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... . [I]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 70 and older—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.