At age 40 and above, maintaining good health becomes increasingly important as the risk of many diseases rises. Regular health checkups can aid in early detection of conditions like breast cancer, cervical cancer, osteoporosis and others. Adopting a healthy lifestyle through diet, exercise, managing stress and avoiding habits like smoking further helps promote wellness and delay the effects of aging. Nutritional supplements also assist in fighting free radicals and maintaining overall health and wellness at this stage of life.

1. FITNESS AT 40FITNESS AT 40
& ABOVE& ABOVE
Dr Vandana BansalDr Vandana Bansal
MBBS, MS, DGO, FCGPMBBS, MS, DGO, FCGP
Gynaecologist & ObstetricianGynaecologist & Obstetrician
Gynaecological Endoscopic SurgeonGynaecological Endoscopic Surgeon
Infertility & IVF SpecialistInfertility & IVF Specialist
DirectorDirector
Well Women ClinicWell Women Clinic
Arpit Test Tube Baby CentreArpit Test Tube Baby Centre
Jeevan Jyoti HospitalJeevan Jyoti Hospital

2. Importance of HealthImportance of Health
• Getting motivated
• Definition of Health
– Health is not merely absence of
disease, but it is a complete physical,
mental and spiritual well being
• Disease
– Genetic, Life style, Toxin, Trauma,
Infection, Cancer, Due to Aging

3. Health at 40 & aboveHealth at 40 & above
• Why health is important at 40?
• Why women?
• Effect of increased life
expectancy
• We are going to live 1/3 of life
beyond 40 yrs

4. Age 40 is a milestone when theAge 40 is a milestone when the
risk of many health problemsrisk of many health problems
increases.increases.
• Demanding job
• Aging parents
• Growing children
• Or all of the above,
• Evaluate your wellbeing
• And to plan for the long-run

5. Understanding AgingUnderstanding Aging
• Aging and menopause
– a natural process
• Aging – gracefully
• Knowledge of health problems and
menopause
• Attitude towards women
• Older and wiser

6. What are the diseases thatWhat are the diseases that
can occur at or after 40?can occur at or after 40?
• Perimenopausal menstrual disorders
• Breast diseases
• Gynaecological cancers
• Diseases due to menopause
• Diseases due to aging

7. Breast diseaseBreast disease
• Breast pain (mastalgia)
– Cyclical
– Acyclical
• Breast cancer
– Risk factors: Infertility, low parity, non-lactation,
family history, long term use of oral contraception pills
& HRT
• Investigation
– Clinical –self examination or by doctor
– Ultrasonography
– Mammography
– FNAC
– MRI

8. Gynaecological cancersGynaecological cancers
• Cervical cancer -commonest
• Uterine cancer
• Ovarian cancer
All are preventable by early detection by
screening test
– Pap’s Smear (colposcopy)
– HPV-DNA detection
– Transvaginal USG & colour doppler
– Routine gynaecological check up
– Vaccines against cervical cancer

9. Defining MenopauseDefining Menopause
“Menopause" is a combination of two
Greek words
Meno = month
pausia = halt
Literally means: “the end of the monthlies”
A French physician coined the term in 1821
• Menopause is universal, natural and irreversible
• It is confirmed when a woman has had no periods
for 12 months
• It is the point at which estrogen and progesterone
production decreases dramatically
• It is the end of menstruation and fertility

10. Diseases due to MenopauseDiseases due to Menopause
• Oesteoporosis
• CVS disease
– Hypertention
– Stroke
– Heart attack
• Atrophy of brain – Memory loss, Alzimerer disease,
• Obesity
• Phycological problems – Depression,
• Urogenital problems –UTI, decrease sex drive
• Effects social life
• Cancer

11. Treatment of MenopauseTreatment of Menopause
• Medical treatment
• Hormonal (HRT) estrogen + progesterone
• Others – Tibolone, Raloxifene,
Phytoestrogen, Antidepressant
• Life style modification
• Diet, exercise, avoidance of risk factor
• Supportive therapy
• Nutritional supplement- Ca, antioxidant,
soya protein & mineral
• Psychotherapy

12. Life Style ModificationLife Style Modification
• Diet
• Exercise
• Avoidance of risk factor
– Body weight
– Alcohol
– Smoking
– Stress
• Support from family and friends

13. Long Terms ConcernsLong Terms Concerns
OsteoporosisOsteoporosis
• Diminution of calcium content in the bones is
called as osteoporosis. It causes bones to
degenerate and decrease in mass.
• It can lead to severe fractures, including hip,
spine and hands.
• Our peak bone mass is reached somewhere
between the ages of 20-30.
• After the age of 30, bone loss is not
adequately compensated by bone formation.
This process is accelerated after menopause
because of estrogen deficiency.

