For women, midlife changes occur somewhere between the ages of 45 and 60, when you are “middle-aged”. Fortunately “middle-aged” has been moving closer to 60 in our perception, given that life expectancies for women in the upper economic brackets have reach the high 80s and even low 90s. (it’s worth noting here that there has been little or no change for the poor on this in our nation).

I don’t know if the physiological evidence supports that midlife changes are moving later or not, but in my un-scientific looking around the fitness studio research, I’m going to say things are definitely happening later, like the 50s.

So what is it that still makes 40 feel so much like a turning point for women? Like it is the top of the hill, from where it’s all downhill from here? One word my friends: Estrogen.

Sometime in your 40’s, your body begins to make less estrogen as it prepares for your post-reproductive years. As your estrogen declines, you become perimenopausal. Perimenopause is what you think of when you think of all those insane menopause symptoms, like night sweats, hot flashes, mood swings, sleep problems. crying jags, etc. That’s the dreaded “change”, not actual completed menopause. (They should just rename that “The Belly”). Perimenopause lasts on average 4 years, but it can take up to 10, right into your early 50s. My doctor tells me the average age for complete menopause is 56. 

You can read all about perimenopause on the web, and talk to your doc about whether you have it or not, how far you are in to it, and how much longer you will probably be in it before you officially hit menopause. They can test your FSH levels at your annual check up, and that may give you some guidance. For this post, we’re just going to lay out some of the fun things you may have in your future, and how to mitigate or even prevent them.

Muscle Loss and Weight Gain

Beginning in your 40s, as your estrogen declines, you will start to lose about 1/2 lb. of muscle per year if you don’t do a fair amount 0f strength training exercise to help stave that off. As you lose muscle, your resting metabolism dips, you burn fewer calories, and you gain weight. It’s pretty much math, and it is challenging to avoid. It takes commitment and focus. And even if you do exercise with the right combo of cardio and strength training for your body, you will still see a slowing basal metabolic rate. It’s called age. But you can fight it, and you should use your 40s to get your workout routine sealed up TIGHT. I tell my girlfriends to be at their best possible weight ever at 48, because the pounds and fat get sneaky smart after that.

Bone Loss

Up until you are 35 or so, you maintain bone density at about the same rate that you lose it. But thanks to your friend estrogen saying adios, you can lose up to 1 percent of bone every year starting in your 40s. You will need strength training and weight-bearing exercise to slow and prevent bone loss, and even help build bone and density. There’s some question about whether calcium supplements help with this, but eating calcium rich foods certainly can’t hurt.

Breast Cancer

Your chances of breast cancer increase from 1 in 288 in your 30s to 1 in 69 in your 40s. After that, your chances increase by decade, but with not with such a big leap, as you can see here). You will want to get your annual mammogram starting at 40. Every year, right around your birthday so you don’t forget. Personally, I will do this til my dying day, since in your 70s, the probability of developing  breast cancer is 1 in 26. Doctors and researchers at the Mayo Clinic, Duke Health, MD Anderson etc.  still recommend an annual mammogram for women beginning at age 40, as do the physicians at our local expert Charlotte Radiology.

Hair Thinning and Loss.

There’s a little good news here ~ hair thinning and loss happen everywhere, so shaving and bikini maintenance are reduced. And while it usually starts in your 40s with, you guessed it, perimenopause, most hair loss is gradual and continues on into your older decades. The bad news is thinning and loss of hair on your head, especially at the hairline and crown. Plus thinning eye lashes and brows. Most of us would gladly trade frequent shaving to avoid that.  Hormone replacement therapy, a treatment some women us for many issues during this life-stage, can aggravate hair-loss with male-pattern baldness. There are treatments and you should consult a dermatologist for your best recourse.

It’s Not All In Your Head. But Some of It Is.

Key parts of women’s brains are affected by the decrease in estrogen. I’m not saying your husband isn’t routinely dumb; I’m just saying when you are, it’s not your fault. You know how you can’t remember words, names, things to do, and multi-task with a vengeance like you used to? says that this is not just because of the normal aging process–it’s part of the normal female aging process. In their article here, says “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.  The good news, according to this article, is that things bounce back after menopause.

