From sleep to supplements to cancer risk, here’s what patients ask about, says a clinical fellow at Cleveland Clinic
Staying healthy as a woman over age 40 starts with asking the right questions, doctors say.
Females in this age group face new health challenges and can sometimes get lost in the shuffle of the traditional health care system, according to Dr. Alexa Fiffick, a family medicine physician and menopause practitioner at Concierge Medicine of Westlake in Cleveland, Ohio.
As menopause is often viewed as a "taboo topic," Fiffick — also a clinical fellow at Cleveland Clinic — is working to empower this group of women to take control of their health proactively.
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"To do that, they need to ask their doctors the right potentially life-saving questions," she said.
In a conversation with Fox News Digital, Fiffick shared the top 9 questions women should be asking — along with her answers.
Dr. Alexa Fiffick, a family medicine physician and menopause practitioner at Concierge Medicine of Westlake in Cleveland, Ohio (left), revealed the most common questions she hears from her patients. (Dr. Alexa Fiffick/iStock)
1. ‘Am I at risk for heart disease?’
Women have a 50% greater chance of having a misdiagnosed heart attack than men, data shows.
It wasn’t until 2020 that the American Heart Association identified menopause as an individual risk factor for heart disease.
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"This giant, stressful health event wasn’t taken seriously for a long time," Fiffick said.
"Finally, the science supports that menopause is a risk factor for heart disease. Women absolutely must ask their doctors about their individual risks based on this information, coupled with their medical history."
2. ‘What types of exercise will keep my heart and brain healthy?’
For adults up to 65 years of age, experts recommend getting 150 minutes per week of exercise, combining moderate-to-vigorous aerobic workouts and strength training sessions.
For women in their 40s, lifting weights becomes particularly important, according to Fiffick.
For adults up to 65 years of age, experts recommend getting 150 minutes per week of exercise, combining moderate-to-vigorous aerobic workouts and strength training sessions. (iStock)
"There is a lot of emerging evidence of the benefits of weightlifting — especially lifting weights that are considered heavy," she said.
"It’s been difficult for this age group in the past to lift heavier, because we were all raised to think that weightlifting builds a more masculine structure," she said.
"But it's really important for bone health and to prevent falls — and it also helps the brain stay cognizant of changes, which can be really helpful to stave off dementia."
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When choosing a weight, it should be heavy enough that it can’t be lifted repetitively with ease.
"It should be a challenge to do the motions with the weight, so you can continue to keep challenging yourself," Fiffick said.
"That sort of heavy weightlifting is associated with maintaining bone density."
"Weight loss is more about your food consumption and less about cardiovascular exercise."
Cardiovascular exercise is also important for keeping the heart healthy, Fiffick said.
"People tend to think of cardio for weight loss because that's what we used to teach in the 80s, 90s and early 2000s — but realistically, weight loss is more about your food consumption and less about cardiovascular exercise," she said.
"So it's really pertinent to staying fit and keeping your cardiovascular system nice and strong."
3. ‘What am I doing now that could hurt my bone density?’
By the time women enter their 40s, most have already reached their peak bone density, as it begins to decrease in the years surrounding menopause, according to experts.
Many of Fiffick’s patients are surprised to learn that certain over-the-counter medications can contribute to bone loss.
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Those include proton pump inhibitors, or PPIs, a type of medication that prevents acid reflux.
"They can help degrade bone if you're on them for a very long time," Fiffick warned.
Some studies have suggested that metformin, a medication that is used to help lower blood sugar levels in people with type 2 diabetes, could also impact bone density, according to the doctor.
By the time women enter their 40s, most have already reached their peak bone density, as it begins to decrease in the years surrounding menopause. (iStock)
Other threats to bone health include significant alcohol or tobacco consumption, she said.
"If you’re having more than around one drink every evening, that's probably a bit too much for bone health," she noted.
"As far as tobacco goes, no amount is a good amount. Those sorts of things are actively hurting your bones."
4. ‘Which supplements are effective and worth the money?’
With so many female-focused supplements on the market, it can be tough to determine which are essential and which can be skipped.
"My two go-to supplements are vitamin D and magnesium," Fiffick told Fox News Digital.
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"Getting enough vitamin D is important to help keep our bones healthy, but it can be difficult to get only through food, so most people need to take a supplement."
Magnesium is also important for women in their 40s due to its impact on bone health, heart health, hormonal balance and mood regulation, according to experts.
"Getting enough vitamin D is important to help keep our bones healthy, but it can be difficult to get only through food, so most people need to take a supplement," the doctor said. (iStock)
"Additionally, magnesium is said to help with the constipation that happens in perimenopause and menopause, as well as helping people sleep a little bit better," Fiffick said.
For calcium, the doctor advises women to get it through diet rather than supplements.
"My two go-to supplements are vitamin D and magnesium."
"Most people who eat a more American diet get more than enough calcium through foods," she said.
To help determine whether you need a supplement, Fiffick recommends going to the National Osteoporosis Foundation website, which provides a list of foods containing calcium and vitamin D to help you calculate your own intake.
5. ‘A clinician told me I’m too young for perimenopause or menopause — is this true?’
Fiffick often hears from patients who assume they're too young to transition into this next phase of life.
"‘Normal’ menopause can happen anywhere between ages 45 and 55 — but sometimes it happens" at a younger age, she told Fox News Digital.
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For women starting the process at between 40 and 45 years old, it’s considered "early menopause," Fiffick said — but it's not treated separately from "normal" menopause.
After 55, it is considered late menopause, she noted.
"The group that we treat really separately are the people who are under 40 when they start menopause — those are the ones we call ‘premature menopause,’" Fiffick said.