14. Osteoporosis:Osteoporosis: a bone thinning diseasea bone thinning disease
that sets the stage for serious fracturesthat sets the stage for serious fractures
Based on: Newsweek Special Issue, Spring/Summer 1999

15. MENOPAUSE AND BONE LOSS IN
WOMEN
Based on: A Harvard Woman Health Watch Special Report 1996

16. High Risk Factors forHigh Risk Factors for
OsteoporosisOsteoporosis
• Low calcium intake in diet
• Sedentary life style
• Family history of osteoporosis
• Smoking, alcohol, and steroids
• Excessive caffeine intake
• Early menopause (before 40 years)
• BMI of 19 or less
• Some medical conditions – over active
thyroid, Cushing's syndrome

17. Diagnosis- ODiagnosis- Osteoporosissteoporosis
• Bone mineral density is measured
by DEXA scan.
• Measured on a scale i.e. T score
• Normal T score is 0-1
• T score between 1-2.5 is
osteopenia, a milder form of
osteoporosis.
• T score <2.5 indicates
osteoporosis.

18. Prevention - OPrevention - Osteoporosissteoporosis
• Prevention is the best key than treatment
• Particular attention is to be given towards DIET and
EXERSCISE , esp. during adolescence and
adulthood.
• Diet rich in calcium and vitamin D( eg. milk, curd,
cheese, egg) should provide at least 1000mg of
calcium and 400 i.u. of vit. D3.
• At least 15-20 min. of sun exposure every day is
essential for vit D supplementation.
• Weight bearing exercises, walking, swimming,
jogging, dancing, aerobics esp. in early life help in
strengthening of bones.

19. Treatment-Treatment- OsteoporosisOsteoporosis
• Diet -should provide at least 1500 mg of
calcium and 600 i.u of Vit D. If not , has to
be taken in form of tablets.
• Exercise- 30-40 min. of walking is essential
at least 4days in a week.
• Drugs- calcium, vit D,
Bisphosphonates(osteophos-70), calcitonin,
HRT, Raloxifene, androgens.
• Avoid smoking, alcohol, and excess caffeine.

20. AgingAging
• Definition
– Is a syndrome of changes that are
deleterious progressive, universal and
far irreversible
• According to Ayurveda
– Aging is a process of increased vata
• In Chinese medicine
– Most symptoms of aging are due to yin
deficiency

21. Factors which effectFactors which effect
longevitylongevity
• Hereditary
• Medical treatment
• Life style
• Sex
Add life to years
& not years to life

22. Why do We Age?Why do We Age?
• Wear and tear
• Toxins accumulation
• Free radicals

23. Biology of AgingBiology of Aging
(Changes)(Changes)
• Heart – Slow, atherosclerosis (low fat diet)
cardio protective exercise
• Lungs – gradual decline ,decreased cough
reflex ↓O2 ↑lung infection (Pranayam), long
walk in nature
• GIT – constipation ( fiber,↑ ↑water)
• Kidney – decreased function ( water, salt)↑ ↓
• Urinary bladder – UTI ( water)↑
• Menopause related changes

24. Biology of AgingBiology of Aging
ContinuedContinued
• Musculoskeletal system
Osteoporosis
Osteoarthritis
• Increase calcium intake, exercise
• Nervous system and cognition changes
Poor temperature control, hypothermia
Decreased memory, brain atrophy
Alzimeher's disease
• Do pranayam & meditation
• Hormonal and metabolic changes
Diabetes ( sugar)↓
Thyroid
• Exercise and meditation

25. Biology of agingBiology of aging
ContinuedContinued
• Ear – hearing loss
• Vision – cataract , vision ( risk of falling)↓ ↑
• Use goggles
• Taste and smell – decreased
• Dental problem- cavities, caries
• Skin – Dry skin, wrinkles
• Use sun block cream
• Stress
• Exercise and meditation
• Immune systems – weak, level of
antibodies increase with age
• Diet and exercise

