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From Paula Begoun's Beauty Bulletin
Skin Care for Perimenopause and Menopause?
It has been said that menopause starts the day you get your first menstrual cycle. I don't know if that's a hopeful comment or a depressing one, but any way you slice it, a woman will have periods for about 40 years after they first begin, and then they'll either gradually or abruptly stop. Though there is still a great deal of research that needs to be done on all the issues surrounding perimenopause (the time before the onset of menopause), menopause (the actual end of the menstrual cycle), and postmenopause, there is also a lot that is known.
Perimenopause and menopause are brought about by the body's changes in hormone production. The sometimes troublesome side effects of menopause are caused primarily by the imbalance between a woman's female hormones (estrogen and progesterone, which become depleted) and her male hormones (like androgens such as testosterone). Because the male hormones decline more slowly, there are proportionately more of them once estrogen and progesterone levels plummet, so they have a stronger impact. This imbalance, for example, can affect hair growth. When estrogen levels decrease, many women experience an increase in androgen production, resulting in varying amounts of dark hair growth on the face—particularly around the chin and moustache area above the lip. Ironically, while the hair on your face may get darker, the hair on your head will have reduced growth and you may experience some balding; the individual hairs actually become smaller in diameter.
The lessening and eventual loss of estrogen and progesterone also affects skin negatively. Aside from problems caused by sun damage, perimenopausal and menopausal women experience thinner, looser and less elastic skin, reduced production of collagen, cessation of oil gland function, and dry skin. Other parts of the body are also influenced by the diminishing amount of female hormones; the vaginal lining becomes thin and can burn and itch, and the breasts' mammary tissue is replaced with more fat tissue, which can cause sagging. (Source: American Journal of Clinical Dermatology, April 2003, pages 371-378).
To make matters even more frustrating, perimenopause and menopause can also cause hot flashes, flushes, night sweats and/or cold flashes, a clammy feeling, intermittent rapid heartbeat, irritability, mood swings, trouble sleeping, heavier periods, flooding, loss of libido, itchy skin, and brittle nails, just to name a few.
As complex and multifaceted as this all sounds, there are actually some fairly exciting options for addressing the side effects of perimenopause and menopause, and these include both alternative herbal options and conventional Western medical choices. For the purpose of this section I'm going to highlight a few of the current options, but I cannot encourage my readers strongly enough to seek out as much information as they can, or to find a doctor who is an expert in this arena. But please avoid the Web sites, companies, or physicians who do not offer a balanced approach to this issue. Medical options are not evil or dangerous, as many alternative-based supplement companies or homeopathic physicians assert; and herbal alternatives are not as ineffective (or as unproven) as many medical doctors assert. Both approaches play a role in mitigating some of the more annoying (as well as intolerable) symptoms of perimenopause and menopause.
Hormone Replacement Therapy: There is no question that Hormone Replacement Therapy (HRT) and Estrogen Replacement Therapy (ERT) are very controversial. Yet, despite the controversy, the research is clear that HRT restores and prevents the loss of skin's support tissue and elastic quality, as well as its thickness and smooth texture (Sources: Journal of the American Geriatrics Society, June 2004, pages 945-949; Skin Research and Technology, May 2001, page 95). The American Journal of Clinical Dermatology (2001, volume 2, issue 3, pages 143–150) summed up what all of these reports concluded by stating, "Estrogen appears to aid in the prevention of skin aging in several ways. This reproductive hormone prevents a decrease in skin collagen in postmenopausal women; topical and systemic estrogen therapy can increase the skin collagen content and therefore maintain skin thickness. In addition, estrogen maintains … stratum corneum [skin] barrier function… . Skin wrinkling also may benefit from estrogen as a result of the effects of the hormone on the elastic fibers and collagen… . t has been suggested that estrogen increases cutaneous wound healing… ."
Because of the potentially serious risks associated with ERT and HRT regarding their effects on heart disease, osteoporosis, and breast cancer, as well as the possible benefits (Source: Best Practice & Research Clinical Endocrinology & Metabolism, September 2004, pages 317-332) you may want to consider weighing out the pros and cons with your physician.
