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The question: Any advice for someone who's never paid serious attention to their health? I've recently celebrated my 40th birthday and I'm finally starting to feel vulnerable. Am I checking for cancer? Calcium? Something else? Where does a women start without feeling like a hypochondriac?

The answer: Often at my clinic, patients come in motivated to improve their health when they reach a landmark birthday like 40 or 50. It can be overwhelming – after leaving a doctor's office, talking with friends or doing a simple Google search – to list all the things that can make a positive change in health after 40. So you're not alone in feeling vulnerable and not knowing where to start.

When I work with my patients, we look at specific areas that we can adjust and improve upon. Last week, I had a female patient in her mid-40s come in who had not seen a doctor since her teenage years. While it was a trying process for her, it was important that we took a critical look at her current and past health, and especially her lifestyle habits. She identified that she smoked regularly, and drank a few glasses of wine nightly. Due to a sedentary shift-work job, she had limited access to healthy foods and rarely had the opportunity to exercise. Looking at the bigger picture was overwhelming for her, so we broke down her goals into bite-size health changes that were more realistic to tackle.

Those goals included:

  • An exercise plan that fit into her work schedule.
  • Working with a dietician who helped her organize a meal plan and healthy snacks to take with her during her shifts. She was also found to have borderline diabetes, which was further motivation to exercise more and eat well.
  • Starting on a nicotine patch and enrolling in a support group for smoking cessation.
  • Cutting down her alcohol to one glass of wine per night.

Well-engrained lifestyle habits are not easy to change as they have often been in place for years. But the first step is identification of the risk, creating a plan and then checking in regularly to maintain the change. It's important to realize that sometimes we may return to our old habits regardless of how well-intentioned we are, but it is possible to refocus and make the change again.

There are also basic preventative health tips for women 40-plus:

Get enough vitamin D and calcium: Because women's bones usually reach their peak mass by their late teens, you need to maintain bone strength by taking calcium and vitamin D through food and supplements. For healthy adults between 19 to 50, aim for 1,000 mg a day of calcium and 400 to 1,000 IU a day of vitamin D3. An excellent resource on calcium-rich foods can be found at

Cover up in the sun: While sun is a good source of vitamin D, harmful UVA and UVB rays can lead to changes in skin that over time can cause aging, discoloration and cancer. Cover up with a sunscreen of at least SPF 15 to protect against these harmful effects.

Get your shots: Ensure that you're up to date with your tetanus status by having this shot every 10 years to protect yourself against this preventable disease.

Make healthy lifestyle choices: It can be incredibly challenging to quit smoking and limit your alcohol intake, but these can reduce life expectancy and quality of life due to negative effects on heart and lung health, and by increasing the risk of cancer. Your health-care provider may be able to offer assistance through counselling or medical aids that can help curb or quit your habits.

Check for cancer: To understand what type of cancer screening is needed, an assessment of your risks needs to be done based on your medical, lifestyle and family history.

The one cancer that you should definitely be screened for is cervical cancer. Cervical cancer is a largely preventable, but 400 Canadian women still die from it every year, and the highest number of deaths occur in those who are not screened. Screening involves having a Pap test. If your results are normal, you should still be screened every three years.

Other screenings: Get your blood pressure checked and do a fasting blood test to assess your cholesterol levels and risk of diabetes. People who don't go to their doctor regularly miss out on these tests, which are recommended after age 40. Women in particular often don't think they're at risk for heart disease or diabetes compared to men.

You're not a hypochondriac in raising these concerns and it's excellent that you're focusing on your health at this time to make positive changes for your future. Just remember to set small, concrete goals and be patient with yourself as you make these changes.

Dr. Sheila Wijayasinghe is the Medical Director at the Immigrant Womens' Health Center, works as a Staff Physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an onsite clinic at Women's Habitat Shelter in Etobicoke. She has a special interest in womens' health, health promotion, and care of marginalized populations.

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