Symptom: Pain and Swelling in Your Calf
Most minor discomfort is a sign of…not much. Maybe you had a heavy meal, a stressful day, a hard workout — and by the next day you feel fine again. But a handful of trivial-sounding symptoms can sometimes be red flags for something more serious. Since it’s often hard to distinguish between the no big deal and the dire, most of us err on the side of ignoring the problem and hoping it goes away. "Women in midlife are often juggling 20 things at once, so they tend to neglect their own health," says Nieca Goldberg, MD, author of Dr. Nieca Goldberg’s Complete Guide to Women’s Health. "That’s why it’s especially important for them to be informed about what really needs medical attention." Here, a guide to eight important symptoms: when you should see a doctor and when you can just keep cruising.
Pain and Swelling in Your Calf
Likely cause: Pulled muscle
Worst-case scenario: Blood clot in the leg
Calf pain is the most common symptom of deep vein thrombosis (DVT), a clot in a deep vein, which is a potentially fatal condition that strikes an estimated 350,000 to 600,000 people in the U.S. every year — most of them 40 and over. "The clot blocks blood flow, causing pain and swelling," says Stephan Moll, MD, of the National Alliance for Thrombosis and Thrombophilia.
Other signs it may be serious: Symptoms of a clot can be pronounced, with significant swelling, redness, and pain, but they can also be mild and easily mistaken for a cramp. The skin may also be warm to the touch. If you’re short of breath, coughing, experiencing chest pain, or having difficulty breathing, a clot may have broken free and traveled to your lungs, clogging a blood vessel there. You’re at increased risk for DVT if you’re on hormone therapy, the pill, patch, or ring; if you smoke or are pregnant; if you’ve just had surgery or have been on a plane flight or car trip longer than three hours; if you’re obese; or if you have a family history of blood clots.
When to act: If the symptoms come on suddenly and don’t go away in a few hours, call your doctor for a same-day appointment. If she can’t see you, go to the ER right away, especially if the swelling and pain are significant, you’re having any breathing or chest symptoms, or you have any other risk factors. "It’s better to err on the side of caution," Moll says. "Half of people with DVT develop a blood clot in the lungs, a condition that can be fatal." Blood clots are usually diagnosed with ultrasound and treated with intravenous blood thinners for a few days, followed by several months of medication. They can be prevented with some lifestyle changes: Maintain a healthy weight; don’t smoke; and on long trips be sure to get up and walk around.
Symptom: Flu-Like Feelings (Fatigue, Nausea, Sweating, Chills)
Likely cause: Virus
Worst-case scenario: Heart attack
"Women tend not to have the Hollywood heart attack with significant chest pain," Goldberg says. "They sometimes just feel like they’re coming down with an infection." That could be one reason women having heart attacks take more than 11 minutes longer than men, on average, to go to the ER.
Other signs it may be serious: Shortness of breath; dizziness; pressure, squeezing, or pain in the chest; pain in the back, arm, jaw, or upper abdomen.
When to act: If you have some of the above symptoms, call 911 and say, "I think I’m having a heart attack. I need an ambulance." At the hospital, the staff should do an electrocardiogram to detect whether your heart is being deprived of oxygen, a blood test to measure cardiac enzymes and proteins, an echocardiogram to see if the heart has been damaged, and possibly cardiac catheterization — inserting dye into the arteries to see them clearly with an x-ray. Getting examined quickly may save your life: It’s estimated that you have a 50 to 70 percent chance of dying if your heart attack takes place outside a hospital. Among women ages 40 to 60, heart disease is as common a killer as breast cancer, but with some precautions, you can decrease your risk. "Keep your blood pressure, cholesterol, and weight under control, and exercise regularly," Goldberg advises.
Symptom: Burning, Tingling, or Numbness in Your Feet
Likely cause: A tight-fitting pair of shoes
Worst-case scenario: Prediabetes (elevated blood sugar levels)
Some 57 million Americans are prediabetic, but because prediabetes is often asymptomatic, most don’t know they’re on the cusp of serious illness. (Without intervention, the condition typically progresses to full-blown diabetes within a decade.) Foot symptoms occur "because the illness damages the nervous and circulatory systems," says John Giurini, DPM, of the American College of Foot and Ankle Surgeons.
