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As we age, like it or not, our bodies change. Some of these changes, like the gray hair and wrinkles, are obvious. Others are more subtle but perhaps even more important for us to understand.

Over time, changes in cells, tissues and entire organs eventually result in changes in function and appearance. While we cannot stop the march of time, there may be lifestyle changes that may slow progression.

Changes that come with age


  • What changes? As with other muscles in the body, the heart muscle can weaken over time. For individuals who become less active as they age, the heart’s left ventricle stiffens and pumps less oxygen-rich blood to the body. The coronary arteries may experience a buildup of plaque called atherosclerosis which can reduce blood flow to the heart as they narrow and harden. High blood pressure can result and contribute to heart disease, heart failure (when the heart is no longer able to pump enough blood to meet the body’s needs) and heart attacks (when blood flow to the heart is suddenly blocked).
  • What can I do about it? First, if you smoke, quit. Follow a healthy lifestyle based on regular physical activity and a heart-healthy diet with plenty of fruits and vegetables. Limit your intake of processed foods. Keep at a healthy weight. Have your blood pressure and cholesterol checked regularly. If you have or are at risk for diabetes, have your A1C checked periodically.

Bones, joints and muscles

  • What changes? Our bones lose density and become more fragile as the mineral content in our bones decreases. Loss of bone mass can lead to osteoporosis and bone fractures, often in the vertebrae or hips. In our joints, the cartilage that acts as a cushion begins to break down from years of repetitive motion leading to inflammation and arthritis. Joint motion becomes more restricted as tendons and ligaments begin to stiffen and lose elasticity. Our muscles start to shrink, with muscle mass declining as the number and size of muscle fibers decrease.
  • What can I do about it? Stretching is an excellent way to help maintain joint flexibility. Weight training can increase muscle mass and strength, enabling people to continue their daily activities without maximal exertion. Long-term regular exercises may slow the loss of muscle mass and prevent age-associated increases in body fat.


  • What changes? As we age, the physical structure of our eyes changes. Eventually, this impacts our ability to focus on nearby objects, distinguish specific colors, or adjust to changing light levels. While these problems are often easily fixed with corrective lenses, other age-related conditions could be more concerning. These include age-related macular degeneration, diabetic retinopathy, cataracts, glaucoma, and dry eye.
  • What can I do about it? Protect your eyes from sunlight by wearing sunglasses that block ultraviolet light. To prevent eye strain from sitting at a computer, take a break every 20 minutes to look about 20 feet away for 20 seconds. If you smoke, quit. Monitor your blood pressure.


  • What changes? Hearing loss typically happens slowly over time. An estimated 3 in 10 adults over 65 have some age-related hearing loss or presbycusis. Changes to the inner ear, middle ear, or nerves are most often to blame. In addition to age, other variables that may impact hearing include diabetes, ear infections, blood pressure, medications, exposure to loud sounds, and heredity.
  • What can I do about it? Preventing age-related hearing loss includes measures used to prevent noise-induced hearing loss. Be careful to avoid loud noises, reduce the amount of time exposed to loud noise, and protect your ears with ear plugs. If hearing loss has already occurred, you may wish to consider hearing aids.


  • What changes? For many, the first age-related changes to our skin are rough, dry patches that can feel scaly or itchy. Most, at some point, will notice their first wrinkles, inevitable as the skin becomes thinner, loses fat, and no longer appears plump and smooth. Years of sun exposure and habits such as smoking can quicken this process. As skin thins, it becomes more transparent and more fragile. It takes longer to heal from cuts and scratches, and bruises. Age spots and skin tags are common in older individuals but harmless. A more significant concern is skin cancer. Most skin cancers are caused by the sun and are generally curable if caught before spreading.
  • What can I do about it? Limit your time in the sun. Seek shade whenever possible. Wear a broad-spectrum sunscreen with an SPF of 15 or higher when outside. Wear a wide-brim hat and cover up with sun-protective clothes. Consider a self-tanner rather than be exposed to UV rays. Wear sunglasses to limit squinting. If you smoke, stop. Limit alcohol which dehydrates the skin. Be gentle when cleaning. Moisturize your skin daily.

