You know about the stubborn weight gain and the sometimes-painful sex (thanks so much, dryness down there), but here are some other unexpected changes you can expect in your 40s.
Hair Loss is More Widespread Than You’ve Heard
What you know: Hair often gets thinner with age, and it can become more noticeable starting in your early 40s. Why? In a word (and it’s a word you’ll hear a lot): perimenopause, which typically starts in your 40s, but for a small percentage of women, it can start as early as the 30s.
What might surprise you: “The hair loss happens everywhere,” says Elizabeth Roth, MD, an internist at Women’s Health Associates in the department of medicine at Massachusetts General Hospital in Boston. That means potentially less leg hair (three cheers for not having to shave as often!) and less pubic hair, which, depending on how your feel about grooming down there, could be good or bad.
What you can do about it: There are effective options for hair loss on the head, but if you’re worried about other areas of your body, you’ll be happy to hear “it’s not an overnight change,” says Roth. “It starts years before menopause and progresses pretty gradually.” Roth advises against using hair-thinning treatments on areas other than your head, especially the pubic region, because what’s recommended for use on your head isn’t recommended for other areas of your body. If you’re really bothered by the thinning though, you could try talking to your doctor to see if there’s anything safe and effective that could help.
Key Parts of Your Brain Are Affected
What you know: You might feel a little foggy and notice that you’re having trouble remembering everything on your to-do list. And that actress who was in that show with whatshisface? Her name isn’t even close to the tip of your tongue.
What might surprise you: This is not just because of the normal aging process–it’s part of the normal female aging process. “We have estrogen receptors in two brain areas that control memory, and when there’s less estrogen, there are structural changes in those areas,” explains Pauline Maki, PhD, a professor of psychiatry and psychology and the director of the women’s mental health research program at the University of Illinois at Chicago, and president of the North American Menopause Society. The first area is the hippocampus, considered the memory center of the brain, and the second is the prefrontal cortex, “which organizes information in meaningful ways so we can remember it better,” says Maki. Estrogen also boosts levels of acetylcholine, a neurotransmitter that helps us form new memories.
What you can do about it: The good news, though, is that your forgetfulness isn’t permanent. “The brain bounces back after menopause,” says Maki. “It adapts to lower estrogen levels, and it compensates.” You might be wondering about skipping the whole forgetfulness phase with estrogen therapy. It does seem to help, as women placed in brain scanners during memory tasks showed more activity in the hippocampus when they were put on the therapy, says Maki. But she notes that memory issues alone aren’t a convincing reason to go on hormone therapy, as it comes with serious risks, like increased chances of breast cancer, heart disease and stroke.
Your Monthly Cycle Goes Rogue
What you know: Eventually, you stop ovulating altogether, and your periods are done.
What might surprise you: “It would be nice if the ovaries gradually made less estrogen, but it’s a very unpredictable pattern,” says Jan Shifren, MD, the director of the Massachusetts General Hospital’s Midlife Women’s Health Center. They can pump out wildly different amounts of estrogen each month once perimenopause hits, which means cycles can be closer together (say, every 25 or 26 days instead of 28) or much farther apart; you could have extremely heavy ones now and again, and there will probably be months where you unexpectedly skip your period altogether. Like we said, chaos.
What you can do about it: If the irregularity is bothering you, ask your doctor about options that can help regulate it, like oral contraceptives or hormone-releasing IUDS.
Your Bladder isn’t Completely Under Your Control Anymore
What you know: Childbearing can do a number on your bladder, and much older women often have issues with incontinence.
What might surprise you: Even if you Kegel like it’s your job, you may have problems in your 40s, because with less estrogen, the bladder muscle and the muscles that support the urethra get weaker, leaving you more vulnerable to leaks. (Oh, the joys of being a woman, right?)
What you can do about it: Luckily, there are a handful of very effective fixes for incontinence, both the stress variety (leaking when you exercise or laugh) and the urge kind (you can’t get the bathroom fast enough), and we’ve outlined all of them here.
UTIs Happen More Frequently
What you know: A lot changes below the waist (vaginal dryness being chief among them) thanks to, you guessed it, lower estrogen levels.
What might surprise you: Urinary tract infections become more common in women after menopause because of those estrogen changes, says Lauren Streicher, MD, the director of the Center for Sexual Medicine and Menopause and an associate clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine. (Estrogen appears to play a protective role against the bacteria that lead to UTIs.) “We see this issue in 60 to 70 percent of women after menopause.”
What you can do about it: Streicher recommends local estrogen like a topical cream, which delivers lower doses than traditional hormone therapy. At low doses, little of the hormone gets absorbed into the bloodstream, so it’s unlikely to affect the rest of your body. (If you’re still concerned, ask your doctor about the most minimal amount that would still help with your problem.) Local estrogen can help restore normal function to urethra tissue, decreasing the risk of UTIs. The Mayo Clinic also recommends common-sense hygiene, like wiping front to back and avoiding irritating products like douches, which can help minimize your risk.