During middle adulthood, the gradual physical changes that began in young adulthood continue. Age-related deterioration reduction in visual abilities, hearing, and the condition of the skin become more apparent. Muscle mass declines, fat deposits increase, and bone density declines. Many physical changes are mediated by the effects of exercise and healthy lifestyles.

The climacteric, or decline in reproductive capacity, occurs over a 10ten-year period for women. Many doctors recommend hormone replacement therapy to counteract the negative effects of menopause, but it is controversial due to increased risk of cancer. Physical and psychological symptoms of menopause vary greatly between individuals and cultures. Sexual activity among married couples remains relatively stable in midlife.

Middle adulthood can bring many serious health concerns, including cancer, cardiovascular disease, and osteoporosis. Hostility predicts health problems, while effective stress management (including both problem-centered and emotion-centered coping strategies), a healthy diet, regular exercise, social support, and regular medical screenings can reduce health risks considerably. An optimistic outlook is related to both physical and psychological well-being.

Cognitive changes during middle adulthood exemplify the lifespan view of development as multidimensional, multidirectional, and plastic. Crystallized intelligence (based on knowledge and experience) increases, while fluid intelligence (representing information-processing skills) declines. Slower processing speed makes effective attention more difficult, and reduction in the use of memory strategies contributes to declines in working memory. However, experience, practice, and metacognitive skills allow healthy adults to compensate for these deficits.

As in other periods of life, the relationship between vocational life and cognitive development during midlife is reciprocal: each builds on and contributes to the other. Life transitions often motivate a return to college, especially for women. Social support from family, friends, and institutional services can help returning students overcome the challenges they face and reap the benefits of expanding their horizons, as well as those of others.