Navigating middle age: A user’s guide to midlife

NEW YORK – Midlife, typically defined as between the ages of 40 and 60, is an inflection point. It is a time when your past behaviours begin to catch up with you and you start to notice your body and mind ageing, sometimes in frustrating or disconcerting ways.

But it is also an opportunity. What your older years will look and feel like is not set in stone, and there is still time to make adjustments to improve health and well-being going forward.

“Things that you do or happen in midlife can have long-term effects on later life,” said Brandeis University psychology professor Margie Lachman, who specialises in middle age. “So it’s a really important period for paying attention to your body.”

The New York Times asked readers for their most pressing questions about middle age and received more than 800 responses.

Here is what experts had to say about their concerns, how and why they arise, which ones you can slow or delay, and why not all changes are bad.

Where did these aches and pains come from?

Some of it might be simple muscle soreness. People tend to be less active in middle age than they were in young adulthood, and if you are not used to working a specific muscle group, tasks such as raking the yard or shovelling snow can leave you achy after, said human bioenergetics professor Scott Trappe, who is also director of the Human Performance Laboratory at Ball State University.

Muscle mass also starts to decline naturally in middle age, which can result in painful joints. “What muscle does is it takes up some of the load that you’re carrying and frees the joints from the pain,” said Dr Arun Karlamangla, a professor of medicine at UCLA who specialises in geriatrics.

Your joints also become stiffer as you age because of the accumulation of wear and tear, which can result in scar tissue.

“The tendons and the muscles lose a little bit of their plasticity,” Dr Trappe said. And when you combine weak muscles and stiff joints with movement – especially movements that are rapid, twisting or high force – you can get “something that tears or pops”, he added.

There is an added risk of injury in women, as their bones become weaker when oestrogen drops during menopause. “You don’t feel bone-density loss. It doesn’t hurt,” said Dr Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health and medical director of The Menopause Society. “You don’t feel anything about that until you break something.”

Is there anything I can do?

All these issues – muscle strength, bone density and joint health – can be improved with exercise. Strength training is critical to offset declines in muscle mass and bone density, and aerobic exercise has important cardiovascular and other health benefits.

“The silver bullet is physical activity,” Dr Karlamangla said. That goes not only for muscle and joint issues, but also virtually any age-related changes.

Why am I gaining weight all of a sudden?

For decades, the general assumption was that people struggle more with their weight in midlife because their metabolism suddenly slows down. But a 2021 paper published in the journal Science cast doubt on that conclusion. The research showed that the amount of calories that people burn, both through their resting metabolism and their daily activities, is fairly stable from ages 20 to 60.

“Everybody kind of thought it would be declining through middle age, but it doesn’t at all,” said Duke University evolutionary anthropology professor Herman Pontzer, who led the research.

Instead, Prof Pontzer added, what feels like sudden weight gain when you hit midlife is more likely the accumulation of a kilogram or two a year over the past few decades. People just might not notice until they hit 40 and are 10kg heavier than they were in college. That gradual weight gain, he added, is usually caused by people eating a few more calories than their body burns every day.

Not everyone agrees with Prof Pontzer’s conclusion.

Dr Susan Roberts, senior associate dean of foundational research at the Geisel School of Medicine at Dartmouth, said some biological changes start to occur in midlife that can affect the body’s composition and metabolism.

First, the natural decline in muscle mass can alter how a person looks in the mirror, especially if he or she has added body fat over the years. That shift does not have a huge effect on metabolism, though – a kilogram of muscle burns only about eight more calories a day than a kilogram of fat.

A bigger contributor to slowing metabolism is the brain, which accounts for roughly 20 per cent of the body’s energy use. The brain starts to shrink gradually in adulthood, and less brain volume can mean fewer calories burned, Dr Roberts said. “I don’t think the brain is the only piece of this, but I think it’s an important piece that is not really recognised.”

What is perimenopause?

Perimenopause can catch women by surprise. Menopause is defined as not having a period for a year, and it hits, on average, around age 51. But women can experience dramatic fluctuations in their ovarian function and oestrogen levels for up to 10 years before they stop menstruating – in some cases starting as early as the mid-30s.

Hot flashes and night sweats are the most frequently reported symptoms, but irritability, brain fog, as well as feelings of anxiety and depression are also common. Many women experience disrupted sleep because of the night sweats, although Dr Faubion thinks hormonal changes may contribute to insomnia in other ways people do not yet understand.