Teeth and gums

  • What changes? Our teeth put up with a lot of wear and tear. Over the decades, the protective coating of enamel on the teeth can wear away, leading to tooth discoloration, cracks and breaks and an increased chance of infection. Dental decay can also result from dry mouth, common among older adults, decreased saliva production, and a side effect of many common medications. The chance of severe tooth damage, enough to require a root canal, triples at age 65. Gum problems, including receding gums and gum disease, are common in older adults and, if undiagnosed and untreated, can lead to irritation, inflammation or even loss of teeth.
  • What can I do about it? Cut down on wear and tear by avoiding chewing on ice or hard foods. If you grind your teeth, consider wearing a night guard when you sleep. Keep your gums healthy with regular brushing and flossing. If you smoke, quit. Drink tap water containing fluoride to help prevent tooth decay.

Aging cannot be avoided, but it can be done gracefully. To start, be proactive with your health and your healthcare by scheduling annual exams and talking to your provider when you have questions. Don’t put off asking about your concerns. Your Welia Health provider is here for you.


Like your skin, bone is a living tissue. It is constantly being broken down and replaced. But unlike your skin, you can’t see what’s happening with your bones. 

Normal bone and bone with osteoporosis

Osteoporosis is a condition that occurs when new bone creation does not keep pace with the loss of old bone. As a result, bones become weak and brittle. There typically are no symptoms in the early stages of bone loss. That’s why osteoporosis is considered a “silent” disease. 

With osteoporosis, even a minor fall can lead to a fracture, most commonly in the hip, wrist or spine. In fact, a bone that breaks much more easily than expected can be a sign of osteoporosis. Other signs of osteoporosis can be a loss of height over time, a stooped posture or back pain caused by a fractured or collapsed vertebra. 

While osteoporosis can affect men and women of all races, white and Asian women over 65 are at the highest risk. For many women, the disease begins to develop a year or two before menopause. Certain medications (e.g. some cancer medications and glucocorticoid steroids) may increase the risk of developing osteoporosis. Your partners at Welia Health can help detect osteoporosis through different screenings. For more information, go to Osteoporosis: When to start screening for better bone health.

Steps to prevent osteoporosis 

You may not be able to see the aging of your bones, like the wrinkles on your face. But you can take measures to avoid the disease and the accompanying fractures. Steps to take include:

  • Stay physically active and participate in weight-bearing exercises like walking. The government guidelines recommend 150 minutes per week.
  • Use weights, body weight or resisted exercise in 2-3 sessions per week.
  • Incorporate balance training in your exercise to reduce the risk of falls.
  • Do exercises that have an element of impact, as it helps stimulate bone development. Exercises like running, jumping, skipping and dancing are good choices.
  • Drink alcohol only in moderation.
  • Quit smoking if you do smoke, and don’t start if you don’t (Quitting tobacco for good).
  • Eat a nutritious diet rich in calcium (1300 mg/day) and vitamin D, which help maintain bone health. 

Bone density exams

In addition to taking steps to prevent osteoporosis, you may wish to talk to your provider about a bone density exam, commonly referred to as a DXA exam. This non-invasive, enhanced x-ray measures bone health, both density and loss. Exams typically take 15-20 minutes and use a detector that captures images of your lumbar spine and hips. Bone density exams are recommended for:

  • Women aged 65 and older
  • For post-menopausal women < age 65 with the following risk factors:
    • Low body weight
    • Prior fracture
    • High-risk medication use
    • Disease or condition associated with bone loss
  • For peri-menopausal, menopausal or post-menopausal women with risk factors for fracture, such as low body weight, prior fracture, or high-risk medication use
  • Women discontinuing estrogen
  • Men aged 70 and older
  • For men < 70 years of age with the following risk factors:
    • Low body weight
    • Prior fracture
    • High-risk medication use
    • Disease or condition associated with bone loss
  • Men or women with a fragility fracture or disease, or condition associated with low bone mass or bone loss
    • Who take medications associated with low bone mass or bone loss

If you already have osteoporosis and your primary care provider prescribed medication to avoid fractures, be sure to take that as directed.

