Abstract
All women go through midlife, a major transition period in women’s lives beginning at age 35–40 years and extending to 60–65 years. Midlife is associated with the onset of functional limitations, and the transition to disability may occur along with the risk for osteoporosis and concomitant fractures. Furthermore, women’s heart health and cardiovascular risk profile especially change during midlife. Other menopause-associated physiological and psychosocial changes include hot flashes, depression, and increased prevalence of sleep disturbances. Midlife is also the period where women understand the importance of adopting a healthier lifestyle and exercising regularly so that health issues in later life can be controlled and prevented. Midlife encompasses the late reproductive to late postmenopausal stages of reproductive aging, which includes the menopausal transition and menopause. In summary, midlife is a critical period for women characterized by a sense of instability that is associated with major changes in health status and priorities, family situation, work, and societal expectations, as well as age-related appearance changes, physical decline, and menopause.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Addis IB, Van Den Eeden SK, Wassel-Fyr CL et al (2006) Sexual activity and function in middle-aged and older women. Obstet Gynecol 107(4):755–764. https://doi.org/10.1097/01.AOG.0000202398.27428.e2
Adimula RA, Ijere IN (2018) Psycho-social traumatic events among women in Nigeria. Madridge J AIDS 2(1):17–28. https://doi.org/10.18689/mja-1000104
Allen RH, Cwiak CA, Kaunitz AM (2013) Contraception in women over 40 years of age. CMAJ 185(7):565–573. https://doi.org/10.1503/cmaj.121280
Amabebe E, Anumba DOC (2018) The vaginal microenvironment: the physiologic role of lactobacilli. Front Med 5:181. https://doi.org/10.3389/fmed.2018.00181
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn, text rev. American Psychiatric Association, Washington, DC
Avis NE, Colvin A, Bromberger JT, Hess R (2018) Midlife predictors of health-related quality of life in older women. J Gerontol A Biol Sci Med Sci 73(11):1574–1580. https://doi.org/10.1093/gerona/gly062
Baber RJ, Panay N, Fenton A (2016) 2016 IMS recommendations on women’s midlife health and menopause hormone therapy. Climacteric 19(2):109–150. https://doi.org/10.3109/13697137.2015.1129166
Baker JH, Runfola CD (2016) Eating disorders in midlife women: a perimenopausal eating disorder? Maturitas 85:112–116
Balasch J, Gratacós E (2012) Delayed childbearing: effects on fertility and the outcome of pregnancy. Curr Opin Obstet Gynecol 24(3):187–193. https://doi.org/10.1097/GCO.0b013e3283517908
Bates GW, Bowling M (2013) Physiology of the female reproductive axis. Periodontol 61(1):89–102. https://doi.org/10.1111/j.1600-0757.2011.00409.x
Bilberg A, Bremell T, Bjersing J, Mannerkorpi K (2018) High prevalence of widespread pain in women with early rheumatoid arthritis. Scand J Rheumatol 47:447–454. https://doi.org/10.1080/03009742.2018.1447683
Boeckner L, Young TD, Boeckner LS et al (2014) Use and views of a distance delivery health promotion program by rural midlife to older women. J Nutr Educ Behav 46:S120–S120. https://doi.org/10.1016/j.jneb.2014.04.067
Bromberger JT, Schott L, Kravitz HM, Joffe H (2015) Risk factors for major depression during midlife among a community sample of women with and without prior major depression: are they the same or different? Psychol Med 45:1653–1664. https://doi.org/10.1017/S0033291714002773
Brown AS, Susser ES (2008) Prenatal nutritional deficiency and risk of adult schizophrenia. Schizophr Bull 34:1054–1063
Burger HG, Hale GE, Robertson DM, Dennerstein L (2007) A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women’s Midlife Health Project. Hum Reprod Update 13(6):559–565. https://doi.org/10.1093/humupd/dmm020
Calleja-Agius J, Brincat MP (2009) Urogenital atrophy. Climacteric 12(4):279–285. https://doi.org/10.1080/13697130902814751
Carolino ROG, Barros PT, Kalil B, Anselmo-Franci J (2019) Endocrine profile of the VCD-induced perimenopausal model rat. PLoS One 14(12):1–19. https://doi.org/10.1371/journal.pone.0226874