Hormone therapy can help, and the risks of side effects are lower when it is started early.

Where did my libido go?

Men and women can experience a decline in sex drive in middle age for a variety of reasons.

Why does it happen to men?

Sometimes, hormones are to blame. Concerns about low testosterone have received a lot of attention recently, and levels do drop with age. However, “most men will continue to retain normal levels throughout life”, said Dr Shalender Bhasin, an endocrinologist at Brigham and Women’s Hospital in Boston who researches testosterone therapy.

Exactly how many men experience testosterone deficiency is hard to pinpoint. According to the American Urological Association, estimates span from 2 to 50 per cent of men at any age, with rates for middle-age men ranging from 4 to 12 per cent.

There is more to libido than testosterone, though. According to one recent estimate, roughly one-fourth of men ages 45 to 54 experience difficulty with their erection, and that percentage increases with age. Erectile dysfunction can make men self-conscious and less eager to have sex, said urology professor Alan Shindel, from the University of California, San Francisco.

Why does it happen to women?

Changing hormone levels in midlife can also affect women’s sex drive, albeit more indirectly. The few studies on the topic do not show a clear and consistent correlation between declining oestrogen during menopause and low libido, and treatment with oestrogen hormone therapy does not appear to increase sex drive, said Dr Holly Thomas, an assistant professor of medicine and clinical and translational science at the University of Pittsburgh.

Women who experience frequent hot flashes and sleep disruption are more likely to report low libido, though, and the vaginal dryness that emerges for some women during menopause can make sex painful and, as a result, undesirable. Treating these symptoms can improve a woman’s overall well-being and her interest in sex.

Psychosocial factors most likely play a bigger role, Dr Thomas said. Research has shown that relationship quality, stress, fatigue and other health issues, including depression, have a significant influence on postmenopausal women’s sex drive.

Is it just in my head or am I already starting to forget things?

Your memory probably is not as good as it was in your 20s and 30s. But that is just a normal part of brain development.

Brain volume peaks in a person’s 20s and then slowly shrinks through adulthood. This loss starts to accelerate in the 50s and 60s. Regions involved in attention, memory and executive functioning are especially affected, which, in turn, can alter some aspects of cognition, such as how fast you think.

Although everyone experiences these age-related brain changes, how quickly they occur and how much cognition declines varies from person to person. Your health and behaviours – particularly exercise, nutrition, sleep, social connections and challenging yourself mentally – contribute to healthy brain ageing.

“This is the first window in time when we start seeing these separations across people, and that’s why it’s such an important period of time to understand,” said Dr Gagan Wig, an associate professor of behavioral and brain sciences at the University of Texas at Dallas.

Although rare, early-onset dementia does happen and is possibly related to genetics.

Which health issues do I need to start looking out for?

Some common health screenings, including mammograms and colonoscopies, are performed to detect a disease at its earliest stage possible, which can make treatment more successful.

Others, including cholesterol checks and blood-sugar tests, are intended to track how an aspect of health changes over time, so doctors can know if and when they need to intervene.

You should have your blood pressure and cholesterol checked regularly, even before you enter middle age. Get tested for prediabetes at 35 if you are overweight or obese, and at 45 otherwise. Mammograms are now recommended starting at 40, and you should get your first colonoscopy at 45.

Bone-density scans are not officially recommended for women until 65, but if you have a family history of osteoporosis, you should talk to your doctor about getting screened earlier.

Treatment of prostate cancer has become more nuanced in recent years, and as a result, so have recommendations around screening; ask your doctor for guidance. And if you are a current or former heavy smoker, get screened for lung cancer starting at 50.

Why does life feel so hard?

The sandwich generation is real. You may be simultaneously taking care of growing children and ageing parents, not to mention juggling the career you have been working towards for decades.

“People in midlife are really burned out because they have too much to do,” Prof Lachman said.

That is the bad news. The good news is you are better equipped to handle all of those responsibilities than when you were younger, said Pennsylvania State University human development and family studies professor David Almeida.

For over two decades, he has surveyed adults of all ages about their daily stress levels. In contrast with the infamous U-shaped happiness curve, which suggests people are most miserable in midlife, he finds that, at least when it comes to handling stress, things tend to get better with age. That may be because “it’s a time of life where we’re more likely to be in charge”, he said.

“It’s not really the crisis time of life that people think it is,” he added. “In terms of daily life, it’s actually pretty good, on average.” NYTIMES