Conquering the Middle Aged You

WebMD Live Events Transcript

Are you are a woman who wants to take charge of your own health and enjoy your years to the fullest? On May 13, 2004, Judith Reichman, MD, author of Slow Your Clock Down: The Complete Guide to a Healthy, Younger You, explained how we age and what we can do to slow down the process.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome to WebMD Live, Dr. Reichman. Before we dive into some questions, please tell us a little bit about your new book.

I wrote this book in order to give my timely thoughts about middle age and beyond. And as I myself have progressed over the years, along with the secrets I have unraveled through my own intense reading of just about every major medical publication that comes out, has made me feel that 50 is the new 30. And that's what I want to share with the reader.

I talk in the introduction about the fact that we all love to sleep in, and we're revolting against the demands of our lives, but by 6:00 p.m. most of us say, "OK, quitting time." And I began to wonder on a hypothetical basis, if we look at our lives as the equivalent of the 24 hours of our days, why we're quitting so soon. I deplore the notion of ending my day in the middle.

As a doctor, I also hate the word "middle" because it's so pejorative. "Middle age" connotes a passing of youth, the time of firm body and sound health, to the middle of our lives when our middles become the repositories of bloat, fat, and misbehaving organs. Many of us are also "midlife crisising" and "midcareering." So this book is a medical and personal quest to optimize the minutes and hours of both our internal and external body clocks -- not just to get more done, but to have the time to savor what we have done, and what we will do in the future.

So what does it take to shake us out of that idea of "knocking off" in the middle of our days and lives? What's the first step?

The first step is to understand what's happening. Knowledge is power, and I talk about our reproductive clock (let's remember I'm really talking to women here) as well as our hormonal clock and what we can do about it. So believe it or not, I start the first chapter and first paragraph on the saga of our pubic hair. Because there it is, starting to grow in embarrassing fashion during puberty, curling and thickening through our emerging womanhood, thinning and graying as we get older, and disappearing at some point when we no longer care about the bikini wax.

This saga reflects what's happening to our hormones as we pass through puberty, our reproductive lives, and menopause. I go on to explain the surge of hormones, estrogen, testosterone, and progesterone that occurs in puberty (enhancing pubic hair growth and a lot of other things), the wonderful waxing and waning of our hormones with each cycle during our reproductive lives, and what happens in perimenopause and menopause.

With this chapter on the reproductive clock, I also tell stories of patients. One is titled "He ran away with my sperm," and it's the story of a woman I've taken care of for many years who, despite my urging, always had to get to the next job level, fix up the house, pay the mortgage, and put off having children until it was "convenient." And so she stayed on the pill. At 40, she was ready to stop the pill and let obliging sperm from her husband meet her ready eggs. When he ran away with a woman who had 28-year-old eggs, whom he met at the gym, she came in with the emergency request for referral to a divorce lawyer, reproductive endocrinologist and sperm bank, in that order. Her saga, although sad and perhaps funny, represents the story of so many women who put off having children.

And so I talk at length about our reproductive capacities, why they diminish as we get older, what we can do, and what the new technologies will allow us to do, to preserve our ability to have children as we get older. I give the stats, the costs, and the concerns of the women who are facing possible infertility; many of whom I feel are in psychological pressure akin to a cancer of the soul.

In the chapter on "When Your Hormone Clock Stops," I tell the two tales of menopause. My period is over. Great. I no longer have to worry about contraception, tale one. Tale two: Test me and let my shrink know what the values are, because I'll have to deal with him if I'm menopausal. And indeed, this loss of hormones can affect women in various ways, and I empathize with them who feel an alien is taking over their body, and try to give them all of the options, from hormone replacement to alternatives.

I think I give one of the most concise and easily understandable evaluations of the studies we're bombarded with. Suddenly we're all aware of the WHI, the ERA, the WHIMS study, the PEPI study, and what those letter mean. What the studies show is put in a way we each understand and this allows each of us to put ourselves in the results and decide if they apply.

I tell women that hormone replacement therapy is a quality-of-life decision, and that if a woman feels that without hormones she can't sleep, has severe hot flashes, night sweats, short-term memory loss, vaginal dryness, and in general feels that she's walking around in a status of jet lag without getting there, that short-term HRT may indeed be appropriate provided she doesn't have significant underlying coronary vascular disease, a history of clots, or estrogen-related cancer.

"There is no medicine, perhaps with the exception of antibiotics, that I or any other doctor can give you that will have as much impact on your longevity and health as exercise."

Each of us takes a risk for quality of life with just about everything we do: going on a freeway, getting on a plane, eating a sundae, not exercising. But we do it because we want it and feel better. HRT falls into that category, although there is data that it does decrease bone loss, colon cancer, skin thinning and wrinkling, and when taken in the beginning of menopause may diminish the future onset of Alzheimer's. The word is not all bad; it's just that we're no longer telling women to stay on estrogen forever, to stay young forever, or to prevent heart disease.

I also talk about the various modes of estrogen replacement (there may be 50 ways to leave a lover and probably as many ways to take hormones). Today, many researchers feel that getting the hormone through the skin or vagina prevents first bypass in the liver, where it can increase clotting factors and have adverse effects on our lipids, especially triglycerides. So my preference is to use a patch or an estrogen ring, especially if the woman has a history of menstrual migraines or finds that if she takes the pill, 18 hours later some of her symptoms, such as hot flashes reoccur.

But having said all this, I must admit that most of the book deals with other issues that are equally important in allowing us to slow our clock and obtain health span and longevity. There is a chapter called "Minuets and Other Exercises to Slow Down Aging." Here I emphasize the fact that there is no medicine, perhaps with the exception of antibiotics, that I or any other doctor can give you that will have as much impact on your longevity and health as exercise.

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