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Middle Age Puberty

There’s no escaping the challenges of midlife. It’s like puberty, only worse.

A woman with long dark and curly hair stands in front of a bathroom mirror and looks at her reflection. Her hand is on the side of her face along her jawline.
Photo credit: Courtesy of Alisa Schindler
A woman wearing a teal shirt smiles as a woman with long dark hair who we only see from the back puts a hand on her shoulder.

Women's bodies are unique - and so are our minds.

These days when I look in the mirror, I’m kind of happy that my vision isn’t what it used to be. I feel a little like a character in one of my favorite children’s books. If you’re as old as I am, you might remember it. It’s a Golden Book classic called The Saggy Baggy Elephant.

“I’d better hide in a dark place where my bags and sags and creases and wrinkles won’t show,” laments Suki, the little elephant. Of course, by the end of the book, he learns that, much like the ugly duckling, he is more beautiful than he knows. Wish I could say I feel the same way.

Yeah, yeah. I know, we’re all beautiful. The aging process is beautiful, life is beautiful. Blah, blah. Come on, admit it, it isn’t easy watching yourself age. And anyone who tells you differently doesn’t own a magnifying mirror. But really, it isn’t just about vanity. Much of the aging process is medical, hormonal and psychological. It involves our sanity (and some justified profanity), as well.

To get a better understanding of the changes and challenges that we women go through, I spoke with Northwell Health’s Dr. Barbara Keber, vice chair of family medicine at Glen Cove Hospital, and Dr. Gianni Rodriguez-Ayala, OB/GYN. Here’s what I learned:

Weight gain

Without hesitation, Dr. Keber said that the number one complaint of women in midlife is weight gain. For most, maintaining our weight is a struggle without the help of aging. “Menopause and perimenopause (which precedes menopause) cause alterations in your metabolism. Along with that, you have disruptions of sleep from changes in hormones, hot flashes and stress. And people who don’t sleep well have increases in hormones (leptin) that cause you to gain weight.” She recommends a healthy diet and plenty of water to aid digestion. “Your system functions better when it’s not processing junk.” So, make sure to eat your fruits and veggies, but totally enjoy a piece of cake now and then. I mean, come on, we’re middle aged, not dead.

Exhaustion and stress

As we age we naturally lose melatonin, which affects our sleep cycle. And you know what makes it worse? Staring at all those blue screens (smartphones, computers, televisions…) at bedtime. But one of the main reasons we're tired is largely related to stress. “Stress causes fatigue because it creates and increases things like adrenaline and cortisol, which also increase our risk for weight gain,” says Dr. Keber.

Sigh. It’s like we’re chasing our own tails.  

“As women, we want to do more always,” adds Dr. Rodriguez-Ayala. Her advice? “Take something off your to-do list and do something for yourself.” I could not agree more. So tomorrow, instead of doing laundry, I will be getting a pedicure. Doctor’s orders.  

The good news: Sleep, stress and weight gain are all interrelated, according to Dr. Keber. So “fixing one helps with the other issues,” she explains. To fight back, she recommends squeezing in 30 minutes of moderate exercise, five days a week. And to choose an activity that you like—walk with friends, yoga, swim, bike… it doesn’t matter as long as you actually do it. And in case you’re wondering, “running around all day doesn’t count as exercise.” Dang.

What were we talking about?

The old memory ain’t what it used to be. I look for a word but it’s just out of my brain’s reach. And my keys? I know they’re around here somewhere. “The brain has to make a protein* in order to make a memory, and as we age we make less of that protein,” Dr. Keber says. Cognitive function declines with age, but we can definitely help our brains to function better. “Social stimulation is key. And keep the brain active—read, do puzzles.” And remember. “Cognitive decline doesn’t mean you have dementia,” she says. Well, phew!

“We are aging. Stuff happens. We deal. And we need to take it with a grain of salt and a glass of wine.”
Alisa Schinder, member of the midlife crisis club

Everything just hurts!

As my friend Beth, 52, says, “If it’s not my hands, it’s my hip. Or my back. It’s all of it, but what can I do?” She’s right. Stiff joints, creaky bones, aching body—aging isn’t for wussies. As we age our bodies deal with natural wear and tear, osteoarthritis, and pain and stiffness from things like bad posture or immobility. We need to protect our joints by maintaining a healthy weight, engaging in steady exercise and avoiding overuse, which only makes things worse. Keber says, “Being a weekend warrior isn’t the best idea. It’s too hard on our joints.” She says things like yoga and Pilates are excellent because they stretch the core as well. I also personally recommend massage. It’s a gift for your body—and your brain.

