What to expect—and your best strategies for prevention.

By Madeleine Burry
January 24, 2019

It’s possible to hit your fourth decade without experiencing many—or any—major medical events. Maybe you’ve had a hospital visit to give birth, or a broken limb or twisted ankle from a playground or skiing accident. At annual physicals leading up to your 40s, the biggest event could just be some tsking noises from your doctor about creeping weight gain, a lax exercise routine, or an uptick in your cholesterol.

Once you hit your 40s, this might all change—or not. “The fact is that most 40-year-olds don’t have any disease,” says David Cutler, MD, family medicine physician at Providence Saint John’s Health Center in Santa Monica, California. “Most of them are pretty darn healthy.”

Still, curious about what to expect healthwise from the 40s, Health asked docs to share some of the conditions they often spot in patients during this big decade. Here are 10 diseases they mentioned.

RELATED: 20 Health Mistakes You Need to Stop Making Before You Turn 40

Overactive bladder

Your bladder can change as you get older, says S. Adam Ramin, MD, urologist and medical director of Urology Cancer Specialists in Los Angeles. “As we age, the nerves that help the bladder might not work as well,” and bladder muscles can thicken with age, reducing its capacity, he says. An overactive bladder and incontinence have many solutions: Kegel exercises can help, as can vaginal estrogen cream and other medications, says Dr. Ramin. “In certain instances we inject Botox in the bladder and that works really well,” he adds. (Here are more surprising uses for Botox.)

Perimenopausal symptoms

By their mid-40s, some women will begin to have perimenopausal symptoms, says Adeeti Gupta, MD, an ob-gyn and founder of Walk In GYN Care. (That’s the case for actress Gwyneth Paltrow, who candidly shared about her experience in this transitional phase leading up to menopause.) While perimenopause isn't exactly an illness, symptoms—including hot flashes, irregular periods, and heavy bleeding—can be disruptive. “Decreased libido can hit some women hard,” notes Dr. Gupta, as testosterone levels decline as part of the hormonal changes occurring in perimenopause. Hormone therapy can help alleviate some of these symptoms in some patients, she says.

RELATED: 8 Ways Your Period Changes When You Reach 40

Kidney stones

They may be tiny (often described as “sand” or “gravel”) but kidney stones—bits of minerals that can form in your urinary tract—are extraordinary painful. Often, as people get older, they are more dehydrated, says Dr. Ramin. That, along with other risk factors such as a changing diet, can lead to an increased chance of developing stones in your 40s and beyond. While kidney stones typically pass on their own, surgery may be required to remove them if they do not. Dietary changes can help prevent reoccurrence. And, some good news for women—while you may get a kidney stone, they're more common in men, says Dr. Ramin.

Urinary tract and prostate infections

Both men and women may experience more infections in their 40s. For women, an increase in urinary tract infections (UTIs) is possible, says Dr. Ramin, due to the thinning vaginal walls and changes to the vagina’s pH that accompany aging. Antibiotics are the recommended treatment, he says. To prevent UTIs, stay hydrated and remember to pee before and after sex.

Men may experience prostate infections in their 40s, particularly if they have a sedentary lifestyle, says Dr. Ramin. Pain—in the testicles, around the anus, or really anywhere between the pelvic bone and belly button—is a major symptom, along with frequent urination or burning when you pee, says Dr. Ramin. The fix is typically threefold: a prescription for antibiotics, along with recommendations to ejaculate more (really!) and stand more frequently, says Dr. Ramin.

RELATED: How Often Should You Pee a Day? A Doctor Weighs In

Food allergies

Developing a food allergy isn’t restricted to childhood. “Allergists are finding more adults developing food allergies than before,” says David Erstein, MD, a board-certified allergist and immunologist. Shellfish and tree nuts are the main offenders. There’s a lot of speculation about what’s driving this increase—some possibilities include widespread antibiotic use and taking NSAIDs, which can disrupt the gastrointestinal environment, says Dr. Erstein.

With experts uncertain about what’s driving the increase in adult-onset allergies, prevention is impossible. (There’s just one exception, says Dr. Erstein—bites from the lone star tick can lead to an allergy to red meat. Avoid those bites, and you can continue to eat red meat sans allergies.) If you notice an allergic reaction (think: difficulty breathing or skin irritation) and suspect it may be due to something you’re eating, Dr. Erstein recommends visiting an allergist to get confirmation.

Osteoarthritis

Around your 40s, osteoarthritis can occur, says Alejandro Badia, MD, board-certified hand and upper extremity orthopedic surgeon with Badia Hand to Shoulder Center in Florida. As cartilage wears away around joints, achiness and discomfort ensues. “It is very common for those who are predisposed to generalized osteoarthritis to begin their problems in the lumbar cervical spine, hips, and knees, and [in] particular joints such as the basal joint of the thumb, more so in women,” he says. Osteoarthritis is the most common form of arthritis, and the best way to avoid it, says Dr. Badia, is with a healthy, balanced diet and weight-bearing exercise.

RELATED: 5 Things You Need to Know About Osteoarthritis, Even If You're Young

Hypertension

At your next physical, your doctor may alert you that you have hypertension, or high blood pressure. Managing this condition is important, since left unchecked, it increases your risk for heart attacks and strokes. Reducing stress is very important for high blood pressure management, says Sanjiv Patel, MD, cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. Other important strategies to lower your blood pressure, says Dr. Patel, are to reduce your sodium intake, have a generally healthy diet, and exercise regularly.

Erectile dysfunction

“Many men in their 40s may start noticing a drop off in their ability to get and maintain an erection,” says Dr. Ramin. Often this is due to other medical conditions, such as obesity, hypertension, or metabolic syndrome, which can all result in reduced blood flow to the penis. While medications (you’ve probably heard of Viagra and Cialis) are available to help, this is a challenging situation for your partner—and you.

One strategy is to broaden your definition of intimacy: Channel younger years, and focus on making out instead of penetrative intercourse. This takes the pressure off your partner and can lead to a physically and emotionally satisfying experience. Sex toys can also have a similar positive result—try these couple-friendly options.

RELATED: 7 Things He's Doing That Could Be Messing With His Penis

Skin cancer

“Skin cancer is one of the major skin concerns I see with age,” says Michelle Henry, MD, a NYC-based dermatologist and dermatologic surgeon. Both basal cell and squamous cell carcinoma are caused by your cumulative sun exposure, says Dr. Henry. Similarly, melanoma is caused by sun exposure, along with genetics, she says.

Your best course of action? Check your moles for changes and keep an eye out for new ones. “Our concern about new moles is increased after the age of 40 as there is a higher risk for melanoma,” Dr. Henry says. And, as you probably know already, be a devoted, diligent user of sunscreen. “Sunscreen is the best prevention,” she says.

Depression or anxiety

Most mental health disorders first appear early in adulthood, well before you reach your 40s, says Anthony P. DeMaria, PhD, a clinical psychologist and psychotherapist and associate director of adult ambulatory psychiatry at Mount Sinai St. Luke's and Mount Sinai West Hospitals in New York City. But adulthood’s challenges—financial anxiety, aging parents, raising kids if you have them, and your changing physical appearance—can be deeply taxing.

“These factors—combined with the perceived pressure to have it all figured out—can leave one psychologically vulnerable,” DeMaria says. For that reason, stressors in your 40s may exacerbate underlying issues such as depression and anxiety. “As is the case with most things, prevention is better than cure,” he says. That includes talking to friends or seeking out therapy.

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