Center for Disease Control and Prevention (n.d.) Sleep home page – sleep and sleep disorders. Availale via https://www.cdc.gov/sleep/index.html. Accessed 8 Mar 2020
Ceylan B, Özerdoğan N (2015) Menopoza girme yaşını etkileyen faktörler ve menopozda yaşam kalitesinin belirlenmesi. Turk Jinekoloji ve Obstetrik Dernegi Dergisi 12(1):43–49. https://doi.org/10.4274/tjod.79836
Chyu L, Upchurch DM (2018) A longitudinal analysis of allostatic load among a multi-ethnic sample of midlife women: findings from the study of women’s health across the nation. Womens Health Issues 28(3):258–266. https://doi.org/10.1016/j.whi.2017.11.002
Collaborative Group on Hormonal Factors in Breast Cancer (2019) Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 394(10204):1159–1168. https://doi.org/10.1016/S0140-6736(19)31709-X
Cortésa YI, Catov JM, Brooks M et al (2019) Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN. Atherosclerosis 164:27–35
Dorner T, Berner C, Haider S et al (2018) Sexual health in patients with rheumatoid arthritis and the association between physical fitness and sexual function: a cross-sectional study. Rheumatol Int 38:1103–1114. https://doi.org/10.1007/s00296-018-4023-3
Duan C, Talbott E, Brooks M et al (2019) Five-year exposure to PM 2.5 and ozone and subclinical atherosclerosis in late midlife women: the study of women’s health across the nation. Int J Hyg Environ Health 222:168–176. https://doi.org/10.1016/j.ijheh.2018.09.001
El Khoudary SR, Chen HY, Barinas-Mitchell E et al (2015) Simple physical performance measures and vascular health in late midlife women: the study of women’s health across the nation. Int J Cardiol 182:115–120. https://doi.org/10.1016/j.ijcard.2014.12.042
Family Caregivers Alliance (2015) Women and caregiving: facts and figures. Available via https://caregiver.org/women-and-caregiving-facts-and-figures. Accessed 14 Mar 2020
Fatima Y (2017) A comparative study of serum estrogen and lipid profile in pre-menopausal and post-menopausal women as atherosclerotic risk factors. IJCBR 4:237–241. https://doi.org/10.18231/2394-6377.2017.0056
Folta SC, Seguin RA, Chui KKH et al (2015) National dissemination of strong women-healthy hearts: a community-based program to reduce risk of cardiovascular disease among midlife and older women. Am J Public Health 105:2578–2585. https://doi.org/10.2105/AJPH.2015.302866
Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F (2018) Effect of maternal age on the risk of preterm birth: a large cohort study. Obstet Gynecol Surv 73(6):340–342. https://doi.org/10.1097/01.ogx.0000541308.53092.4a
Gerber LM, Sievert LL (2018) Neighborhood disorder, exposure to violence, and perceived discrimination in relation to symptoms in midlife women. Women’s Midlife Health 4(14):1–11. https://doi.org/10.1186/s40695-018-0043-0
Geremew AB, Gelagay AA (2018) Modern contraceptive use and associated factors among married women in Finote Selam town Northwest Ethiopia: a community based cross-sectional study. Women’s Midlife Health 4(1):1–8. https://doi.org/10.1186/s40695-018-0044-z
Glick M (2020) Health in 2020 and beyond: what do the numbers tell us? J Am Dent Assoc 151(1):1–3. https://doi.org/10.1016/j.adaj.2019.11.007
Graff-Iversen S, Hewitt S, Forsén L et al (2019) Associations of tobacco smoking with body mass distribution; a population-based study of 65,875 men and women in midlife. BMC Public Health 19:1–10. https://doi.org/10.1186/s12889-019-7807-9
Green KA, Zarek SM, Catherino WH (2015) Gynecologic health and disease in relation to the microbiome of the female reproductive tract. Fertil Steril 104(6):1351–1357. https://doi.org/10.1016/j.fertnstert.2015.10.010
Hajnasiri H, Gheshlagh RG, Sayehmiri K, Moafi F, Farajzadeh M (2016) Domestic violence among Iranian women: a systematic review and meta-analysis. Iran Red Crescent Med J 18(6):1–10
Hall JE (2015) Endocrinology of the menopause. Endocrinol Metab Clin N Am 44:485–496. https://doi.org/10.1016/j.ecl.2015.05.010