Lower sex drive

When Dr. Keber mentioned this, I wondered if women really brought this up to their doctors. She said no but when she brought it up to them, the truth would come out. There’s vaginal dryness from a drop in estrogen and decreased libido from a drop in testosterone. Add that to everyday stress and exhaustion, and women would just rather be left alone. Hmm… I wonder if that’s why it’s called a dry spell?

While I know it seems embarrassing to bring up, believe me, your doctor has heard it all. And there are over-the-counter lubricants and prescription estrogen creams that might help. But it’s also important to relaaxxxxx.

Bone loss

In the years after menopause, we can lose up to 20 percent of bone mass. In fact, one in three women over 50 will experience an osteoporotic related fracture. It seems Elaine had more “shrinkage” to worry about than George.** One of the most important things we can do to help our bones is getting enough calcium and vitamin D into our diets and—surprise—exercise! A combination of aerobic supplemented with resistance training will help us maintain our muscle mass and bone density, which decreases our risk for falls. We’ve seen enough commercials to know that we don’t want to fall, and if we do, we definitely want to get up.

So thirsty!

Reduced estrogen also makes our skin, nails and hair dryer, and forget what it does to our poor cracked feet. What to do? Dr. Keber says that most people are not drinking enough water. We should really aim for six to eight 8 ounce glasses of water a day. So, hydrate, moisturize, repeat.

“It isn’t easy watching yourself age. And anyone who tells you differently doesn’t own a magnifying mirror.”
Alisa Schinder, member of the midlife crisis club

Bladder control

In the minutes before one of my workout classes, there’s a line of women my age waiting for the bathroom. Is it because we all waited until the last minute to go? No, it’s because we share a not-so-secret truth—our pelvic floors are kaput! Like every doctor I’ve ever seen, Dr. Rodriguez-Ayala recommends the almighty Kegel. There’s also something called bladder training, which involves going before “at risk” activities and drinking less at night. But if leakage is something that is truly interrupting your life, she says, surgery could be a reasonably easy and effective option. If it’s just annoying, I suggest crossing your legs before you sneeze.

A hairy situation

This one is fun. Apparently once the careful balance of hormones goes haywire, facial hairs can appear. It’s generally much ado about nothing, but since the hair on our heads is a little thinner and lackluster (remember those hormone rich pregnancy days?!), it’s ironically annoying. There’s no shortage of options here: Plucking, waxing, laser hair removal...there are many ways to say goodbye to your little friends.

Can you hear me now?

All of a sudden, that person complaining about loud music at a party is me! And I can barely hear what people are saying right next to me. What the hey is going on? Dr. Keber says, “Presbycusis is difficulty hearing in an environment with a lot of exigent noise, and also higher frequencies, female voices in particular, which is why men don’t hear their wives speak.” Oh, really, is that why? Can you hear me rolling my eyes? Dr. Keber adds that it’s a natural process because the auditory canal becomes thinner and there’s also a buildup of wax. If you’re really struggling to hear, get yourself checked out. There have been huge technological advancements for hearing aids in recent years.


This is my favorite affliction. No matter if I pee when I cough, can no longer see whether the person walking toward me is a man, a woman or a lamppost, and I occasionally sprout a nice thick chin hair when it seems the hair on my head barely grows, I need to be mature about things. I’m aging. Stuff happens. I deal. And I need to take it with a grain of salt, a sense of humor, and a glass of wine. There’s no point in making myself crazy. Acceptance and appreciation. That’s also part of the transformation of middle age.

Not that we should just give in and give up. As with all things, we can do a crappy job of taking care of ourselves or a good one. So check in with your doctors regularly. They have the experience and education to offer you treatments and suggestions to ease many of our midlife maladies. And if anything seems amiss, please don’t wait.

In the end, one thing seems clear. We could all benefit from just chilling the hey out.


RbAp48 - Really? Who’s going to remember that!  

** Random Seinfeld reference. If you’re a certain age, you got it.

Next Steps and Useful Resources

  • Find an OB/GYN near you and make an appointment today.
  • Check out our So You're stories on The Well: Real people getting real procedures and telling it like it is.
  • Get the care you need with the expertise you trust at Katz Institute for Women's Health.

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Published August 13th, 2018
A woman wearing a teal shirt smiles as a woman with long dark hair who we only see from the back puts a hand on her shoulder.

Women's bodies are unique - and so are our minds.