The term ‘middle aged’ is a bit of a misnomer. It suggests a period of time where we hover for a while, chewing on the last flavours of youth, and salting the beginning of something more profound and a bit sad.

It’s not quite that cosy … or despairing

These days, midlife is said to start at 40 and end at 60. And given that many of us now live to 80 and beyond, 40 is the midway point. Beyond that, there is no middle.

It’s probably more helpful, and realistic, to think of midlife as the third quarter in the footy match of life. You’re bruised, a little out of breath, maybe worried how the game is going, but still managing to get a kick in.

The New York Times recently asked its readers to name their concerns about middle age.

The top seven complaints were aches and pains, weight gain, perimenopause, low sex drive, memory loss, chronic diseases and finding life hard.

Let’s take a look at the issues, and how you can best deal with them. Keeping a sense of perspective and placing real value on your one and only life.

Ouch! What’s with these aches and pains? 

Unless you’ve injured yourself, or have an illness, or you’re wracked with stress, your aches and pains in middle age – that we tend to whinge about – are a wake-up call.

They’re making it plain that you are not bouncing back the way you used to.

They’re telling you that old age isn’t that far away, you need to get in shape for it, and you’re almost certainly not moving enough.

At least half of the age-related changes to muscles, bones and joints are caused by disuse.

And fewer than one in 10 Australians over the age of 50 years do enough exercise to improve or maintain cardiovascular fitness.

Yes, our bodies change

Muscle mass starts to noticeably decline in middle age, and this causes the joints to ache.

Joint movement becomes stiffer and less flexible, in part because the amount of lubricating fluid inside your joints decreases and the cartilage becomes thinner.

Ligaments also tend to shorten and lose some flexibility, making joints feel stiff.

A healthy diet, good sleep and exercise will set you right. 

The good news: These aches and pains – in your knees, neck, lower back, shoulders and hips – are preventable, even reversible, through exercise.

Some weights to keep the muscles intact, so they can properly support your joints. A bit of cardio for the heart. At the very least, get into walking.

Much of the time we’re suffering muscle soreness.

It’s either self-inflicted by lack of physical activity, and becomes a chronic issue. Or it’s a short-term byproduct of working out, as has been the case throughout the life of anyone who exercises.

Even if you develop osteoarthritis, more commonly after hitting 50, regular exercise is vital. It keeps your joints and muscles healthy and flexible, and can help reduce pain. 

For safe and effective exercises, see here.

Why am I turning to fat all of a sudden?

It’s not your metabolism slowing down. It really isn’t.

That idea was put to bed by a 2021 paper that found our metabolism remains stable from the age of 20 until 60, when it begins to drop.

Yes, it slowed down after childhood and into young adulthood … but that was a long time ago.

Hormonal changes punish women fairly brutally with abdominal fat that is hard to shift. This distribution of fat in women may be related to metabolism.

But overall, we tend to put on half to one kilogram every year. This gain represents a less-than-healthy diet, a low rate of exercise, too much stress, too little sleep.

What to do? See what Harvard Medical School advises.

Perimenopause is the pits

Most women in their 40s don’t expect to have hot flushes until they hit menopause – the time that marks the end of a woman’s reproductive life.

Menopause is when you haven’t had a period or spotting for 12 months.

In Australia, the average age for women to reach menopause is 51 to 52.

In the meantime, what most women have been dealing with for years is perimenopause, the prolonged transition period that leads to menopause. Its onset catches out most women.

This is where the production of oestrogen becomes erratic and then declines, usually starts in a woman’s 40s. This is a time when you can still get pregnant.

On average perimenopause lasts four to six years, but it can last from one to 10 years.

The first thing a woman will notice is her periods are erratic and can be heavier than normal.

Symptoms are physical, mental and emotional.

About 20 per cent of women have no symptoms. About 60 per cent  experience mild to moderate symptoms. The remaining 20 per cent have severe symptoms that interfere with daily life, including work life.

See here for the more common physical symptoms. And here for common emotional and mental symptoms.

Overall, there are 34 symptoms of perimenopause.

This is a significant, complex and poorly discussed issue.

And get this: Why are women twice as likely to develop Alzheimer’s than men? A 2022 study suggests menopause is the trigger.

Read here about and here about perimenopause, and the treatments for the various side effects.

Some carry increased risks of cancers and heart disease.

Have you seen my sex drive?

One of the consequences of perimenopause and beyond is a declining and often disappearing sex drive.

Apart from the hot flushes, there’s the disturbed sleep and tiredness, headaches, sore muscles and joints, vaginal dryness and sore breasts. They’re just the mood killers.

What kills the sex drive in women is declining estrogen and testosterone.