Your Cycle Becomes Totally Unpredictable

You expected this to change with menopause; what you didn’t realize is that it can start way, way before that and that it is so random. Your estrogen levels go haywire in perimenopause, and your ovaries can produce different amounts each month, leading to completely rogue behavior by your monthly cycle. Shorter, longer, skipped all together for several months then back, heavier, worse, better again, you name it. It may seem odd given your age, but birth control pills and IUDs can help with this, and can eliminate your period altogether until your FSH levels are low enough that you are probably in menopause. Talk to the doc.

Closed for Business 

Once again, your dearly departing estrogen can cause serious dryness down there, compounding a decreasing loss in desire. Your body is literally signaling that it’s time to stop procreating. Granted, your husband is not getting that signal, not that you’d necessarily want him to, but you are not alone if you wish you could put your sex life on hold for a while. Talk to your doctor about a low dose estrogen topical, or testosterone replacement, or hormonal therapy.  There are risks and there are rewards and you and your doctor can work through them. Dryness and irritation can lead to UTIs and infections, so don’t just lie there in discomfort and think of England.

What is With Your Waistline

The lower your estrogen, the wider your middle. Muffin tops become a real threat. Your body will just not burn fat like it used to, and the body fat you add migrates to your belly and waist now, and not to your hips and thighs as it did during your childbearing years. You WILL have to change your diet and you will have to exercise if you want any semblance of a curvy silhouette as you move from your 40s into your 50s. You will need to eat less, because your resting metabolism is burning less. Your body needs fewer calories to survive and starts storing extra as fat. Your testosterone is dropping, so you may find you just don’t have the strength to exercise like you used to and burn those extra food calories. Now more than ever, you need to realize that exercise is only like 30% of the equation. Diet is the big gun, at 70%. This is not a dieting post, cause that could be another whole series. This article does a good job covering why your new BFF should be protein (just ignore that it reads at first like an infomercial) and this one from recaps some common wisdom.

Welcome to Wine O’Clock in the Morning

This is the decade when most of us first start dealing with the 3 am wake up call. You fall asleep in minutes, sleep so soundly for 3-4 hours and then, bang, you wake up and stay up for HOURS. You can try blaming it on stress, menopause, snoring, children, pets and more. Trust me, it’s the wine. Or really the alcohol, but the wine is the worst. There are several theories I’ve found on why this happens = alcohol reduces REM sleep, alcohol provokes acid reflux, alcohol messes with your endocrine system, or your sympathetic nervous system, wine has more sugar, wine has sulfites, etc. You will need to do your own personal research on this matter, which means, you will need to stop having that glass or two of wine if you aren’t sleeping through the night. You can FERBERIZE yourself. Try skipping 3 full nights in a row and see what happens on night 2 or 3. Try switching to Vodka or other clear liquor. (Yes, there’s a reason women over 50 are practically married to Tito’s.) Try weekends only. Do the Whole30. But test it out. I’m sad to say, you will probably find your drinking days are also in decline, cause you seriously need your beauty sleep from here on out.


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This is by far one of the best decades of your life, despite dealing with all these glorious changes. You are smarter, prettier and stronger than you were in your 20s, and you can still turn heads when you enter the room. Just remember, there are real, significant physical changes happening during this decade, and you will have to accommodate and address them. Consider again the most important points of this article:

  • I tell my girlfriends to be at their best possible weight ever at 48, because the pounds and fat get sneaky smart after that.
  • I’m not saying your husband isn’t routinely dumb; I’m just saying when you are, it’s not your fault.
  • Don’t just lie there in discomfort and think of England.
  • Exercise is only like 30% of the equation. Diet is the big gun, at 70%.
  • You can FERBERIZE yourself on the wine every night.

Go Forth and Enjoy your 40s, and find more posts about them on scoop HERE.


The Scoop on Turning 40 is Brought to You by Charlotte Radiology Breast Centers.