Hammond GK, Chapman GE, Barr SI (2011) Healthy midlife Canadian women: how bone health is considered in their food choice systems. J Hum Nutr Diet 24:61. https://doi.org/10.1111/j.1365-277X.2010.01125.x
Hanley C, Matthews KA, Brooks MM et al (2018) Cardiovascular fat in women at midlife: effects of race, overall adiposity, and central adiposity. The SWAN Cardiovascular Fat Study. Menopause 25:38–45. https://doi.org/10.1016/j.physbeh.2017.03.040
Haraldsdottir A, Torfadottir JE, Valdimarsdottir U et al (2015) Fish and fish-liver oil consumption in adolescence and midlife and risk of CHD in older women. Public Health Nutr 19:318–325. https://doi.org/10.1017/S1368980015001020
Harlow SD, Derby CA (2015) Women’s midlife health: why the midlife matters. Women’s Midlife Health 1(5):1–3. https://doi.org/10.1186/s40695-015-0006-7
Harlow SD, Gass M, Hall JE et al (2012) Executive summary of the stages of reproductive aging workshop + 10: addressing the unfinished agenda of staging reproductive aging methods-scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women. Menopause 19(4):387–395. https://doi.org/10.1097/gme.0b013e31824d8f40
Harlow SD, Dusendang JR, Hood MM, Woods NF (2017) Contraceptive preferences and unmet need for contraception in midlife women: where are the data? Women’s Midlife Health 3(1):1–8. https://doi.org/10.1186/s40695-017-0026-6
Hedgeman E, Hasson RE, Karvonen-Gutierrez CA et al (2018) Perceived stress across the midlife: longitudinal changes among a diverse sample of women, the Study of Women’s health Across the Nation (SWAN). Women’s Midlife Health 4(2):1–11. https://doi.org/10.1186/s40695-018-0032-3. Epub 2018 Mar 16
Heitz U, Studerus E, Menghini-Müller S et al (2019) Gender differences in first self-perceived signs and symptoms in patients with an at-risk mental state and first-episode psychosis. Early Interv Psychiatry 13(3):582–588
Hörder H, Johansson L, Guo X et al (2018) Midlife cardiovascular fitness and dementia. Neurology 90:e1298–e1305. https://doi.org/10.1212/WNL.0000000000005290
Hubacher D, Trussell J (2015) A definition of modern contraceptive methods. Contraception 92(5):420–421. https://doi.org/10.1016/j.contraception.2015.08.008
Im E-O, Ham OK, Chee E, Chee W (2015) Racial/ethnic differences in cardiovascular symptoms in four major racial/ethnic groups of midlife women: a secondary analysis. Women Health 55:525–547. https://doi.org/10.1080/03630242.2015.1022813
Im E-O, Ko Y, Chee E et al (2017) Midlife women’s cardiovascular symptoms: a cluster analysis. Health Care Women Int 38:1275–1288. https://doi.org/10.1080/07399332.2017.1332626
Izetbegovic S, Stojkanovic G, Ribic N, Mehmedbasic E (2013) Features of postmenopausal uterine haemorrhage. Med Arch (Sarajevo, Bosnia and Herzegovina) 67(6):431–434. https://doi.org/10.5455/medarh.2013.67.431-434
James SL, Abate D (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392(10159):1789–1858
Jawaheer D, Lum R, Gregersen P, Criswell L (2006) Influence of male sex on disease phenotype in familial rheumatoid arthritis. Arthritis Rheum 54:3087–3094. https://doi.org/10.1002/art.22120
Jenabi E, Shobeiri F, Hazavehei SMM, Roshanaei G (2015) Assessment of questionnaire measuring quality of life in menopausal women: a systematic review. Oman Med J 30(3):151–156. https://doi.org/10.5001/omj.2015.34
Kar SK, Jain M (2016) Current understandings about cognition and the neurobiological correlates in schizophrenia. J Neurosci Rural Pract 7(3):412–418
Karoll C (2018) What we need to know about eating disorders in midlife. Eating Disorders. Available via https://www.edcatalogue.com/need-know-eating-disorders-midlife/. Accessed 14 Mar 2020
Keeling J, Smith D, Fisher C (2016) A qualitative study exploring midlife women’s stages of change from domestic violence towards freedom. Womens Health 16(1):1–8
Kline CE, Irish LA, Buysse DJ et al (2014) Sleep hygiene behaviors among midlife women with insomnia or sleep-disordered breathing: the SWAN sleep study. J Womens Health (Larchmt) 23:894. https://doi.org/10.1089/jwh.2014.4730
