March 11, 1996 12:00 PM

“Most women in their 20s and 30s plow through life with very few health problems,” says the author of Dr. Nancy Snyderman’s Guide to Good Health. “But when we pass 40, we’re old enough to be at risk for just about everything.”

Reason enough, perhaps, for a book subtitled What Every Forty-Plus Woman Should Know About Her Changing Body. But Snyderman, 43, a head-and-neck surgeon—and medical correspondent for ABC’s Good Morning America—says she didn’t write her new guide just to confirm her audience’s fears. ‘Many of the illnesses that scare women are totally preventable,” she says. And though she believes women’s health care gets short shrift—both in the public arena, where more research funding goes to male diseases, and in the examining room, where male doctors still often dismiss complaints as nervous overreactions—there’s more good news. “We still have the best medical care in the world,” says Snyderman, who practices at the California-Pacific Medical Center and the University of California, San Francisco. “If you have the information you need to use the health-care system, the system can take care of you.”

Addressing everything from hot flashes to heart attacks, her book provides that information for women, who needn’t see their advancing years as a tragedy. Snyderman certainly doesn’t. Twice divorced and now married to TV producer Doug Myers, 38, she manages to see patients and sit in for GMA’s Joan Lunden or report on the famine in Somalia, all while raising three young children. “Nothing rattles me since I turned 40,” she says. “I eat well; I exercise. And I’m mature enough not to sweat the small stuff.”

Snyderman, who lives in San Francisco with Myers, Kate, 9, Rachel, 7, and Charlie, 18 months, discussed the care and feeding of the over-40 female with reporter Jane Sugden.

What are the most serious health problems women face as they age?

Women have a higher incidence of heart disease, cancer and strokes—the three leading causes of death for both sexes—as they get older. The risks rise with menopause: As estrogen levels drop, the protective effect the hormone has on the heart goes away, your bones become more brittle, and your risk for cancer rises. Heart disease, the No. 1 killer, comes later in women—usually after 65—but 44 percent of women who have heart attacks die within a year, compared to only 27 percent of men.

Why are heart attacks more lethal in women?

Since women are only now being included in research studies, there is still the feeling in physicians’ psyches that heart disease is a man’s disease. And the warning signs may mimic indigestion. So doctors may diagnose another condition, commonly an ulcer or gallbladder disease. If you suspect something more is going on or have a history of heart disease, you have to demand further tests.

What can a woman do to reduce her risk of heart disease?

You cannot smoke. Period. Eat lots of fruits and vegetables—especially foods rich in vitamin C—and less meat. Beware of prepared dishes that are loaded with salt and fat. Toxins linger in body fat. An average of 1,500 calories a day is about right. Women over 40 should have their blood pressure checked yearly and monitor their cholesterol levels if there’s a family history of heart disease. And they should diminish stress in their lives. Stress raises bad cholesterol levels and may even cause your arteries to constrict. You must learn how to throttle back periodically.

How should an older woman protect herself against breast cancer?

In addition to eating a low-fat diet, every woman in her 40s should have a yearly mammogram. These exams may not always detect tumors in younger, fatter breast tissue, but in older women, mammography can reduce the mortality rate from breast cancer by 30 percent. Do a self-exam mid-cycle every month; early detection can save your life.

What can women do to continue feeling well during menopause?

When menopause begins, usually from the mid-40s to 50, women may feel spacey and tired. Again, exercise and proper diet help. All women should be taking extra calcium at this age to ward off brittle bones. If you’re having a bumpy time, supplemental estrogen can be a good short-term treatment for many, but consult your doctor—especially if you have a family history of breast or ovarian cancer.

Do incidents of depression increase with age?

There is no evidence of this. It’s assumed that many mothers get depressed because their children are grown and gone. In fact, for older women who have fulfilling lives, the rates of depression are extremely low.

How does midlife divorce affect a woman’s health?

It puts tremendous stress on a woman, especially one who’s been married for years and hasn’t developed her independence. I know the toll it can take on your body. To be divorced is to fail. It robs you of self-esteem, and the last thing you think about is your health. This is a time when you should exercise more to clear your head, not eat mashed potatoes and curl up in a ball. Talk to loved ones who are understanding and get professional help. You will feel less alone.

How can women make sure doctors take their health concerns seriously?

Go into your doctor’s office with a list of questions you need answered. Speaking up for yourself is especially important in the world of managed care, where doctors may not tell you to see a specialist outside your HMO because it means less money for them or because it goes against HMO rules.

Is there anything that improves in the second half of life?

Absolutely. New motherhood can be more gratifying when you’re older, because you have done so many other things to define who you are. Sex may get better because we’re finally comfortable with our bodies. And many of us look better after 40—we’re fit and we’ve taken charge of our lives. There is no reason why you can’t stay healthy and energetic from decade to decade.

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