D deficient because we spend less time in the sun. Vitamin D is necessary for calcium absorption.
At 50, you need to take charge of your muscles and bones. As you approach menopause, the body’s ability to build new bone decreases and increase risks for fractures. You lose bone mass. At the same time women lose muscle mass at the rate of 1 percent per year, putting them at risk for falls in later life.
Osteoporosis affects 44,000,000 people, most of whom are women. You should be taking in 1200 mg of calcium daily. Try to balance your calcium intake to get at least half from food and supplement the rest. To keep your bones healthy without compromising your cholesterol choose low fat daily products like sardines, dark leafy greens, soybeans, and fortified cereals like Total.
Weight bearing exercise helps to strengthen your bones. That is exercise where you are standing like walking, dancing or running.
Talk to your doctor about getting bone densitometry, a radiological test that measures bone mass. Bone densitometry is indicated in women as young as 50, if there is a family history of hip fractures, personal history of cigarette smoking, heavy alcohol use and low body weight. Taking steroids or thyroid medications may also increase risk for osteoporosis.
Turning 50 is a time to take care of you and have a healthier life. The importance of lifestyle changes like diet and exercise cannot be overstated, because it impacts a range of health issues including cardiovascular disease, bone health and breast cancer. It’s empowering to take charge of your health because it helps keep you in control and improves not only your physical outlook, but your emotional outlook as well.
While some controversy exists about screening mammography for early detection of breast cancer, the benefits in women over 50 have been clearly established. Women who are at increased risk for breast cancer may need to be screened more intensively, with other tests in addition to mammography. Knowing your risk for breast cancer helps you and your doctor plan your screening strategy appropriately.
Family history is an important tool for all of us to understand our unique individual risks for a variety of diseases. It’s clear that certain cancers and other diseases may be more common in certain families.
Recommendations for breast cancer screening should be modified for women with significant family history of the disease.
The American Cancer Society recommends beginning colon cancer screening at age 50. Colonoscopy is an important tool and is capable detecting cancer early. In addition, polyps are detected on colonoscopy can be removed, thus preventing cancers from forming. The recommended frequency for colonoscopy and other tests to screen for colon cancer may depend on family history of the disease.
If you smoke you need to quit, as smoking triples a woman’s risk for heart disease, brings on early menopause and increases the appearance of wrinkles.
The link between smoking and lung cancer is very clear. Certain individuals who are at increased risk for lung cancer may be eligible for screening for the disease with specialized CT scans.
Prior sun exposure can increase the risk for skin cancers, including melanoma, and individuals at increased risk can have regular skin checks with dermatologists for screening and early detection.
Turning 50 is an opportunity to consider how your lifestyle factors can be modified to preserve health and prevent disease. Proper diet, moderate exercise, and the avoidance of risk taking (including smoking, excess alcohol intake, etc.) can help you at 50 maximize your chances of becoming a healthy, vigorous, active 75-year-old.
For more information, please visit the Joan H. Tisch Center for Women’s Health.
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