At Welia Health, we believe that prevention is the best medicine, and that mantra is definitely true with osteoporosis. The risk of osteoporosis depends on many factors, so it’s hard to detect the condition until it’s already an issue. That means it’s essential to take steps to reduce your risk of osteoporosis as you age. It just so happens that those steps are the basic tenets of a healthy lifestyle.

If you’re concerned about osteoporosis, talk to your Welia Health provider and learn what you can do today to lower your risk or to determine if a screening is right for you. Visit MyChart or call 320.679.1313 to schedule an appointment.


Article by Rachel Cady, MD, Welia Health Women’s Health and OB/GYN provider

While everyone talks about menopause symptoms, it is perimenopause, or the menopause transition (MT) that is usually the most symptomatic for women. Perimenopause begins with menstrual cycle irregularities and ends following one year of absent menses. The average age of perimenopause is 47, and the average age of menopause is 51-52 year old. MT lasts about 4-8 years, but tends to be longer in smokers and in those with earlier symptom onset.

Common perimenopause symptoms

Below are the most common symptoms you’ll experience during perimenopause:

  • Menstrual cycle changes
  • Hot flashes
  • Vaginal/vulvar dryness with painful sex
  • Poor sleep
  • Weight gain
  • Difficulty concentrating and concerns about one’s memory
  • Mood changes, depression and anxiety

Menstrual cycles vary depending on if ovulation (release of egg) occurred. About 25% of menstrual cycles in the perimenopause are ovulatory. Ovarian follicle aging progresses in the perimenopause. Progesterone and estrogen levels are extremely variable, which changes bleeding patterns.

Very heavy bleeding or bleeding in between periods are abnormal, and you should schedule a visit with your clinician. Cycles in early perimenopause are 7 or more days shorter, while cycles in the late perimenopause are at least 60 days apart.

Hot flashes that occur during the perimenopause are the result of a narrowing in the brain’s thermoregulatory center. This area of the brain is estrogen sensitive. When estrogen levels decline, the body is not able to accommodate as quickly. Therefore, skin redness, sweating, sometimes anxiety, and waking up at night result. About 75% of women report hot flashes with the average duration of about 5-7 years.

Metabolism goes down about 25% for perimenopausal women, which commonly results in weight gain. Most women have no idea this is going to happen, and are therefore not prepared.

So, what other things do you have to look forward to during MT?

  1. Bone loss starts in perimenopause.
  2. Risk factors for heart disease increases in the MT, including high blood pressure and high cholesterol.

Okay, so those weren’t really “things to look forward to.” But I can tell you something good!

Being prepared helps lessen symptoms

The latest-and-greatest data clearly shows that by being proactive, planning ahead, being open to treatment options, and being prepared, you can help yourself be healthier in the postmenopause.

Women on average are living one third of their lives postmenopause. The New York Times recently referred to perimenopause as “The Puberty of Midlife,” and most importantly, the conversation is not being heard enough.

Women are hungry for accurate information pertaining to health. Perimenopause is not “doomsday.” By recognizing what is normal, understanding common symptoms and their causes/treatments, and having a preventive/proactive mindset, you can largely lessen these symptoms. Perimenopause remains a wonderful time to check in with your clinician to help in this process.

Welia Health’s Women’s Health providers can help you navigate your transition through perimenopause to menopause. Meet our Women’s Health providers. Sign onto MyChart to schedule an appointment.


Milk does the body good whether you’re 10 or 50, and for a similar reason: bone health. The big difference is that at 10 years old you’re building bone strength, at 50, you’re trying to preserve it.

Osteoporosis is a condition that causes bones to become brittle and fragile, and it’s more common in women than men. Bone fractures attributed to osteoporosis affect an estimated 1.5 million people annually. They can seriously impact one’s health and quality of life.