Herbal Alternatives (phytoestrogens, also called plant estrogens): As someone who has been drinking 8 ounces of soy milk per day and eating lots of tofu for the past nine years, I am obviously big on phytoestrogens. But that is only anecdotal, and I would never want you to rely on anecdotal information for any health matter. In reality, research about the benefits of plant sources of estrogens such as soy products and red clover extracts is mixed. Some indicate they don't help at all (Source: Obstetrics and Gynecology, October 2004, pages 824-836) while others say there is benefit (Source: Biochemical Pharmacology, September 2004, pages 1171-1185). Research on Dr. Andrew Weil's Web site (http://www.drweil.com) offers a very balanced approach between herbal and Western medical choices including information about HRT and ERT and herbal alternatives such as soy, black cohosh, dong quai, damiana, evening primrose oil, and borage oil.
It is probably wise for women to get a baseline estrogen count around the age of 40 and then again at 45 to determine what normal is for you. That way you can monitor your hormonal changes and the balancing effect that varying combinations of supplements are having on your body.
As you surf the Internet for more information about menopausal issues you will undoubtedly encounter Web sites promoting (in almost cult-like fashion) the benefits of topically applied "natural progesterone" creams. However, it's important to point out that while natural progesterone is an option, you should be aware that natural progesterone creams are not regulated in any way by the FDA, and so they are, in actuality, merely cosmetics. That means any cosmetics company can put progesterone into whatever product they want. Regrettably, there is little research indicating any benefit of using these creams, other than what is extolled by the companies selling these products. This is also true for other "natural" or bio-identical hormonal treatments including pregnenolone, testosterone, progesterone, estrone, estradiol, and estriol. The research I could find suggests there is some benefit but there is no data on safety or long-term effects (Source: Menopause, May-June 2004, pages 356-367) and another study showed there were potential negative side effects such as depression (Source: European Journal of Endocrinology, May 2003, pages 571-577).
Skin Care Options: I would love to say that there are skin-care products out there that positively affect the changes that occur in perimenopausal and menopausal skin, but there aren't. There is simply no information suggesting that applying soy extract, black cohosh, wild yam, or evening primrose oil to the skin can mitigate any of the changes taking place in the epidermis and dermis, and definitely not in comparison to taking those substances orally. None of those substances are a problem if they show up in skin-care products, but their benefits are most likely not any different from those of other anti-inflammatory and antioxidant cosmetic ingredients, which is impressive but not for reversing the effects of menopause.
The truth is the real basics for skin care continue to apply to perimenopausal and menopausal women alike: sun protection, treating the skin type you have (not all menopausal women have dry skin), considering using Retin-A or Renova, and using gentle skin-care products loaded with antioxidants. If you have dry skin, use an emollient moisturizer with antioxidants and anti-inflammatory agents (which most products these days contain). The use of hydroquinone or arbutin-based skin-lightening products is another important option if skin discolorations (such as melasma or chloasma) are present. But there is nothing you can apply to skin (other than over-the-counter or prescription-only estrogen creams) that can alter the actual condition of your skin caused by the depletion of hormones.
Note: What about the use of effective AHAs and BHA for menopausal women? This depends more on the condition of your skin than anything else. For some women (usually those over 70—well after menopause) the skin can become so thin it can literally tear when gently scratched or rubbed. This thinning is a result of many factors but primarily it is brought about by a combination of estrogen loss, genetic aging, and sun damage. All of these things cause the skin cells to produce "less skin" and what is produced is less healthy skin. In terms of genetic aging, skin cells seem to have a preprogrammed mechanism that slows down skin cell turnover, causing a buildup of dead skin cells on the surface of skin. It would be helpful if there were a way to tell skin cells not to slow down production, stay healthy (produce normally), and not build up on the surface of skin. Renova (prescription only) is the only real option we have for helping the skin to produce healthier skin cells. As for AHAs and BHA, they indeed help the outer layer of skin to shed by removing built-up dead skin cells. For some women in their 70s, 80s, and 90s with extremely fragile skin, removing dead skin cells may be problematic (they may indeed need the dead skin cells to stick around on the surface for as long as possible). However, for many women who don't have that kind of fragile skin the benefit of removing surface dead skin cells is that it absolutely helps improve the appearance of skin, allows healthier skin cells to come to the surface, and allows better penetration of moisturizers. It is also thought that AHAs and BHA can stimulate the production of collagen, which also has benefit.
