If you’ve ever found yourself scrolling at 2 a.m. trying to figure out what the hell your body is doing, welcome. This week: five midlife health risks worth knowing — and what to ask at your next appointment.
Recurrent UTIs after menopause have a treatment many women still aren’t offered.
When estrogen drops, the tissue of the bladder and urethra thins and vaginal pH rises, which makes infections more likely. It's part of a cluster called genitourinary syndrome of menopause, or GSM. CIDRAP reports that new research links low-dose vaginal estrogen to fewer hospitalizations and lower rates of sepsis in older women.
Symptoms of GSM also include feelings of urinary urgency, vaginal atrophy, pain with sex, and vaginal dryness. In November 2025, the FDA began removing the black box warning on vaginal estrogen that made doctors and women wary of using it.
What to ask: Could GSM be contributing to repeat UTIs? Is low-dose vaginal estrogen right for me?
Heart disease is the No. 1 killer of women. Midlife is when your risk deserves more attention.
A Philadelphia woman wrote in The Guardian that she almost missed the symptoms of her heart attack. She went to the ER after experiencing pressure in her chest and rib cage after standing — not what usually comes to mind regarding heart attack. Indigestion, nausea, and GI distress can also be heart attack symptoms. While heart attacks can happen at any age, risk rises after menopause as declining estrogen brings changes in cholesterol, blood pressure, and blood sugar.
What to ask: Have I ever had my Lp(a) checked? Would ApoB or a coronary artery calcium score provide useful information based on my personal and family history? New chest pressure or other possible heart-attack symptoms warrant a call to 911 — not a question saved for your next appointment.
Some women are first diagnosed with ADHD in midlife —after years of being treated for anxiety or depression.
NPR reports that a survey of women with ADHD showed the largest group was diagnosed for the first time between 41 and 50. Many reported that problems with organization, time management, and brain fog became more challenging during perimenopause and menopause. Because girls with ADHD are more likely to appear distracted or disorganized, many aren’t diagnosed until adulthood.
What to ask: I've had trouble with attention and organization for years, and it's gotten harder — would an ADHD evaluation make sense?
More than 1 in 3 postmenopausal women have prediabetes. Many don't know it.
Researchers reported in a recent study in the journal Women’s Health that prediabetes and unrecognized high blood sugar had risen substantially among postmenopausal U.S. women. Black women are least likely to be told by their clinicians about their status. Prediabetes is an increased risk for developing Type 2 diabetes.
What to ask: Am I due for a diabetes screening? An A1C test may be appropriate based on risk factors.
Your shoulder can apparently freeze in midlife too. Researchers are finally asking why.
The pain comes on without an obvious injury, wakes you up at night, and then your arm becomes harder to move. Frozen shoulder is most common between ages 40 and 60 and affects women more often than men. TIME reported this week that researchers are investigating whether declining estrogen contributes to inflammation and tightening in the shoulder joint — and whether hormone therapy might help.
What to ask: Is my stiff shoulder frozen shoulder? Ask which movement is safe, because keeping the shoulder immobilized for long periods can worsen stiffness.
Midlife should not require a medical degree and a 2 a.m. search spiral. Save this list for your next appointment.
See you next Friday. — Trista