"As your body stops having estrogen, it stops being able to protect your brain, your bones and your heart."
Starting menopause before the age of 40 can increase the risk of metabolic syndrome, Fiffick warned, which can contribute to the development of cardiovascular disease.
"That happens because as soon as your body stops having estrogen, it stops being able to protect your brain, your bones and your heart," she said.
For women starting the process at between 40 and 45 years old, it’s considered "early menopause," the doctor said. (iStock)
"So all of the ‘diseases of aging’ — meaning high blood pressure, cholesterol, heart attacks, type 2 diabetes, osteoporosis fractures — those all come on much quicker if you are menopausal earlier."
A younger menopausal patient is treated differently than a menopausal woman in her 50s, Fiffick said.
"All the ‘diseases of aging’ come on much quicker if you are menopausal earlier."
"For the older patients, we’re mainly trying to make you feel better and maybe do some preventative things," she said.
"For women under 40, we’re trying to get you at least enough estrogen and progesterone so it's as if your ovaries didn't close up shop. So it's a very different approach than for someone who's a little bit older."
6. ‘How much protein should I be eating?’
Women’s nutritional requirements change as they age, Fiffick said.
A general rule of thumb is for women in their 40s to consume about 0.8 grams of protein per pound of body weight — and the large majority aren’t hitting that mark, the doctor noted.
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"If a woman comes into my clinic and I have her walk me through an average day of eating, even if she’s a meat eater, she’s likely only getting around 50 grams," Fiffick said.
"With the average body weight exceeding 130 or 140 pounds, that’s not nearly enough."
Fiffick encourages her patients to start tracking their protein to get a baseline, and then look for ways to augment that.
A general rule of thumb is for women in their 40s to consume about 0.8 grams of protein per pound of body weight. (iStock)
An easy way to increase protein is to add powder to shakes, which usually have about 30 grams of protein, she advised.
"If you do that in addition to eating chicken, fish, legumes and other sources of protein, you’ll usually be much closer to the goal."
7. 'How much sleep do I need each night?'
Women in their 40s fall into what Fiffick calls the "sandwich generation," which can make it challenging to get the appropriate amount of sleep.
"Some women have really young kids, others have teens, and some have kids in their 20s," she said.
"Recent research found that these women tend to need upward of eight to 10 hours of sleep," Fiffick noted.
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While the longtime rule of thumb has been that seven hours is sufficient, "that is not necessarily good enough for women," the doctor said.
Sleep plays an essential role in all aspects of wellness, according to Fiffick — including metabolism, heart health and brain function.
While the longtime rule of thumb has been that seven hours is sufficient, "that is not necessarily good enough for women," the doctor said. (iStock)
"We see a lot of people complain about ‘brain fog’ in perimenopause and menopause," she said.
"And one of the biggest reasons for that is the fact that they're not sleeping."
Fiffick encourages her patients to advocate for themselves and ask their doctors for help with sleep optimization, "because it's literally vital."
8. ‘Am I a candidate for weight-loss medications or surgeries?’
As women progress into their 40s, hormonal and metabolic changes can lead to weight gain.
Some women come into Fiffick’s office and say, "I don’t want to cheat by using weight-loss medication," she said.
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"But it's not cheating," the doctor said. "For some people, it's the right fit and can help them see significant improvement."
As every patient’s needs and goals are different, Fiffick said it’s essential for each woman to talk to her doctor and weigh the risks and benefits of medicinal or surgical options.
As women progress into their 40s, hormonal and metabolic changes can lead to weight gain. (iStock)
Some of the most important weight-loss strategies include getting enough protein and drinking enough water, according to the expert.
"By ‘front-loading’ your day with protein, you’ll stay full for longer, as it’s a slow-burning energy," Fiffick said.
With carb-heavy breakfasts, she warned, you’re destined for a 10 a.m. slump.
When it comes to hydration, 3 liters of water daily is associated with weight loss or weight maintenance during perimenopause and menopause, Fiffick said.
"So if it's not the right time to talk about meds with a certain patient, I automatically go back to protein and water," she said. "In 99% of cases, one of those could be better."
9. ‘What is my personal risk of cancer, and how can I help prevent it?’
Some of the most common cancer types affecting women include breast, colorectal, lung, cervical, endometrial, ovarian and skin — and the risk increases with age.
To help gauge your risk, Fiffick emphasized the importance of knowing your family history.
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"This is critical in order for a doctor to be able to do a good risk assessment for hereditary cancers," she said.
A surprising share of women don’t have this information, in the doctor’s experience.
"The longer I've been a physician, I’ve realized that we don't know what our mothers, fathers, aunts, uncles and cousins have going on with their health," Fiffick said.
To help gauge your risk, the doctor emphasized the importance of knowing your family history. (iStock)
"Learning those things so that you can really understand your risk is critical — it may genuinely save your or your child's life."
One of the most effective ways to reduce cancer risk is to limit or eliminate alcohol consumption, according to Fiffick.
Dr. Alexa Fiffick, who is also a clinical fellow at Cleveland Clinic, is working to empower women to take control of their health proactively. (Dr. Alexa Fiffick)
"Drinking more than one glass of wine or one cocktail at night is associated with a significantly increased risk of seven or eight different types of cancers," she noted.
Obesity is another major risk factor for cancers, the doctor said.
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"I heard a recent citation that up to 30% of all new breast cancers each year are associated with nothing other than obesity as the risk factor," Fiffick said.
"So the two things that are really within your control are weight and alcohol consumption — and if you're a tobacco smoker, please stop. It's terrible."
Melissa Rudy is senior health editor and a member of the lifestyle team at Fox News Digital. Story tips can be sent to
