THE WHO KNEW? GUIDE TO YOUR FUTURE

You don't need an oracle to predict what health challenges may await you! Turn the page for lesser-known issues as you age–plus what to do about them.

- BETH HOWARD

Surprises can be fun—say, for a marriage proposal or when someone shows up at your door with a giant sweepstakes check. But when it comes to health concerns as you age, you'd probably prefer to be prepared. That's why we've put together a decade-by-decade guide to things you may not know to expect and how to get ready for them, mentally and physically.

WHAT TO EXPECT IN YOUR 40s

YOU'VE HEARD...

The changes of perimenopause are on the way, or maybe you're already experiencing them: hot flashes, mood swings, sleep woes, and irregular periods as estrogen fluctuates in the run-up to menopause.

WHAT MAY SURPRISE YOU:

Vaginal dryness can start now, even before menopause hits, leading to problems like painful sex. That's why health care professionals should be talking about this with women in their 40s, says Sheryl Kingsberg, Ph.D., division chief of behavioral medicine in the department of ob/gyn at University Hospitals Cleveland Medical Center and a professor at Case Western Reserve University School of Medicine. The gradual loss of estrogen causes vaginal tissues to become thinner, drier, and less pliable. You might even experience tiny breaks in the skin with penetration.

Because low estrogen is responsible, a lubricant or moisturizer may not be sufficient. That's why supplemental vaginal estrogen—via a ring, a vaginal insert, a cream, or a suppository—is the first line of treatment, Kingsberg says. Relatively younger women may not like the idea of hormone therapy, but while use of systemic estrogen combined with a progestogen may raise the risk of breast cancer slightly, estrogen is safe for almost everyone when applied locally because very little of it enters the bloodstream.