Women’s Health at Midlife

Women’s Health at Midlife

In 2014 the North American Menopause Society (NAMS) published Recom­mendations for Clinical Care of Midlife Women, a compilation of key points and recommendations for women’s health at midlife and beyond, with the goal “to improve the under­standing and management of women’s health at this critical stage of life.”1

Jan L. Shifren, MD, who served as editor-in-chief of the NAMS recommendations, says that the ultimate aim of the work is to improve the way women are cared for at midlife: “The more we edu­cate clinicians, the better care women will receive. If we provide clear, concise, evidence-based infor­mation about midlife women’s health to clinicians, they will provide better care to patients.

“Midlife women’s health is not just about hot flashes, vaginal dryness, and bone health. The midlife transition and decisions about hormone therapy can impact or be impacted by so many other concerns,” Dr. Shifren adds. “In creating these recommendations, we tried to cover a com­prehensive range of related issues, including stress reduction, psychological support, nutrition, and other topics.”

The recommendations are freely available to the public on the NAMS website, menopause.org, and are a valuable resource for patients as well as clinicians. Understanding the recommendations can help women make empowered choices about their health and engage in productive conversa­tions with their providers. Here, Dr. Shifren shares key points from the recommendations along with insight into how women can take control of their health at midlife and beyond.

Q: What can women take away from the NAMS recommendations that can help them make empowered decisions about their health?

A: One of the take-home messages of the NAMS recommendations is that eating a healthy, well-balanced diet; maintaining a normal weight; and exercising regularly will impact almost all aspects of a woman’s overall health. Recommendations regarding healthy lifestyle choices were incorpo­rated into almost every topic, including cancer pre­vention, osteoporosis risk reduction, and meno­pausal symptom management.

Another message that emerged in many of the recommendations was the critical importance of stress reduction for health at midlife: engaging in meditation or other mind-body techniques and making more time for yourself can be very produc­tive because stress has such a significant adverse effect on so many aspects of our health.

A key message for women is that a healthy midlife is really in your own hands. Let your clini­cian help you, but at the end of the day choosing healthy lifestyle behaviors truly will make a dif­ference in your health and quality of life beyond menopause.

Q: What information is most important for women to share with their healthcare pro­viders at midlife and beyond?

A: It is very important when you interact with your healthcare providers not to be shy. For instance, vaginal dryness and discomfort with intercourse are highly prevalent in postmenopausal women. As you age beyond menopause, hot flashes get better but vaginal symptoms get worse. What we find in studies is that women don’t discuss these symptoms with their healthcare providers, and clinicians don’t ask. One of the real messages to patients is that if something is bothering you, bring it up; don’t assume it will embarrass your provider or that effective treatments are not available.

I also encourage women to write down ques­tions and concerns ahead of their appointments. There is so much to cover during a typical visit, it is important to be sure your agenda doesn’t get lost. Depending on the concern, your clinician may pro­vide helpful information and advice or might refer you to someone with greater expertise in that area.

Q: Do you have any other recommen­dations for women about managing their care and inter­acting with their care team?

A: It is important for women to recognize that clinicians are under a lot of time pressure during an office visit, but that does not mean they don’t care. If you have a concern that might take a lot of time, ask if you should schedule a follow-up appointment to address it. Sug­gesting a return appointment is especially important if you feel a problem is not receiving the attention it deserves.

Also, as you do your own research about any health con­cerns you may have, be aware of the agenda of the source providing the information. Be especially wary of websites that are advertising a prod­uct as well as those that ask you to share personal information. Choose carefully the websites you select for health information.

Women also should know that there are clinicians who are specifi­cally certified in caring for midlife women. NAMS Certified Menopause Practitioners (NCMPs) have passed a comprehensive competency exami­nation and are committed to con­tinuing education in midlife wom­en’s health. You can find an NCMP in your area at menopause.org.


  1. Shifren JL, Gass MLS, NAMS Recommenda­tions for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical care of midlife women. Menopause. 2014;21(10):1038-62. doi: 10.1097/gme.0000000000000319.

Jan L. Shifren, MD, NCMPis Associate Profes­sor of Obstet-rics, Gynecology and Reproductive Biology at Harvard Medical School in Boston, Massachusetts. She is a reproductive endocrinologist at the Massachusetts General Hospital and Director of the Mass General Midlife Women’s Health Center. Dr. Shifren currently divides her time among research, teaching and patient care and focuses her research on menopause, including the effects of estrogens, androgens and alternative therapies on menopausal symptoms, mood, and sexual function. Dr. Shifren is currently immediate past President of the North American Menopause Society (NAMS) and is a member of the American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Society of Reproductive Endocrinologists, Endocrine Society, and Society for Gynecologic Investigation.