Ko Y, Chee W, Im E-O (2019) Evaluation of the cardiovascular symptom index for midlife women in multiethnic/racial midlife women. Health Care Women Int 41:489. https://doi.org/10.1080/07399332.2019.1694521
Komesu YM, Schrader RM, Ketai LH, Rogers RG, Dunivan GC (2016) Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history. Int Urogynecol J 27(5):763–772. https://doi.org/10.1007/s00192-015-2888-1
Krasselt M, Baerwald C (2014) The current relevance and use of prednisone in rheumatoid arthritis. Expert Rev Clin Immunol 10:557–571. https://doi.org/10.1586/1744666x.2014.904746
Krukova TL, Saporovskaia MV, Voronina ME (2018) Predictors of middle aged women’s psychological well-being: attitudes toward parents. Soc Welfare Interdiscip Approach 8(2):21–28. https://doi.org/10.21277/sw.v2i8.381
Levine ME, Lu AT, Chen BH et al (2016) Menopause accelerates biological aging. Proc Natl Acad Sci U S A 113(33):9327–9332. https://doi.org/10.1073/pnas.1604558113
Lindenmeyer A, Griffiths F, Green E, Thompson D, Tsouroufli M (2008) Family health narratives: midlife women’s concepts of vulnerability to illness. Health 12(3):275–293. https://doi.org/10.1177/1363459308090049
Liu Y, Wheaton AG, Chapman DP et al (2016) Prevalence of healthy sleep duration among adults – United States, 2014. Morb Mortal Wkly Rep 65:137–141. https://doi.org/10.15585/mmwr.mm6506a1
MacInnis M (2010) Lifestyle strategies in the management of women’s midlife health concerns. Can Pharm J 143:S21. https://doi.org/10.3821/1913-701X-143.sp2.S21
Matthews KA, Chang Y, Kravitz HM et al (2014) Sleep and risk for high blood pressure and hypertension in midlife women: the SWAN (Study of women’s health across the nation) sleep study. Sleep Med 15:203–208. https://doi.org/10.1016/j.sleep.2013.11.002
Mitro SD, Harlow SD, Randolph JF, Reed BD (2016) Chronic vulvar pain in a cohort of post-menopausal women: atrophy or vulvodynia? Women’s Midlife Health 2(1):1–9. https://doi.org/10.1186/s40695-016-0017-z
Müller N (2018) Inflammation in schizophrenia: pathogenic aspects and therapeutic considerations. Schizophr Bull 44:973–982
Muralidharan A, Harvey PD, Bowie CR (2018) Associations of age and gender with negative symptom factors and functioning among middle-aged and older adults with schizophrenia. Am J Geriatr Psychiatry 26(12):1215–1219
Nicolau ZFM, Andersen ML, Tufik S, Hachul H (2015) Can sleep hygiene behaviors improve sleep quality in midlife women? J Women’s Health 24:252–253
Owen MJ, Sawa A, Mortensen PB (2016) Schizophrenia. Lancet 388(10039):86–97
Page H (2016) Depression among African American midlife women: delineating the role of stress. Doctoral dissertation. Available via https://scholarcommons.sc.edu/etd/3813. Accessed 15 Mar 2020
Pencina K, Thanassoulis G, Wilkins JT et al (2019) Trajectories of non-HDL cholesterol across midlife: implications for cardiovascular prevention. J Am Coll Cardiol 74(1):70–79
Pettee Gabriel K, Mason JM, Sternfeld B (2015) Recent evidence exploring the associations between physical activity and menopausal symptoms in midlife women: perceived risks and possible health benefits. Women’s Midlife Health 1(1). https://doi.org/10.1186/s40695-015-0004-9
Pines A (2017) Sleep duration and midlife women’s health. Climacteric 20(6):528–530. https://doi.org/10.1080/13697137.2017.1335702
Prairie BA, Wisniewski SR, Luther J et al (2015) Symptoms of depressed mood, disturbed sleep, and sexual problems in midlife women: cross-sectional data from the study of women’s health across the nation. J Women’s Health 24(2):119–126. https://doi.org/10.1089/jwh.2014.4798
Purabdollah M, Lakdizaji S, Rahmani A, Hajalilu M, Ansarin K (2015) Relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis. J Caring Sci 4:233–241. https://doi.org/10.15171/jcs.2015.024
Seeman MV (2016) Gendering psychosis: the illness of Zelda Fitzgerald. Med Humanit 42:65–69
Seeman MV (2018) Women who suffer from schizophrenia: critical issues. World J Psychiatry 8(5):125–136
Sharifi K, Anoosheh M, Foroughan M, Kazemnejad A (2014) Barriers to middle-aged women’s mental health: a qualitative study. Iran Red Crescent Med J 16(6):e18882. https://doi.org/10.5812/ircmj.18882.
