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.

So if you truly want to slow your clock you have to minimally do 30 minutes of aerobic exercise (and it can just be walking most every day), plus 15 minutes of weight resistance exercises, two or, ideally, three times a week. And to make it easy, I give examples of exercises. In order to get the woman psyched up to do it, I give the horror stories of what will happen if she doesn't!

Subsequent to that chapter, I also have a chapter on how to take a bite out of time, subtitled, "What Should I Eat?" And here I talk about our bigger is better mindset, and our American "right" to get more for our money, and some of the issues it's caused, including our American obesity epidemic. I tell the reader how to evaluate a diet, how to figure out how many calories she needs to lose a certain amount of weight (I try to keep her expectations realistic), and how 10% loss of body weight can have major positive health effects. And I explain that keeping that off is more important than losing 50 pounds for a reunion, followed by a rebound months later.

I give what is now considered a healthy eating pyramid, and I give an actual diet that I suggest, which is called the LA-meets-Mediterranean Diet, to slow your clock down. Then I give guidelines on what to each in restaurants, what to eat while traveling, and what to do when invited out to dinner. Because I commute to New York every other week from Los Angeles, I feel like I can be expert in telling women what to do about airborne eating (by the way, I've not gained weight as a result of my travels).

I then go on to one of my favorite chapters called "Herbs, Schmerbs, and Verve." This is where I address the $18 billion-a-year supplement industry. I talk about what vitamins do, how much we need, what we should take, and what will make a difference in our health. Then I go on to talk about other supplements, so called "antiage" supplements, amino acids, human growth hormone, and DHEA, as well as all the herbs that are out there, and what they can and can't do based on valid studies rather than the non-FDA-approved promises on the bottles.

In that story of the woman who put off having children you raise an interesting point, that it seems some women need to both be reminded they will not be young forever, and at the same time told they don't have to give up on living a full life just because they are over 40. That's a lot to process and accept!

Well, life is a lot to process. Our bodies may continue to look and feel great, but the unfortunate fact is that our ovaries have their own clock. Because we're born with a certain number of follicles, the cells that produce the egg, we have no way of slowing. In our late 30s the follicles that are left are what I call rejects. Although they can work, they work at a slower speed; fewer of them will "take" when it comes to fertilization, and when an embryo is formed there is a greater chance for chromosomal abnormalities and miscarriage as we enter our 40s. If we don't realize that, we may miss out on an opportunity to spontaneously conceive with our own eggs.

What we're now doing in our 40s is pushing those eggs to come forth and ovulate at greater numbers with fertility drugs, and we're not allowing nature to take its course. We're actually harvesting eggs, inserting sperm, through the process of in vitro fertilization, to improve the odds, but those odds remain lower the older we are, and after age 42 the odds are so low that many fertility clinics will advise a woman to use younger donor eggs for fertilization. The resulting embryo is then implanted in her uterus, so she's the biologic or birth mother, but not the genetic mother.

What are the main health issues that women over 40 need to begin educating themselves about?

Quickly going ahead with what's in the book, (and I wrote this so a woman can look at the chapter that interests her, or use it for a source of information on a particular subject), there is a chapter called "Disease Prevention and Detection for a Longer and Better Life." What I start with is what kills us, and go from there. If we can detect those diseases, or prevent them, then clearly we'll lengthen the span of our lives. Heart disease is the major cause of death in women. So, I talk about how we can prevent broken hearts, and what tests women should have to ensure their heart is whole and doing well.

I talk about our cancers; the one that worries us the most is breast cancer, but the one most likely to kill us is lung cancer (we've come a long way, baby!.) And I spend a lot of time helping women figure out how to stop smoking. Anyone who has finished this book and thinks she can still light up safely has not really read the book.

I do give at the end of the chapter a checklist of the routine tests you should have. I call it the health span list. When we buy a new car we get a list of when to bring the car in for checkups. With that in mind, although I don't want to give expiration dates, I've given a "slow the clock" list of what to do monthly, annually, three years, five years, and at least once in your life. It's a list you can tack up to your refrigerator to remind you of what you need to have done. The disease you detect may be your own.

And I tell stories of patients who, because they did their tests, are alive and well:

  • The woman who said she'd never have a colonoscopy and then had one. We caught colon cancer early.

  • The woman who came in with hot flashes. I insisted on checking the cholesterol levels. One thing led to another, and she had emergency angioplasty. She was a heart attack waiting to happen.
  • A woman who had a lump and it's probably nothing, and the mammogram was normal. Not only was the lump not normal, she had positive lymph nodes.

Just so everyone will really want to read the book, I wrote a chapter called "Looking Young From the Outside In." This is where I talk about what ages our skin, what we can do about it, aggressive "wrinkle be gone" medical therapies, and all the creams over the counter. Basically, it's what women can do to keep their skin looking young, and what the dermatologists and plastic surgeons are offering. And since I'm not selling anything I can tell them what works, what doesn't, and how much it costs.

I did write and epilogue called "My 120," and this is something I do in all my books, because when all is said and done my patients usually turn to me and say, "What do you do?" because she's not going to do something I don't. I use the 120 because there's a wonderful biblical expression that when translated from Hebrew is, "May you live to 120." So I figured that was a pretty good goal. I'll die trying to get there.