26. Diseases due to AgingDiseases due to Aging
• Heart
– Hypertension
– Heart attack
– Stroke
• Hormonal
– Thyroid
– Diabetes
• Bone and joint
– Osteoporosis
– Osteoarthritis
– Rheumatoid arthritis
– Gout
• Cancers
• Skin, Dental Eye
and Ear
• Psychological
problem
– Depression
• Neurological
problem
– Brain atrophy
– Alzimeher's disease
– Brain tumor

27. Damage by Free RadicalsDamage by Free Radicals
(ROS)(ROS)
• Damage healthy cells, aging, diseases
– Arthritis, heart disease, cataract and cancer
• Oxidation inside the body – antioxidants are
inside the body to take care
– Digestion
– Respiration
• Oxidation outside the body
– Radiation from sun
– Smoking
– Environment pollution
– Food and drinks
• Cold drinks
• Junk foods
• Processed food

28. Fight Against FreeFight Against Free
RadicalRadical
• Stop smoking
• Use sunscreen, avoid UV rays by
goggles/umbrella
• Decreased alcohol
• Prevention from environment pollution
• Good sleep
• Antioxidants
Vit A, C, E, zinc, selenium, CoQ, lycopene

29. AntioxidantsAntioxidants
• Antioxidants are important to fight against
free radicals and hence aging
• Common anti-oxidants are vitamins A, C,
and E, Co-enzyme Q10, lycopene
• It can be available in food or can be given
as supplement
• Following foods are excellent sources of
antioxidants
– Sweet potato, carrot, broccoli, peas, cauliflower,
tomato, citrus fruits, water melon, seeds and
nuts

30. Taking care of your healthTaking care of your health
(treatment of aging and menopause)(treatment of aging and menopause)
• There is no treatment, you cannot prevent it
– you can only delay it
• Prevention by regular health check up
• Healthy lifestyle (healthy habits and healthy
mind)
• Calorie restriction- Healthy diet longevity ↑by 50%
• Health and nutritional supplements
• Detoxification
• Exercise- yoga, meditation
• Breathing and pranayam
• Alternative systems of therapies

31. Regular Health Check upRegular Health Check up
after 40after 40 (prevention)(prevention)
• General examination
– Pulse, BP, Heart, Lungs
– P/A, P/S, P/V (Gynae
checkup)
– Hb, FBS, Liver &
Kidney function test
– Thyroid profile
– Lipid profile
• USG – abdomen and
pelvis
• Pap’s smear
• Mammography
• DEXA SCAN
• Eye check up
• Dental Check up
• Test for memory
• Detoxification

32. Colorectal Cancer ScreeningColorectal Cancer Screening
TestTest
• Colonoscopy
• Sigmoidoscopy
• Fecal occult blood test
• Stool DNA test

33. Healthy LifestyleHealthy Lifestyle
• Healthy habits, healthy mind
• Good sleep
• Regular eating pattern
• Taking out time for exercise
• Positive Attitude in life
• Good stress management
• Avoiding tobacco and alcohol

34. Positive Attitude andPositive Attitude and
Stress ManagementStress Management
• Make friends with positive attitude
• Have a pet
• Have hobbies
– Music, dancing, gardening etc.
• Exercise helps to keep you positive by
realizing good hormone-endrophin
• Love yourself and people around you
• Do meditation and pranayam
• Be Social, complement people

35. DietDiet
• Calorie restriction – healthy diet
critical to delay the onset of aging
• Sooner you start, greater the benefit
• What you eat helps you to age
gracefully
• Diet:
– High in fiber
– Low saturated fat
– Complex carbohydrate (whole grains)
– Decreased caffeine, salt and sugar
– With moderate protein
– No processed food
– With lots of fruits and fresh vegetables

36. DietDiet
Food classification
– Impact of inflammation at cellular
level
• Pro-inflammatory - accelerate aging
• Neutral
• Anti-inflammatory
– richly coloured fruits
– Vegetables
– fish

37. Dietary TipsDietary Tips
• Good and bad fat
• Saturated - block artery, increase cancer-
 meat, diary product and coconut oil,
 Unsaturated –
 monounsaturated -groundnut, mustard oil
 Polyunsaturated – sunflower, soyabean, olive (omega3 omega
6)
• Understanding cholesterol
• HDL (good cholesterol)
• LDL (bad cholesterol
• Ratio HDL/LDL should be 3:1
 (garlic, vitamin C, Vit B3, oily fish)
• Cut out sugar and salt (4-6gm)
• Fibers –Nature’s broom-↓ amt of fat absorbed, protects arteries
• Fresh fruits and vegetables- 30% of your diet
• Be sparing with proteins - 4.8-8% of total calorie intake
• Eat according to your blood group and ayurveda

