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Middle age
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== Physical characteristics == Middle-aged adults may begin to show visible signs of [[aging]]. This process can be more rapid in women who have [[osteoporosis]].{{Cn|date=December 2023}} Changes might occur in the nervous system. The ability to perform complex tasks remains intact. In the normal range of 45 to 55, women experience [[menopause]], which ends natural fertility.<ref>{{cite book|url=https://books.google.com/books?id=SozvHsW4VysC&q=gynecology%20menopause%20range%2048-55&pg=PA435|title=Obstetrics and Gynecology Recall|first1=F. John|last1=Bourgeois|first2=Paola A.|last2=Gehrig|first3=Daniel S.|last3=Veljovich|date=1 January 2005|publisher=Lippincott Williams & Wilkins|via=Google Books|isbn=9780781748797|access-date=1 November 2020|archive-date=10 January 2023|archive-url=https://web.archive.org/web/20230110030051/https://books.google.com/books?id=SozvHsW4VysC&q=gynecology%20menopause%20range%2048-55&pg=PA435|url-status=live}}</ref><ref>{{cite web |title=What is Menopause? |date=16 October 2024 |url=https://www.nia.nih.gov/health/what-menopause#transition}}</ref> Menopause can have many side effects. Changes can occur to [[Skin#Age|skin]], and other changes may include a decline in [[physical fitness]], including a reduction in aerobic performance, a decrease in maximal heart rate, and graying and loss of hair. Sensory sensitivity in middle-aged adults has been shown to be one of the lowest.<ref>{{Cite journal|last1=Harkins|first1=S. W.|last2=Price|first2=D. D.|last3=Martelli|first3=M.|date=1986-01-01|title=Effects of Age on Pain Perception: Thermonociception|journal=Journal of Gerontology|volume=41|issue=1|pages=58–63|doi=10.1093/geronj/41.1.58|pmid=3941257|issn=0022-1422 }}</ref> These measurements are generalities, and people may exhibit changes at different rates and times.<ref>{{Cite journal|display-authors=3|last1=Leyk|first1=Dieter|last2=Rüther|first2=Thomas|last3=Wunderlich|first3=Max|last4=Sievert|first4=Alexander|last5=Eßfeld|first5=Dieter|last6=Witzki|first6=Alexander|last7=Erley|first7=Oliver|last8=Küchmeister|first8=Gerd|last9=Piekarski|first9=Claus|last10=Löllgen|first10=Herbert|date=2010-11-19|title=Physical Performance in Middle Age and Old Age |journal=Deutsches Ärzteblatt Online|volume=107|issue=46|pages=809–816|doi=10.3238/arztebl.2010.0809|pmid=21151416|issn=1866-0452|pmc=2999945 }}</ref> Mortality rates can begin to increase, due mainly to health issues like heart problems, [[cancer]], [[hypertension]], and [[diabetes]].<ref name="Stern-2016" /> Still, the majority of middle-aged people in industrialized nations can expect to live into [[old age]]. Starting around age 35, pregnant women are considered to be of advanced maternal age, and significant declines in fertility begin to occur that usually end with menopause around age 50.<ref>{{Cite web|url=https://familydoctor.org/pregnancy-35-advanced-maternal-age/|title=Pregnancy After 35: Advanced Maternal Age|first1=familydoctor org editorial|last1=staff|first2=Alex|last2=Rice|first3=Alex|last3=Rice|date=September 7, 2017|website=familydoctor.org|access-date=October 4, 2022|archive-date=October 4, 2022|archive-url=https://web.archive.org/web/20221004030024/https://familydoctor.org/pregnancy-35-advanced-maternal-age/|url-status=live}}</ref> Middle-aged urban adults who are experiencing [[Frailty syndrome|frailty]] and [[poverty]] show an association with increased H<sub>2</sub>O<sub>2</sub> induced oxidative [[DNA damage (naturally occurring)|DNA damage]].<ref>{{cite journal |vauthors=Smith JT, Noren Hooten N, Mode NA, Zonderman AB, Ezike N, Kaushal S, Evans MK |title=Frailty, sex, and poverty are associated with DNA damage and repair in frail, middle-aged urban adults |journal=DNA Repair (Amst) |volume=129 |issue= |pages=103530 |date=September 2023 |pmid=37437502 |doi=10.1016/j.dnarep.2023.103530 |url=|doi-access=free |pmc=10807508 }}</ref>
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