How Hormonal Aging Affects Your Skin
Estrogen has such a dramatic effect on the body, we often forget how much it does for our skin. This essential hormone keeps skin soft, supple and firm by encouraging collagen production. Along with its connective partner elastin, collagen makes up our skin's structural support system. Together, they're responsible for the skin's youthful resiliency.
During the years leading up to menopause (late 30s to mid-40s) the body continues to produce skin-enhancing estrogen--but in increasingly limited quantities. Studies show that skin loses up to 30% of its collagen in the first five years after menopause. The skin can become more fragile and thin with increased wrinkling, sagging and the possibility of facial hair and acne breakouts.
Menopause begins when your ovaries start to make significantly less estrogen and progesterone, typically between the ages of 45 and 55. Since the face has a high concentration of estrogen receptors, menopause may be at its most visible there--in the form of deep creases, dull tone and crepe-like texture. 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 multiple options available today for addressing the side effects of perimenopause and menopause, and these include both alternative herbal options and conventional Western medical choices. While we may highlight a few of the current options, women should 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).
Over the last couple of years the focus has been big on phytoestrogens. But the information is only anecdotal and no one should 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 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 currently by the FDA. 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. We are hoping that more funding will go into the research effort to establish the viability of natural hormone therapies. This is also true for other “natural” or bio-identical hormonal treatments including pregnenolone, testosterone, progesterone, estrone, estradiol, and estriol. The research available suggests there is some benefit but there is little published data on safety or long-term effects (Source: Menopause, May-June 2004, pages 356-367) and an earlier study showed there were potential negative side effects such as depression (Source: European Journal of Endocrinology, May 2003, pages 571-577).
Skin Care Options.
It would be great to say that specific skin care solutions are available to permanently remedy the skin conditions initiated through menopause. 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 basic conditions for skin care continue to apply to perimenopausal and menopausal women alike: need for sun protection, treating the cyclical variations in the skin between oily and dry, dealing with hormonally induced acne breakouts and skin sensitivity. The challenge for menopausal women is that all of these conditions are happening simultaneously. What does every woman need in her menopausal skin care kit? A super retinoid (Vitamin A) to increase vascular flow, exfoliate the dead dry skin. Team up the Vitamin A with pure glycolic acid at concentrations of 15% (e.g., Resurfacing Acclerataor from Skin Authority) for removing surface dead skin cells. This step absolutely helps improve the appearance of skin, allows healthier skin cells to come to the surface, and allows better penetration of moisturizers. Studies also show that AHAs and BHA can stimulate the production of collagen, which also has benefit. Once dead skin is removed, utilize moisturizing products infused with antioxidants and anti-inflammatory agents (e.g. Daily Cell Defense from Skin Authority). The use of hydroquinone or arbutin-based skin-lightening products (e.g., Hyperpigmentation treatment from Skin Authorityi) is another important option if skin discolorations (such as melasma or chloasma) are present. The most important step is keeping hormonal discoloration at bay is to wear an effective sunscreen with Parsol 1789 or Avebenzone as a key ingredient to prevent further melanin stimulation.
These skin care basics will keep skin balanced and healthy against the ravages of hormonal changes; however, there is nothing you can apply to skin (other than estrogen creams) that can alter the actual depletion of hormones.
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