As men age, there is a decline in the male sex hormone, testosterone. But it happens gradually, usually less than one per cent a year, beginning from the age of 30 to 40.

Also, from 50 onward, many men start to suffer with some degree of erectile dysfunction.

Although this can be a permanent consequence of prostate cancer treatment, most erectile dysfunction cases are a consequence of an unhealthy lifestyle.

Both this natural drop in testosterone – and erectile dysfunction – can be worsened by obesity, extreme stress and some medications or diseases, including drinking too much alcohol.

For women, some good news

Some good news and bad news regarding the hormone testosterone: A new Australian study finds that testosterone treatment could significantly improve sexual desire, function and wellbeing in post-menopausal women.

International expert reaction to this study has been positive.

On the downside, a US study finds that testosterone replacement therapy in ageing men – seeking to recover their drooping libido – have a 21 per cent higher risk of suffering a heart attack or stroke.

Researchers are investigating drugs that might return the sex drive to woman and men.

It may well be that the glucagon-like peptide 1 (GLP-1) class of drugs – sensationally adopted for weight loss, but also type 2 diabetes – might be the pathway. They’re being investigated for all manner of issues.

And with the ageing population needing to be entertained, there could be a lot of money in returning a spring to the middle-aged step. 

Why am I forgetting things?

Dementia can happen to anybody. But it is much more common after the age of 65.

However, middle age is when people start to fear that dementia is creeping into their over-crowded brains.

A few years ago, Kristyn Bates, a researcher in experimental and regenerative neuroscience, out of the University of Western Australia, told me that the prevalence of middle-aged and older people scaring themselves into wrongly thinking they’re losing their minds is so high it has led to the creation of a whole new area of research: “Subjective memory complaint.”

She said: “There is nothing wrong with their memory that we can measure. They perform normally. Because it’s poorly defined, the prevalence of subjective memory complaint is between 20 to 50 per cent of the elderly population.”

The key issue here is that the healthily ageing brain doesn’t lose memories, they just take longer to retrieve.

Your fears are overblown

Professor Peter Schofield, former executive director of Neuroscience Research Australia, told me that the fear and anxiety that middle-aged people harbour about dementia isn’t unreasonable, because age is the biggest single contributor to developing dementia.

But the fear is overblown.

“Yes, as we age our brains shrink. Yes, they slow down a bit. We begin to lose neurons and they aren’t replaced at the rate they once were. And so in some measure we are not as sharp or quick as we once were.

“But in the vast majority of the population aged in their 40s, 50s and 60s, that lack of sharpness is more a function of the complexity of what their brains are dealing with … it’s more a matter of selective attention than a measure of clinical pathology.”

However, because dementia is a high-profile issue many people are much more anxious about it.

“Every time they can’t find their keys is an impending sign of dementia. Losing your keys is an anxiety issue, not a cognitive one.”

Schofield said that people “attribute too much to middle age” as a time of mental decline.

So calm the heck down.

Age-related chronic diseases  

As we age, the risk of cancers and cardiovascular disease begin to creep up.

You need to become diligent about regular health checks and screening for various conditions.

From the age of 40 

• Every year have a dental check-up
• Every two years have a heart disease risk assessment AND your blood pressure checked.
• Every three years have a diabetes risk assessment AND have an eye test.
• Every five years have your cholesterol and lipids tested AND females should have a cervical screening test.
• At regular intervals have skin cancer checks AND have a depression risk assessment.

From the age of 50

• Every year, in addition to the above have an osteoporosis risk assessment AND (females) a mammogram to screen for breast cancer AND a screen for bowel cancer.   
• If you’re a current or former heavy smoker, get screened for lung cancer starting at 50.

Happiness bottoms out

The ‘sandwich generation’ refers to middle-aged people caring for children (what do you want now?) and ageing parents (I can drive you there later).

To an extent that’s just about everybody. You may not have children and parents living with you, but it sure feels like it.

These stressful demands come at a time when your career might have plateaued or become dreary.

Plus, you’re starting to feel that life is short and you wish you could carve out more time for yourself. How to shrug off this ennui?

Find a purpose to your life. Discovering life’s purpose won’t make your stressors disappear. But it might feel that way.

Multiples studies have found that people with a strong purpose in life have less heart disease and are much less likely to die early.

Over the past decade, research into “life’s purpose” as a modifiable lifestyle factor – like exercise, diet, smoking and drinking booze – has bloomed.

In other words, getting a purpose in life is something you can take up – as a preventative health measure – or abandon.

But how on earth do I discover life’s purpose?

It’s simply done. Head to the dance floor, the garden, write poetry. It’s not as dorky as it sounds. It’s about engaging with the big questions by doing something that matters to you.

Check out our report from 2022 here.