Wellness Pillars: Your Roadmap to Feeling Your Best in Midlife — and Beyond
By Dr. Abigail DeVries
Here are the top things women can do to stay strong, independent, and genuinely well — not just in midlife, but for the decades that follow. I’ve organized these into nine evidence-based Wellness Pillars, and together they’re a roadmap for healthspan: not just living longer, but living well longer.
1. Chronic Disease Prevention and Management
The most common diseases that rob women of their quality of life in their 60s, 70s, and beyond — heart disease, diabetes, osteoporosis, cancer — develop over years, quietly, before they make themselves known.
That means the work we do now is more important than most people realize. This pillar covers four key areas:
- Prevention: Adopting lifestyle habits that reduce metabolic disease risk
- Vaccination: Protecting against infections that can be genuinely debilitating or deadly — shingles, pneumonia, RSV, and influenza
- Screening: Staying current on recommended cancer screenings to catch precancers and early-stage disease while treatment is most effective
- Management: If you already have a chronic condition — diabetes, hypertension, high cholesterol — we manage it aggressively and intelligently, using current evidence-based guidelines alongside lifestyle tools that can sometimes reverse disease rather than just control it
Consider using habit stacking to gradually add in more activities that will help you age strong.
2. Hormone Health
Estrogen isn’t just a reproductive hormone. It protects your cardiovascular system, your bones, your brain, your mood, your sleep, and your metabolic health. When it declines women feel it across every system in the body. The question isn’t whether your hormones are changing. It’s whether you have the right support to navigate that change well.
Optimizing estrogen, progesterone, and sometimes testosterone is one of the most powerful things we can do to help you feel good now and protect your long-term health.
3. Sleep
If I had to pick the single most underestimated pillar, it would be this one.
During sleep your body repairs itself. Chronic poor sleep or lack of sufficient sleep accelerates every disease process we’re trying to prevent. And perimenopause, with its night sweats and hormonal fluctuations, is a common catalyst for sleep problems in women who never had them before.
Getting sleep right means more than going to bed earlier. It means:
- Eliminating the habits that silently destroy sleep quality — particularly alcohol and caffeine (which has a longer half-life than most people realize), and social jet lag (wildly different sleep times on weekdays vs. weekends)
- Testing for and treating sleep apnea, which is underdiagnosed in women and often missed
- Addressing hormones — often the root cause of waking at 3am
- Managing stress, which is both a cause and a consequence of poor sleep
4. Nutrition
Nutrition advice is everywhere, and a lot of it is contradictory. I keep it practical and focused on what the evidence actually supports for women in midlife:
- 5+ servings of fruits and vegetables per day — the research on this is unambiguous
- ~100 grams of protein per day — essential for preserving muscle mass as we age, and most women are significantly under-eating protein
- 25+ grams of fiber per day — for metabolic health, gut health, and cardiovascular protection
- Limit the usual suspects: processed foods, fried and packaged foods, white flour, high-fructose corn syrup, added sugar, and alcohol
- Stop eating 3 hours before bedtime — it makes a real difference for sleep and metabolic health
- Supplement strategically: a daily multivitamin, vitamin D, and maybe magnesium glycinate at night. Plus creatine for muscle building and improved cognitive functioning. That’s it.
5. Physical Activity
Movement is medicine. There is no drug that comes close to matching the health benefits of regular physical activity.
For women in midlife specifically, the targets are:
- 150 minutes of moderate or 75 minutes of vigorous cardio per week
- 7000 steps per day as a general baseline for daily movement
- Resistance training 2-3x per week — non-negotiable for bone density, muscle mass, metabolic health, and functional strength
- Exercise “snacks” if you have a sedentary job — even 3–5 minutes of movement every hour has measurable benefits
- Short bursts of jumping and high-intensity cardio–keeps your bones strong and limits the decline of your cardiovascular capacity.
- Flexibility and balance work — not glamorous, but essential for long-term independence and fall prevention
One more thing I address here that often gets overlooked: urinary incontinence. Leaking when you exercise is not normal, and it shouldn’t stop you from being active. It’s treatable.
6. Mental Health
The brain changes during the menopause transition and often women realize they don’t want to carry the heavy load they’ve been shouldering all their lives. Leaning into this instinct and getting the right support can literally be life changing.
That means:
- Developing real, sustainable tools for stress management
- Seeking support for unresolved trauma, which has documented effects on physical health outcomes
- Treating depression and anxiety appropriately — often a combination of medication and therapy is the most effective approach
- Considering a daily meditation practice — the evidence for its benefits continues to grow
7. Keep Your Mind Active
Cognitive decline is one of the things my patients fear most. Women account for nearly two-thirds of all Alzheimer’s diagnoses.The good news is that the brain responds to challenge and stimulation the same way muscle responds to resistance training: use it intentionally, and it gets stronger.
Keeping your mind active looks like:
- Learning something new — a language, an instrument, a sport or game
- Reading — books, long-form articles, anything that requires sustained attention
- Staying socially engaged — conversation and connection are among the most cognitively protective activities we know of
- Prioritizing the other pillars — sleep, exercise, hormone health, and nutrition all have direct, documented effects on brain health
8. Relationships
For women in midlife specifically, this includes:
- Addressing conditions that affect sexual health — vaginal dryness, pain, low libido
- Having honest conversations about relationship dynamics that may need attention
- Prioritizing time with supportive friends — not as a luxury, but as a health behavior
- Identifying and actively engaging with your community, whether that’s a faith community, a neighborhood, a running group, or something else entirely
9. Purpose
As life expectancy increases, the lucky ones among us may literally have another half a life to live. Many of the women I see in their 40s and 50s are at a hinge point in life. Kids are getting older. Caregiving responsibilities are shifting — or intensifying. The structure that defined their 30s is changing. And there’s a quiet (sometimes not-so-quiet) question underneath everything: What’s next? What do I actually want?
I want my patients to:
- Acknowledge and celebrate the enormous contribution they make as caregivers, nurturers, and community builders — without minimizing their own needs in the process
- Protect time for themselves — not after everything else is handled, but as a non-negotiable
- Actively imagine the next phase: How do you want to spend your time? Where do you want to contribute? What would make this chapter feel meaningful and full?
Purpose is associated with better health outcomes, lower rates of depression, and longer life.
Putting It All Together
Obviously you cannot focus on all of these pillars at once, but I think it’s helpful to periodically review how you are doing in each of these areas. Then you can be intentional about what to prioritize next. And consider using habit stacking to gradually add in more activities that will help you age strong. If you have thoughts or questions I look forward to hearing from you!
About the author. Dr. DeVries is a board-certified family physician with over 20 years of experience caring for patients, leading clinical teams, and shaping health systems across North Carolina and the U.S. She is also a menopause society certified practitioner.
Throughout her career, Dr. DeVries has worked at the intersection of direct patient care, public health, value-based care, and population health.
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