I tell the reader what I do, based on all my reading and so called secret knowledge: What I eat, the exercise, what I've done in the past, like everyone else, the good, the bad, and the lazy, and how I'm trying to fix it now. Although I do not give the answer to mortality, I'm trying to give a road map for women to mature with the health and sense of well-being they want.

How do you feel about natural progesterone cream as part of HRT?

The cream often doesn't really have progesterone. It's made from wild yams, and the skin cannot convert it to true progesterone. When used in conjunction with estrogen, it may not protect the lining of the uterus to precancerous changes. However, there are modes of natural FDA-approved progesterone that will protect the uterine lining. These include prometrium, and there are two other forms of progesterone that haven't been FDA approved, but are used in Europe and often used with appropriate follow-up by doctors in the U.S. That includes a vaginal gel, Prochieve, and a special progesterone-releasing uterine system called Mirena.

"There is a greater chance for chromosomal abnormalities and miscarriage as we enter our 40s. If we don't realize that, we may miss out on an opportunity to spontaneously conceive with our own eggs."

I'm 40 years young but it seems that gravity has taken control. I also have hepatitis C and I'm extremely tired all the time. Should I attempt to exercise, because the rear end isn't looking too good!

First, talk to the specialist who is treating the hepatitis C. If you are in hepatic failure or severe liver compromise, you may need therapy before attempting to do the other things in your life.

In general, we tend to gain fat in our middles as we get older, and less in the tush and thighs. It's been found the best way to combat that newly developing apple shape, which is a risk for heart disease, is to do aerobic exercise. But clearly, any exercise program has to be cleared with your doctor, if you have an underlying medical condition.

Does your book touch on perimenopause symptoms and solutions?

Oh, yes. Before menopause, there's peri, which can last anywhere from three to 10 years. It's a time of life when our hormones can be fluctuating from highs, similar to when we were pregnant, to lows that mimic menopause. I explain why we get the symptoms, what's happening, and ways to deal with them. One of my favorites is simply to do a "corporate takeover" of the misbehaving ovaries by using low-dose birth control pills. This can be safely done until menopause as long as the woman doesn't smoke (I think the pill should be over the counter; smoking should be by prescription), doesn't have uncontrolled high blood pressure, or has a history of family history of abnormal clotting.

If a woman does stay on the pill, she may not know when she goes through menopause because she'll get regular cycles and feel fine. So at 50 or 52 I suggest she goes off for two weeks, then have a blood test to check hormone levels. If she's entered that stage, she can stay off the pill to see how she feels, then make a decision about HRT.

How can I get rid of dark circles under my eyes?

Sometimes the circles are due to change in pigmentation, which can be treated with Retin-A, or Tazaroc; sometimes it has to do with fluid or fat accumulation, or changes in the accumulation, so that pouches are formed, and that can be dealt with through some new surgical techniques. On occasion, it's a genetic phenomenon that is hard to treat. But in order to differentiate, you need to see a dermatologist or a plastic surgeon.

Remember that dark circles often occur as a result of simple lack of sleep. Sleep is one of the best things we can do for our skin. Be sure you are sleeping seven to eight hours a night, nutrition is good, and make sure you're not abusing alcohol or cigarettes.

I am a 52-year-old woman in good health and normal weight with no bad habits! Ha. I am still cycling (menstruating). What is the average age for a woman to stop menstruation? I am still fairly regular but I am getting more and more tired as the years go by and wonder if it is related to the fact that I am still fertile.

The average age of menopause if 51.7. But it's a Gaussian curve, which means that is an average age, and there are women who will go through it at 47 and others at 55. You can sometimes get an idea as to whether you'll be early (in your case, you're not early), or late, by looking at your mother. If she had a late menopause there's a good chance that you will too. It's dependant on the number of follicles that have been in your ovaries from puberty on.

Now, the fact that that you are menstruating does not mean you're fertile. The reproductive pause generally occurs 10 years before menopause. Having said that, however, I have to, as a doctor who goes according to guidelines, suggest that every woman who still gets her period naturally use some form of contraception, because surprises can occur.

As far as fatigue, I'm not sure that's a part of the perimenopausal symptoms. The issue is are you exercising, taking care of yourself, getting enough sleep, is nutrition good, are you under stress, and if, like all of us, the answer is yes and no, I'd start there rather than saying that it's your hormones.

I exercise regularly but find myself growing out of my clothes at age 46. What should I do?

Unfortunately, every decade our basal body metabolism diminishes by 5% to 10%. So if we eat the same and exercise the same, we'll gain weight. And the secret is to decrease what you eat so that you have less to burn. That means portion size, and if that doesn't help, make sure your doctor checks your thyroid function. Then be honest with yourself. Is the type of exercise you're doing really burning those calories?

We are almost out of time, Dr. Reichman. Do you have any final words on aging gracefully for us?

At this point, I'll simply say that we are extraordinarily lucky to be in a time and place where we can acquire the knowledge and access the health care and make the behavioral changes that will slow our clocks down.

Thanks to Judith Reichman, MD, for sharing her expertise with us. For more information please read her book, Slow Your Clock Down: The Complete Guide to a Healthy, Younger You . And also be sure to visit our message boards, including Women's Health: Friends Talking, to share your concerns with others and ask questions of our in-house experts. You'll be welcomed warmly!

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Last Editorial Review: 9/30/2004