Other signs it may be serious: Some prediabetics may also experience tingling and numbness in the arms or hands, says Giurini. If you have full-blown diabetes, you may also experience frequent urination, excessive hunger or thirst, weight loss, fatigue, or blurry vision. The risk factors for type 2 diabetes include being older than 45, being overweight, being sedentary, having a family history of diabetes, having had gestational diabetes, or having given birth to a baby weighing more than 9 pounds.
When to act: If you have burning or tingling feet for more than a few weeks, call your internist and ask to be seen in the next week for a checkup and a fasting blood sugar test, Giurini suggests. Recent studies have shown that by losing 5 to 7 percent of your body weight through diet and exercise, you can prevent the development of diabetes.
Symptom: Bloating and Pelvic Pain
Likely cause: Gastrointestinal bug
Worst-case scenario: Ovarian cancer
Several medical groups, including the American Cancer Society, warned in 2007 that bloating and pelvic pain can be early signs of ovarian cancer — big news, since doctors have long believed that this often deadly disease is symptomless until it’s too advanced to treat. "If caught early, ovarian cancer is up to 90 percent curable," says Barbara Goff, MD, of the University of Washington.
Other signs it may be serious: Additional symptoms of ovarian cancer include feeling full quickly or having difficulty eating, urinating frequently or with great urgency, and changing bowel habits. You’re at increased risk if you have a family history of the illness, have tested positive for mutations in the genes BRCA 1 or BRCA 2, or have been on hormone therapy. (Your risks are lower if you have had at least one child, breastfed a baby, taken birth control pills, and maintained a healthy weight.)
When to act: "If the symptoms are new, occur almost every day, last more than a few weeks, and don’t go away if you eat more fiber, reduce your salt intake, or exercise more frequently, schedule an appointment with your gynecologist," says Linda R. Duska, MD, of the University of Virginia, in Charlottesville. Ask to be seen within two weeks. Diagnosis is tricky, so don’t be afraid to push your doctor for appropriate testing: a pelvic ultrasound and perhaps a blood test to check your level of CA-125, a substance found in high amounts in the blood of many women with ovarian cancer. Partly because the incidence of ovarian cancer rises with age, the ACS recommends annual pelvic exams for all women over age 40.
Symptom: Persistent Cough
Likely cause: A cold
Worst-case scenario: Adult-onset asthma, a condition that can worsen as women enter midlife
Other signs it may be serious: "If you cough only when you’re exercising or sleeping, that can indicate asthma," says Vincent Tubiolo, MD, of the American Academy of Allergy, Asthma and Immunology. Other symptoms include wheezing, particularly when you exhale; shortness of breath; and tightness in the chest. Risk factors are obesity, allergies, smoking, and a recent respiratory tract infection. "Women who have taken estrogen for 10 years have a 50 percent higher risk of developing asthma," Tubiolo says. "And people with acid reflux are at increased risk, possibly because the acid irritates the airways and triggers an asthmatic cough."
When to act: Asthma isn’t usually an emergency, but it makes sense to consult a doctor since the disease can be progressive (and even life-threatening when breathing problems are severe). Also, the condition can limit your physical activity and interfere with your sleep, both of which can affect your long-term health. Asthma is diagnosed with a pulmonary function test that measures airflow. "People feel a lot better once they receive treatment," Tubiolo says. Reduce your risk by avoiding smoke, including the secondhand variety, and maintaining a normal weight.
Symptom: No Matter How Much You Sleep, You Don’t Feel Well-Rested
Likely cause: The flu
Worst-case scenario: Sleep disorder
Don’t dismiss daily fatigue as an inevitable consequence of aging. Feeling tired is a common symptom of two of the most prevalent sleep interrupters for midlife women: sleep apnea and restless legs syndrome, a neurological disorder that causes an itchy, twitchy sensation in the legs that makes it difficult to stay still and, as a result, fall asleep. "Many people think sleep apnea only affects overweight men, but it’s nearly as common in women after menopause," says Lisa Shives, MD, of Northshore Sleep Medicine, in Evanston, Illinois. Like sleep apnea, RLS often worsens as you get older.
