A 2003 study by AARP found that 34 percent of all women over 40 in the survey were dating younger men, and 35 percent preferred it to dating older men. Mandel says that women in these relationships—the kind that shows like Courteney Cox’s Cougar Town have made icons of—are put under a particular strain when it comes to aging and body image, even more so than women who are married to men their own age. “When your husband is young and your body is changing, you are more stressed and insecure than the average woman.

“Stress is an inflammatory process, which causes cardiovascular problems, and has been implicated in many disease processes as well as exacerbating symptoms,” says Mandel. This can also, she says, lead older women to exercise addiction and severe dieting.