Skin Care for Perimenopause and Menopause?
It has been said that menopause starts the day you get your first menstrual cycle. I don't know if that's a hopeful comment or a depressing one, but any way you slice it, a woman will have periods for about 40 years after they first begin, and then they'll either gradually or abruptly stop. Though there is still a great deal of research that needs to be done on all the issues surrounding perimenopause (the time before the onset of menopause), menopause (the actual end of the menstrual cycle), and postmenopause, there is also a lot that is known.
Perimenopause and menopause are brought about by the body's changes in hormone production. The sometimes troublesome side effects of menopause are caused primarily by the imbalance between a woman's female hormones (estrogen and progesterone, which become depleted) and her male hormones (like androgens such as testosterone). Because the male hormones decline more slowly, there are proportionately more of them once estrogen and progesterone levels plummet, so they have a stronger impact. This imbalance, for example, can affect hair growth. When estrogen levels decrease, many women experience an increase in androgen production, resulting in varying amounts of dark hair growth on the face—particularly around the chin and moustache area above the lip. Ironically, while the hair on your face may get darker, the hair on your head will have reduced growth and you may experience some balding; the individual hairs actually become smaller in diameter.
The lessening and eventual loss of estrogen and progesterone also affects skin negatively. Aside from problems caused by sun damage, perimenopausal and menopausal women experience thinner, looser and less elastic skin, reduced production of collagen, cessation of oil gland function, and dry skin. Other parts of the body are also influenced by the diminishing amount of female hormones; the vaginal lining becomes thin and can burn and itch, and the breasts' mammary tissue is replaced with more fat tissue, which can cause sagging. (Source: American Journal of Clinical Dermatology, April 2003, pages 371-378).
To make matters even more frustrating, perimenopause and menopause can also cause hot flashes, flushes, night sweats and/or cold flashes, a clammy feeling, intermittent rapid heartbeat, irritability, mood swings, trouble sleeping, heavier periods, flooding, loss of libido, itchy skin, and brittle nails, just to name a few.
As complex and multifaceted as this all sounds, there are actually some fairly exciting options for addressing the side effects of perimenopause and menopause, and these include both alternative herbal options and conventional Western medical choices. For the purpose of this section I'm going to highlight a few of the current options, but I cannot encourage my readers strongly enough to seek out as much information as they can, or to find a doctor who is an expert in this arena. But please avoid the Web sites, companies, or physicians who do not offer a balanced approach to this issue. Medical options are not evil or dangerous, as many alternative-based supplement companies or homeopathic physicians assert; and herbal alternatives are not as ineffective (or as unproven) as many medical doctors assert. Both approaches play a role in mitigating some of the more annoying (as well as intolerable) symptoms of perimenopause and menopause.
Hormone Replacement Therapy: There is no question that Hormone Replacement Therapy (HRT) and Estrogen Replacement Therapy (ERT) are very controversial. Yet, despite the controversy, the research is clear that HRT restores and prevents the loss of skin's support tissue and elastic quality, as well as its thickness and smooth texture (Sources: Journal of the American Geriatrics Society, June 2004, pages 945-949; Skin Research and Technology, May 2001, page 95). The American Journal of Clinical Dermatology (2001, volume 2, issue 3, pages 143–150) summed up what all of these reports concluded by stating, "Estrogen appears to aid in the prevention of skin aging in several ways. This reproductive hormone prevents a decrease in skin collagen in postmenopausal women; topical and systemic estrogen therapy can increase the skin collagen content and therefore maintain skin thickness. In addition, estrogen maintains … stratum corneum [skin] barrier function… . Skin wrinkling also may benefit from estrogen as a result of the effects of the hormone on the elastic fibers and collagen… . t has been suggested that estrogen increases cutaneous wound healing… ."
Because of the potentially serious risks associated with ERT and HRT regarding their effects on heart disease, osteoporosis, and breast cancer, as well as the possible benefits (Source: Best Practice & Research Clinical Endocrinology & Metabolism, September 2004, pages 317-332) you may want to consider weighing out the pros and cons with your physician.