38. Drinking FluidsDrinking Fluids
• Water
– the healthiest drink
– Don’t rely on thrust
• Alcohol – drinking alcohol in moderation
is not bad
• Caffeinated drinks (2-3 cups a day– normal)
– Overuse can cause sleep disturbances,
vitamin deficiency, BP, stress↑ ↑
hormones,promote bone loss
– Instant coffee – has least caffeine
– Unfiltered coffee – has highest caffeine
• Herbal tea
• Fruits and vegetable juices

39. Food IntoleranceFood Intolerance
• Food intolerance should not be
confused with allergy
– An intolerance occurs when the
body finds a substance difficult to
cope with
– Allergy to a substance is a active
fight that involves the body’s
immune system

40. Food Commonly CausingFood Commonly Causing
IntoleranceIntolerance
• Cow’s milk
• Wheat
• Soya products
• Caffeine
• Chocolate
• Orange juice
• Tomato
• Food additives
No cure you have to simply
avoid the relevant food

41. Sign and SymptomsSign and Symptoms
for food intolerancefor food intolerance
• Anxiety, Depression
• Fatigue, Headache
• Skin disorder, Asthma
• Joint or muscular pain
• Rheumatoid arthritis
• Ulcer (mouth or stomach)
• Water retention
• Stomach bloating
• Nausea, vomiting
• Constipation, diarrhoea
• Irritable bowel syndrome

42. Nutritional Supplement andNutritional Supplement and
Anti Aging Food & HerbAnti Aging Food & Herb
• Nutritional supplements Common nutritional supplements
are include vitamins B, vitamins A and C, folic acid, calcium,
magnesium, zinc, iron, chromium, and trace minerals
• Anti aging food and herbs
– Garlic prevents heart disease, improves tone and texture of
skin
– Siberian ginseng supports the adrenal glands and immune
functions, useful in treating memory loss
– Ginkgo biloba works particularly well on the brain and
nervous system
• Avocado
• Berries
• Black berries, Blue berries, Straw berries, Cherry, Black grapes
• Cruciferous vegetables
• Cabbage, cauliflower, broccoli, sprouts
• Fresh fruits and vegetables
• Garlic, Ginger, Nuts and Seeds, Soya, Water melon, Whole
grain – wheat, bread & pasta, unpolished rice, Yogurt, Water

43. ImmunizationImmunization
• Yearly influenza vaccine.
• HPV Vaccine- 8 Yrs to 26 Yrs
• Meningococcal
• Pneumococcal
• Tetanus Diphtheria Pertussis Booster
(every 10 yrs)
• Herpes Zoster Vaccine to prevent
Shingles (60 and above)

44. DetoxificationDetoxification
(rejuvenation and spa therapy)(rejuvenation and spa therapy)
• 3 Routes:
Skin

Massage

Scrubbing

Steam
Lungs

Deep breathing exercise

Pranayam

Walking in fresh air, breathing clean air
Kidney

Drink plenty of pure water (8-10 glasses of
water)

45. ObesityObesity
• Is a disease in which excess body fat has
accumulated to such an extent that health
maybe negatively affected.
• BMI (Body mass Index): Wt in kg/Ht in mt2
– Under weight > 18.5
– Normal 18.5 – 24.9
– Overweight 25-29.9
– Class I obesity 30-34.9
– Class II obesity 35-39.9
– Class III obesity
• > 40 severe obesity
• 40-49.9 morbid obesity
• > 50 super obese

46. Body Fat %Body Fat %
(do you need to loose weight)(do you need to loose weight)
• Total body fat expressed as % of total
body weight
• Men with > 25% of body fat and
women with >33% of body fat are
obese
• Can be measured by DEXA SCAN
• Obesity is one of the leading
preventable cause of death
• A BMI of over 32 is associated with
doubling the risk of death

47. Types of ObesityTypes of Obesity
• Android and Gynaecoid
• Intraabdominal fat has a strong correlation
with CVS, women with abdominal obesity
has CVS risk similar to men
• Waist circumference is related to
metabolic syndrome – such as diabetes
• Waist/Hip ratio
 0.9 for men
 0.85 for women
• Absolute waist circumference
 102 cm in men
 88 cm in women