Other signs it may be serious: If you’re a snorer and you wake up feeling as if you’ve been hit by a truck, chances are you have sleep apnea. The condition relaxes the muscles of the throat, making it difficult to get sufficient air, and the lack of oxygen triggers mini awakenings — sometimes hundreds of times a night. Other signs of sleep apnea: waking with a headache and sore throat; experiencing memory or concentration problems; feeling irritable or depressed. Fatigue-related symptoms such as irritability are also common with RLS.
When to act: If the symptoms of either disorder persist for more than a month, see your internist, who may be able to diagnose the problem based on your description. If not, she may refer you to a sleep specialist for further evaluation. Sleep apnea is treated with a continuous positive airway pressure device, a mask that fits over your nose and/or mouth during sleep and helps open airways with gentle air pressure. RLS is treated with dopamine-like drugs, but some sufferers can control symptoms by limiting caffeine, walking regularly, and massaging or stretching their legs before bedtime. Practicing yoga or meditation may relieve some symptoms. Likewise, lifestyle changes may ease the effects of sleep apnea: Drop pounds if you’re overweight, avoid alcohol, quit smoking, and try to sleep on your side, a position that sometimes reduces symptoms.
Symptom: Trouble Finding the Right Words
Likely cause: Sleep deprivation
Worst-case scenario: Stroke
It’s easy to laugh off a little brain freeze as a senior moment, but if your word problems amount to more than a minor slipup (for example, saying "runny hosted peanuts" instead of "honey roasted peanuts" is normal; saying "red place mat" when you mean "honey roasted peanuts" is not), it could be a stroke, which occurs when a blood vessel in the brain either bursts or is blocked by a clot, depriving brain cells of oxygen. "Language impairment — when you have trouble speaking, or say nonsense words or words that don’t go together — is common in left hemisphere strokes," says Argye Hillis, MD, of the Johns Hopkins University School of Medicine.
Other signs it may be serious: Weakness on one side of the body, slurred speech, dizziness, blurred vision, headache, neck stiffness, or lack of coordination are all red flags. A temporary bout of amnesia (not being able to remember what you did for the past few hours) or symptoms that last only a few minutes could signal a transient ischemic attack (TIA), a ministroke that raises your risk of the real deal substantially, especially over the following few days. Certain factors raise your odds of having a stroke: getting migraines with an aura; smoking; being overweight; having heart disease, diabetes, or high blood pressure; and being on the pill or HT.
When to act: "Call 911 if any of these symptoms develop suddenly — for example, if you’re not able to do something that you could do five minutes earlier," Hillis says. A quick response is critical, because receiving a clot-busting drug within the first three hours improves the odds of recovery by an estimated 30 percent. "Even if symptoms go away on their own, you should get to the emergency room as soon as possible to be evaluated for the cause of the TIA, so a stroke can be prevented," Hillis recommends.
Symptom: A New Mole
Likely cause: Harmless skin growth
Worst-case scenario: Skin cancer
While it’s common to develop new moles before midlife, finding a new one or seeing changes in an existing mole after age 40 could be a sign of melanoma, the deadliest type of skin cancer.
Other signs it may be serious: "If a mole — new or old — turns darker or black, becomes asymmetrical, or causes pain, itching, or bleeding, you should get it checked out right away," says Robert Brodell, MD, a dermatologist in Warren, Ohio, who is a spokesperson for the American Academy of Dermatology. The more moles you have, the greater your risk for melanoma. Being fair and spending lots of time in the sun (even if you only did so in your youth) raises your risk, as does every single sunburn. "If you have lots of sun damage, like freckles, you have a higher risk too," Brodell says.
When to act: "Call your dermatologist as soon as you notice something unusual and say, ‘I have a changing mole, and I’m worried about it.’ She should get you in within a week or two," Brodell says. If you don’t have a dermatologist, ask your doctor for a referral. The dermatologist should check your whole body for signs of skin cancer and biopsy anything that looks suspicious. "Fortunately, when melanoma is caught early it’s very curable," Brodell says. To protect your skin, apply a broad-spectrum sunscreen with at least SPF 30 every day, have full-body screenings annually, and check your body for new or changing moles once a month.
Originally published in MORE magazine, March 2009.