Herbal Alternatives (phytoestrogens, also called plant estrogens): As someone who has been drinking 8 ounces of soy milk per day and eating lots of tofu for the past nine years, I am obviously big on phytoestrogens. But that is only anecdotal, and I would never want you to rely on anecdotal information for any health matter. In reality, research about the benefits of plant sources of estrogens such as soy products and red clover extracts is mixed. Some indicate they don't help at all (Source: Obstetrics and Gynecology, October 2004, pages 824-836) while others say there is benefit (Source: Biochemical Pharmacology, September 2004, pages 1171-1185). Research on Dr. Andrew Weil's Web site (http://www.drweil.com) offers a very balanced approach between herbal and Western medical choices including information about HRT and ERT and herbal alternatives such as soy, black cohosh, dong quai, damiana, evening primrose oil, and borage oil.
It is probably wise for women to get a baseline estrogen count around the age of 40 and then again at 45 to determine what normal is for you. That way you can monitor your hormonal changes and the balancing effect that varying combinations of supplements are having on your body.
As you surf the Internet for more information about menopausal issues you will undoubtedly encounter Web sites promoting (in almost cult-like fashion) the benefits of topically applied "natural progesterone" creams. However, it's important to point out that while natural progesterone is an option, you should be aware that natural progesterone creams are not regulated in any way by the FDA, and so they are, in actuality, merely cosmetics. That means any cosmetics company can put progesterone into whatever product they want. Regrettably, there is little research indicating any benefit of using these creams, other than what is extolled by the companies selling these products. This is also true for other "natural" or bio-identical hormonal treatments including pregnenolone, testosterone, progesterone, estrone, estradiol, and estriol. The research I could find suggests there is some benefit but there is no data on safety or long-term effects (Source: Menopause, May-June 2004, pages 356-367) and another study showed there were potential negative side effects such as depression (Source: European Journal of Endocrinology, May 2003, pages 571-577).
Skin Care Options: I would love to say that there are skin-care products out there that positively affect the changes that occur in perimenopausal and menopausal skin, but there aren't. There is simply no information suggesting that applying soy extract, black cohosh, wild yam, or evening primrose oil to the skin can mitigate any of the changes taking place in the epidermis and dermis, and definitely not in comparison to taking those substances orally. None of those substances are a problem if they show up in skin-care products, but their benefits are most likely not any different from those of other anti-inflammatory and antioxidant cosmetic ingredients, which is impressive but not for reversing the effects of menopause.
The truth is the real basics for skin care continue to apply to perimenopausal and menopausal women alike: sun protection, treating the skin type you have (not all menopausal women have dry skin), considering using Retin-A or Renova, and using gentle skin-care products loaded with antioxidants. If you have dry skin, use an emollient moisturizer with antioxidants and anti-inflammatory agents (which most products these days contain). The use of hydroquinone or arbutin-based skin-lightening products is another important option if skin discolorations (such as melasma or chloasma) are present. But there is nothing you can apply to skin (other than over-the-counter or prescription-only estrogen creams) that can alter the actual condition of your skin caused by the depletion of hormones.
Note: What about the use of effective AHAs and BHA for menopausal women? This depends more on the condition of your skin than anything else. For some women (usually those over 70—well after menopause) the skin can become so thin it can literally tear when gently scratched or rubbed. This thinning is a result of many factors but primarily it is brought about by a combination of estrogen loss, genetic aging, and sun damage. All of these things cause the skin cells to produce "less skin" and what is produced is less healthy skin. In terms of genetic aging, skin cells seem to have a preprogrammed mechanism that slows down skin cell turnover, causing a buildup of dead skin cells on the surface of skin. It would be helpful if there were a way to tell skin cells not to slow down production, stay healthy (produce normally), and not build up on the surface of skin. Renova (prescription only) is the only real option we have for helping the skin to produce healthier skin cells. As for AHAs and BHA, they indeed help the outer layer of skin to shed by removing built-up dead skin cells. For some women in their 70s, 80s, and 90s with extremely fragile skin, removing dead skin cells may be problematic (they may indeed need the dead skin cells to stick around on the surface for as long as possible). However, for many women who don't have that kind of fragile skin the benefit of removing surface dead skin cells is that it absolutely helps improve the appearance of skin, allows healthier skin cells to come to the surface, and allows better penetration of moisturizers. It is also thought that AHAs and BHA can stimulate the production of collagen, which also has benefit.