Bone density and osteoporosis

Doctors can screen for osteoporosis by testing your bone density or how strong your bones are. Bone density, or bone mineral density (BMD), is the amount of bone mineral in bone tissue. Testing BMD is the only way to know for sure that you have osteoporosis. At Welia Health, we use a dual energy X-ray absorptiometry or DEXA, which is the most common test for osteoporosis. Doctors measure bone density at the hip and spine, as these areas provide a good idea of whether you’re likely to fracture other bones in your body.

Screening recommendations

There has been some controversy over osteoporosis screening, largely surrounding a perception that pharmaceutical companies were pushing to lower recommended screenings to increase demand for osteoporosis drugs to drive profits. Medical associations such as the American Academy of Family (AAFP) Physicians and the American College of Obstetrics and Gynecology (ACOG) and have similar guidelines, which we follow at Welia Health.

American Academy of Family Physicians

  • Recommends against DEXA screening in women younger than 65 years and men younger than 70 years with no risk factors

American College of Obstetrics and Gynecology
(2012/Reaffirmed 2014)

  • Recommends BMD testing with DEXA beginning at age 65 years in all women
  • Recommends selective screening in postmenopausal women younger than 65 years who have osteoporosis risk factors or an adult fracture

Risk factors for osteoporosis

Around age 50, both women and men experience increased bone loss. Women tend to lose more bone as they transition into menopause, given the loss of estrogen. The hormone plays an important role in replacing older bone with newer dense bone, throughout a woman’s life. (In men, testosterone converts to estrogen to build bone mass.)

Osteoporosis in 4 stages
Osteoporosis in four stages.
From left to right: healthy bone, osteopenia, osteoporosis, severe osteoporosis.

Although bone loss starts to occur around 50, the medical guidelines don’t call for screening until age 65, unless there are risk factors beyond sex, age and race (you’re at greatest risk if you’re white or of Asian descent). Your Welia Health provider can help you determine whether you have risk factors that merit a screening before 65 years old. Some of the risk factors include:

Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.

Body frame size. Women (and men) with small body frames are at higher risk because they might have less bone mass to draw on as they grow older.

Thyroid problems. Too much thyroid hormone can cause bone loss, which can occur with an overactive thyroid or taking too much thyroid hormone medication to treat an underactive thyroid. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.

Dietary factors. Osteoporosis is more likely to occur in people who have had low calcium intake throughout their lives, as the latter contributes to lower BMD. Eating disorders or severely restricting food intake can also weaken bones. Gastrointestinal surgery can also increase osteoporosis risk because when you reduce the size of your stomach or remove part of the intestine, it limits the amount of surface area available to absorb nutrients, such as calcium.

Steroids and other medications. Long-term use of oral or injected corticosteroid medications (e.g. prednisone and cortisone) disrupts the bone-rebuilding process. Other medications connected to osteoporosis risk include medications used to treat:

  • Seizures
  • Gastric reflux
  • Cancer
  • Transplant rejection

Medical conditions. Osteoporosis can also be more common in people who have:

  • Celiac disease
  • Inflammatory bowel disease
  • Kidney or liver disease
  • Cancer
  • Lupus
  • Multiple myeloma
  • Rheumatoid arthritis
  • Alcoholism

Lifestyle choices. Many of the risk factors above are out of your control. But some are not. The lifestyle choices that affect your osteoporosis risk include:

  • Inactivity: People who are sedentary have a higher risk of osteoporosis. Any weight-bearing exercise and activities that promote balance and good posture are helpful for your bones. But walking, running, jumping, dancing and weightlifting seem particularly helpful.
  • Excessive alcohol consumption: Regularly drinking more than two alcoholic drinks a day increases your risk of osteoporosis.
  • Tobacco use: Tobacco contributes to weak bones, though its exact role in osteoporosis isn’t clear.

If you’re concerned about osteoporosis, talk to your Welia Health provider and learn what you can do today to lower your risk or to determine if a screening is right for you.

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