More than 60 million American women—almost half of all women in the United States—live with some form of heart disease. It’s easy to take the beating of our hearts for granted, but no other health threat looms larger for women than cardiovascular risk. In fact, one in every five women’s deaths in 2021 was due to heart disease.
But for all the danger it poses to women throughout their lifetimes, cardiovascular disease is also one of the most straightforward conditions for taking steps to reduce risk. The key is to recognize the lifestyle habits that can lower that risk and incorporate those into your life as early as possible.
“We know that healthy diet and exercise have to be the mainstay of heart health,” says Kathryn Lindley, a cardiologist at Vanderbilt University Medical Center. And then there are the habits to avoid—smoking, vaping, and excessive alcohol intake—for the best heart and overall health.
After heart disease, the second biggest killer of women in the U.S. is cancer. While it’s not possible to test for every type of cancer, screenings exist for the three responsible for the most female cancer deaths—breast, lung and colorectal cancer.
The good news is that not smoking, eating a healthy diet, and regularly exercising also reduce risk of nearly all cancers. And these same lifestyle habits also lower the likelihood of developing metabolic disorders, such as obesity and type 2 diabetes—two other diseases increasingly harming women in the U.S.
In the five stories we’ve covered as part of this women’s health series, we’ve asked experts what the big issues are that women should focus on each decade.
The 20s
A woman’s 20s are her opportunity to build a strong foundation for health in future decades. That means establishing healthy habits, learning about her family medical history, and finding a primary care provider “you trust who knows that all your body parts are connected,” says Stacey Rosen, a cardiologist at Northwell Health in New York. That provider could be a family doctor, an internal medicine doctor, an OBGYN or a nurse practitioner—what’s most important is the relationship you develop with them.
If you only regularly see one doctor in your 20s, an expert says, it should be an OBGYN. That’s because many health issues that arise decades later stem from sexual and reproductive health.
Though most cancer screenings begin in women’s midlife, prevention for one cancer starts in the 20s. The only reason cervical cancer is no longer a major cause of women’s deaths is the combination of cervical cancer screenings, which start at age 21, and the human papillomavirus (HPV) vaccine, which prevents not only cervical cancer but also vulvar, vaginal, oral and anal cancers. Rates of cervical cancer and oral cancer have been increasing in middle-aged women, but the HPV vaccine, recommended through age 26 and available into women’s 40s, has the potential to reverse those trends in the coming years.
How else can you build a strong foundation for your health in your 20s? Read the full story here
The 30s
While many people begin to start a family in their 20s, an increasing number of women wait until their 30s to conceive. If you’re planning a pregnancy, start by talking to your OBGYN before you get pregnant “so you can see what you need to maximize your health before you get pregnant,” says Jill Rabin, an OBGYN at Northwell Health in New York. And if pregnancy is not part of your plans, “then you need to use contraception if you’re having heterosexual sex,” she says.
During your pregnancy, keep in mind how inextricably entwined heart health and reproductive health are in women.
The one cancer screening that all women in their 30s should regularly undergo is cervical cancer testing.
“The important thing to realize is that really important reproductive points in our life with pregnancy and menopause are truly interrelated with our long-term cardiovascular health,” Lindley says. Some of the most common pregnancy complications, such as preeclampsia, gestational diabetes, and preterm birth, increase the risk of heart and stroke later in life.
“Remember how those risk factors are an opportunity to identify and treat long-term cardiovascular risk to keep people on a path to long-term heart health,” she says.
But those aren’t the only complications you face in your 30s. Read the full story here
The 40s
As women enter their 40s, their risk of cancer and cardiovascular disease start rising. Now is the time to assess your current health and look for ways to improve it before you enter menopause, when it becomes harder to lose weight and get sufficient sleep, Rosen says. “It’s an important time for optimizing blood pressure, cholesterol, weight, and physical activity,” she says.
As cancer risk gradually rises in the 40s, women should continue cervical cancer testing and begin screening for two of the biggest cancer killers of women: colorectal and breast cancer.
It’s also an important time to begin screenings for breast and colon cancer. If you have a strong family history of these cancers, you have probably begun receiving screenings in a previous decade. But most women should get their first mammogram at age 40 and then continue getting them every two years thereafter.
Screenings for colon cancer begin at 45, and although women have multiple options for colorectal cancer screenings, the gold standard for prevention is a colonoscopy, says Rajeev Jain, a gastroenterologist at Texas Digestive Consultants in Dallas. “Probably 90 percent of colorectal cancer deaths are preventable if we could have scoped them in a timely fashion and undergone a high-quality colonoscopy,” he says.
What about thyroid issues and changes to your skin? Read the full story here
The 50s
Women’s fifth decade of life is usually dominated by one word: menopause.
Starting at an average age of 51, menopause occurs when a woman has stopped having periods for at least one year. Menopause and perimenopause—the stretch of time from when symptoms begin until menstruation stops—involve changes in nearly every system within a woman’s body.
Menopause, and the years leading up to it, involve changes in nearly every system within a woman’s body. Experts say a particular priority for women in their 50s is focusing on their cardiovascular health and screenings for diabetes, high blood pressure, and high cholesterol.
“Everyone’s journey is going to be a little different,” says Asima Ahmad, a reproductive endocrinology and fertility specialist and chief medical officer at Carrot Fertility, but among the changes women may experience are sleeping difficulties, hot flashes, night sweats, fatigue, a slowed metabolism, mood changes, vaginal dryness, weight gain, headaches, changes to sex drive, and problems with concentration.
Two of these symptoms—hot flashes and night sweats—may be indicators of the other big health threat in women’s 40s: heart disease. Women under age 60 who have a greater number and intensity of hot flashes and night sweats, also have a greater risk heart attack or stroke.
But the good news is that you can do something about it. Read the full story here
The 60s
Continuing the trend from earlier decades, heart health should be the focus for women heading into their 60s and beyond. A healthy diet, aerobic activity, and muscle strengthening exercises— which also protects your bones as they begin to weaken—together remain the cornerstone of protecting your heart and brain. But it’s also important to recognize a heart attack if it occurs.
“Women will often get shortness of breath, accompanying chest pain, back pain, a fatigue that’s easy to write off,” Rosen says. “You have that Spidey sense. If something’s not right, get it checked out because this becomes dangerous time for women.”
Women in their 60s should be on the lookout for cognitive decline, osteoporosis, and heart conditions, among other potential health issues.
Another important body part that deserves attention is your pelvis. Perhaps you’ve heard you should “do your Kegels,” but many women don’t fully grasp how important it is to maintain the strength of their pelvic floor. The pelvic floor muscles support the bladder, uterus, and bowels and tighten the vaginal, urethra, and anal openings. As you age, and particularly if you had pregnancies, these muscles can gradually weaken, increasing the risk of pelvic organ prolapse and incontinence. The risk becomes even greater after menopause, with the loss of estrogen.
Pelvic organ prolapse, where one or more of the pelvic organs bulge into the vagina, occurs in up to half of all women at some point, and the urinary incontinence associated with a weakened pelvic floor is the top reason that women enter nursing homes, Rabin says. But you can do exercises to strengthen these muscles.
“I recommend people maximize their pelvic floor strength every decade and that way, if they keep it as strong as possible, they’re less likely to have prolapse and incontinence,” Rabin says.
Your 60s also has major implications for your immune system. Read the full story here
If all these recommendations feel like a lot, focus on one at a time. No one can change habits overnight, but each positive change is a step toward a healthier life.
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