48. Problems due to ObesityProblems due to Obesity
• Effect of increase fat mass
 Obst sleep apnea
 Osteo arthritis
 Social stigmatization
 Infertility
• Effect of increase number of fat cells
 Diabetes and insulin resistance
 Cancer
 Cardio vascular diseases
 Non alcoholic fat liver disease

49. Tips for Weight LossTips for Weight Loss
• Consume fewer calories- take frequent meals
• Types of food- eat acc to your blood group and
body type
• Change your eating pattern permanently
• Avoid afternoon sleep- do not take water
immediately after meal
• Avoid mixing cereals
– ↓cereals with in complex carbohydrate and fruits↑
and vegetables
• Avoid canned foods
• Take vegetable juices in place of fruit juices
• Do some house hold work
• Avoid sugar and extra salt

50. Exercise after 40Exercise after 40
• Aerobic exercise can modify lipoprotein
levels in postmenopausal women
• Brisk walking and vigorous exercise are
strongly associated with a reduced risk
for coronary events (fatal and nonfatal
myocardial infarction), hot flushes and
osteoporosis

51. WeWe’re busy, but…’re busy, but…
• One thing all of us can agree on about life
in our forties and beyond is this: We're
busy. Careers are in full bloom, the kids
are more involved than ever with school
and extracurricular activities, and we are
always finding some new project to
volunteer our time for.
• We have to be motivated, let’s start today
“If you try to reach on the moon
at least you will fall on the star”

52. Benefits of ExerciseBenefits of Exercise
• Decrease weight
• Smooth menopause
• Prevention of heart diseases
• Prevention of diabetes
• Prevention of oestoporosis and oesto
arthritis
• Positive attitude and better stress
management
• Improvement in sexual life
• Overall improvement in well being leading
to improvement in performance –
professionally and emotionally

53. Types of ExerciseTypes of Exercise
• Aerobic exercise- swimming, brisk
walking, cycling, dancing
• Anaerobic exercise – weight lifting,
squash,
• Flexibility exercise – yoga, power
yoga,
• Stamina, strength, and suppleness

54. How Much Should youHow Much Should you
ExerciseExercise
• Make realistic goals
• To remain fit
• At least 30 min a day
• To loose weight and cardio-protection
• At least 45 min a day
• Start by atleast 5 min a day
• Achieve target heart rate
• 220-age=max heart rate (MHR)
• Optimal heart rate is 60 – 80% of max heart rate
• Make exercise a part of your life-
change your habits
• Exercise does not give immediate
results – have patience

55. Fitness HabitsFitness Habits
• If you do not get time to exercise
walk/cycle to your office/college
• Upto 2 floors do not use lift
• Do not watch TV while lying down
Do not eat while watching TV, reduce
your TV time, do gardening..
• Eat when you are hungry, and less at
night
• Do some house hold works
• Stand while talking on the phone

56. Watch your Actions
They become your habits
Watch your Habits
They become your destiny

57. Alternative Systems ofAlternative Systems of
TherapyTherapy
• Aroma therapy, Massage
• Acupressure, Acupuncture
• Homeopathic
• Ayurveda
• Magnetic therapy
• Colour therapy
• Pranik Healning and reki

58. Staying HealthyStaying Healthy
• Balanced Diet
• Proper Exercise
• Get Adequate Sleep on Regular Basis
• Decrease or Manage Stress
• Immunization
• Screening Exams
• Approach Health, Holistically, Mind,
Body, Spirit

59. ConclusionConclusion
In the end my lecture is dedicated
to all the women on this earth –
may they live longer and
healthier.
I give my best wishes from Well
Women Clinic which will keep
promoting health happiness and
harmony among women of all age

60. Thank YouThank You

61. Menopause Clinic
(cessation of periods)
Menorrhagia Clinic
(heavy menstrual bleeding)
Body & Skin care Clinic
Cancer Detection Clinic
Family Planning Clinic
Infertility Clinic
High Risk Pregnancy Care
Obesity Clinic
Multispeciality Hospital and
Infertility Research Centre
162, Bai-Ka-Bagh, Lowther Road,
Allahabad – 3 Phone: Clinic:2417258;
JJH: 2417248/52/54
e mail: jeevanjyotihospital@gmail.com