Sharifi V, Amin-Esmaeili M, Hajebi A et al (2015) Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iran mental health survey-2011. Arch Iran Med 18(2):76–84
Shufelt C, Dutra E, Torbati T, Ramineni T (2019) A clinical prescription for heart health in midlife women. Maturitas 119:46–53. https://doi.org/10.1016/j.maturitas.2018.11.004
Sievert LL, Huicochea-Gómez L, Cahuich-Campos D, Koomoa D-L, Brown DE (2018) Stress and the menopausal transition in Campeche, Mexico. Women’s Midlife Health. https://doi.org/10.1186/s40695-018-0038-x
Solek CM, Farooqi N, Verly M, Lim TK, Ruthazer ES (2018) Maternal immune activation in neurodevelopmental disorders. Dev Dyn 247:588–619
Sternfeld B, Colvin A, Stewart A et al (2017) The effect of a healthy lifestyle on future physical functioning in midlife women. Med Sci Sports Exerc 49:274–282. https://doi.org/10.1249/MSS.0000000000001109
Subu MA, Holmes D, Elliot J (2016) Stigmatisasi dan Perilaku Kekerasan pada Orang Dengan Gangguan Jiwa (ODGJ) di Indonesia. J Keperawatan Indonesia 19(3):191–199
Subu MA, Holmes D, Elliott J, Jacob JD (2017) Persistent taboo: understanding mental illness and stigma among Indonesian adults through grounded theory. Asian J Pharmacy Nurs Med Sci 5(1):1–11
Tagurum YO, Chirdan OO, Obindo T, Bello DA, Afolaranmi OT et al (2015) Prevalence of violence and symptoms of post-traumatic stress disorder among victims of ethno-religious conflict in Jos, Nigeria. J Psychiatry 18:178. https://doi.org/10.4172/1994-8220.1000178.
Taylor B, Matthews KA, Hasler B et al (2016) Bedtime variability and metabolic health in midlife women: the SWAN sleep study. Taylor BJ, ed. Sleep 39(2):457–465. https://doi.org/10.5665/sleep.5464
The North American Menopause Society (2007) Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of North American Menopause Society. Menopause 14(2):168–182. https://doi.org/10.1097/gme.0b013e31803167ab
Thomas AJ, Mitchell ES, Woods NF (2018) The challenges of midlife women: themes from the Seattle midlife women’s health study. Women’s Midlife Health 4(8):1–10. https://doi.org/10.1186/s40695-018-0039-9
Thomas AJ, Mitchell ES, Woods NF (2019) Undesirable stressful life events, impact, and correlates during midlife: observations from the Seattle midlife women's health study. Womens Midlife Health 3(5):1. https://doi.org/10.1186/s40695-018-0045-y. PMID: 30766725; PMCID: PMC6318955.
Maine M, Kelly J (2016) Pursuing Perfection: Eating Disorders, Body Myths, and Women at Midlife and Beyond. Routledge. ISBN 1138890723, 9781138890725
Mangweth-Matzeka B, Hoek HW (2017) Epidemiology and treatment of eating disorders in men and women of middle and older age. Curr Opin Psychiatry 30(6):446–451. https://doi.org/10.1097/YCO.0000000000000356
Thurston RC, Barinas-Mitchell E, von Känel R et al (2018) Trauma exposure and endothelial function among midlife women. Menopause 25(4):368–374. https://doi.org/10.1016/j.physbeh.2017.03.040
UKEssays (2018) Psych-social changes in middle adulthood. Available via https://www.ukessays.com/essays/psychology/psychsocial-changes-in-middle.php?vref=1. Accessed 14 Mar 2020
Upchurch DM, Stein J, Greendale GA et al (2015) A longitudinal investigation of race, socioeconomic status, and psychological mediators of allostatic load in midlife women: findings from the study of women’s health across the nation. Psychosom Med 77:402–412
van de Leemput J, Hess JL, Glatt SJ, Tsuang MT (2016) Genetics of schizophrenia: historical insights and prevailing evidence. Adv Genet 96:99–141. https://doi.org/10.1016/bs.adgen.2016.08.001
Watson NF, Badr MS, Belenky G et al (2015) Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep 38(8):1161–1183
World Health Organization (2013) Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization, Geneva, pp 1–50
Xu Q, Zhao Y, Chen H, Jing J (2016) Exploring sleep quality and related factors in Chinese midlife women. Health Care Women Int 37:620–635. https://doi.org/10.1080/07399332.2015.1037443
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Editors and the World Health Organization
About this entry
Cite this entry
Dias, J.M., Subu, M.A., Abraham, M.S., Al Yateem, N. (2021). Women’s Midlife Health. In: Haring, R., Kickbusch, I., Ganten, D., Moeti, M. (eds) Handbook of Global Health. Springer, Cham. https://doi.org/10.1007/978-3-030-05325-3_129-1
Download citation
DOI: https://doi.org/10.1007/978-3-030-05325-3_129-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-05325-3
Online ISBN: 978-3-030-05325-3
eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences