Menopause
How it Will Effect Your Skin and What Can Be Done About It.
by Diana Howard, PhD
Reprinted from Dermascope,
published in the United
States.
Since the 40 million women of the baby-boom generation began turning 50 several years ago, attention has focused on the overall effects of menopause on the body. More specifically, skin and body care professionals have realized that in order to meet the needs of their demanding clientele, they must not only be prepared to address this issue with therapeutic treatments to offset symptoms associated with this physiological change but they must be prepared to answer questions that their clients might have regarding this change of life.
When a woman nears the age of 50, her menstrual cycles become shorter and less regular. Ovulation does not occur consistently during each cycle, irregular and missed periods are common, and fertility is lower. Eventually, she will cease ovulating and menstruating altogether, a phenomenon called menopause. The actual menopause itself lasts one week, as the word menopause means , "last natural menstrual period". However, many people use this term to describe what is really known as the climacteric, the time of change that may actually go on for many years.
The average age that menopause occurs in the USA is 52 years, with a normal range of 45-55. About 1% of women, however, reach menopause before the age of 40. Interestingly, women in developing countries tend to reach menopause at an earlier age, which has been associated with poor nutrition. Other factors may effect when a woman goes through menopause such as if she gave birth to twins or if she is a smoker; both phenomena appear to trigger an earlier menopause.
What causes menopause?
The major cause of menopause is age-related changes in the ovaries. The number of follicles remaining in the ovaries of menopausal women is significantly reduced. In addition, the follicles that remain become less sensitive to stimulation by pituitary hormones, even though their levels are elevated, resulting in fewer mature follicles and a reduction in the production of corpora lutea. This results in lowered estrogen and progesterone production, which in turn leads to changes in the skin. These changes will be the focus of this article.
Before we can really understand what happens during menopause, we need to first review the hormonal and physical processes that occur during the normal, regular menstrual cycle. The menstrual cycle is a very complex set of processes, many of which are poorly understood. But, the major phases and their control are quite well documented.
The menstrual cycle is divided into 3-phases: Menstrual (destructive) phase, Follicular (growth) phase; Luteal (secretory) phase.
1. Menstrual (destructive) phase: It is customary to designate the first day of the cycle (day 1) as the first day of the menstrual phase. This is the day on which menstruation begins, and it is chosen as a starting point because a woman is more aware of this day than any other. The menstrual phase usually lasts about 5 days but may range from 1-8 days.
2. Follicular (growth) phase: The follicular phase begins at the end of the menstrual phase, or on about day 6 (if menstruation lasts 5 days). During the follicular phase, follicles in the ovaries grow quickly and begin to secrete the estrogen hormone, (-Estradiol. (-Estradiol, in turn, stimulates the growth of the uterine lining (the endometrium). This phase continues until ovulation, which occurs on or about day 14 of a 28 day cycle (day 16 of a 30 day cycle).
3. Luteal (secretory) phase: The luteal phase lasts from ovulation to the beginning of menstruation. It is during this phase that the corpus luteum, which is formed from the wall of the ovulated follicle, secretes (-Estradiol and progesterone. Both hormones serve to prepare the uterus for the arrival of an embryo (if fertilization of the egg has occurred). The egg disintegrates if fertilization does not occur, and its remains are washed out of the body in the menstrual flow.
Each of these phases is under the control of hormones and each hormone has control over its own production. The whole thing works something like this:
In order for (-estradiol and progesterone to be produced by the ovaries, the follicles must be stimulated by hormones produced by the Pituitary Gland (the "Master Gland" of the body). These Pituitary hormones are collectively known as "Gonadotropins" (Gn). There are two that are involved in the menstrual cycle: One is called FSH (Follicle Stimulating Hormone) and it functions to stimulate ovarian follicles to grow and produce (-estradiol. The other is called LH (Luteinizing Hormone) and it works with FSH to stimulate follicles, after ovulation, to produce progesterone plus (-estradiol. In order for FSH and LH to be produced, the Pituitary must be stimulated by another hormone. This hormone is called GnRH (Gonadotropin Releasing Hormone). GnRH is produced by the brain also, this time by the Hypothalamus. Please refer to Chart 1A.
So, how does the Hypothalamus "know" when to produce GnRH? Probably the easiest way to understand this very complex series of processes is to look at what's happening at each phase of the menstrual cycle. (The numbers refer to various stages noted on Chart IB)
1. During the Menstrual Phase, the (-estradiol (estrogen) levels in the blood are very low. The Hypothalamus detects these low levels of (-estradiol and, in response, begins secreting GnRH.
2. The Pituitary Gland detects the rising levels of GnRH and begins secreting FSH and LH.3. During the beginning and middle parts of the Follicular Phase, FSH is transported to the ovaries by the blood where it stimulates several ovarian follicles to start growing and secreting (-estradiol. LH is stored in the pituitary for later use. Its secretion is controlled by (-estradiol levels.
4. As (-estradiol level rise in the blood, the (-estradiol is detected by the Hypothalamus. As a result of these rising levels of (-estradiol, the Hypothalamus begins to slow-down its production of GnRH. Which, in turn, causes the Pituitary Gland to slow its production of FSH and LH. 5. During the later parts of the Follicular Phase, the ovarian follicles are now producing large amounts of (-estradiol and the high levels of (-estradiol are now detected by the Pituitary Gland.
6. The high level of (-estradiol now stimulates the Pituitary to secrete a "surge" of LH (and, to a lesser extent, FSH).
7. At the end of the Follicular Phase, LH stimulates one of the ovarian follicles to become mature and LH stimulates ovulation (release of the egg).
8. Once ovulation has occurred, the Luteal Phase begins. It is during this phase that LH stimulates the follicle to start producing Progesterone (and, to a lesser extent, FSH stimulates additional (-estradiol secretion).
9. The Hypothalamus detects the rise in Progesterone and (-estradiol levels and responds by slowing its production of GnRH. The lowered GnRH levels are detected by the Pituitary resulting in the turning-off of LH and FSH production.
10. As the levels of LH and FSH decrease, the ovarian follicle ceases to produce Progesterone and (-estradiol. Blood plasma levels of Progesterone and (-estradiol now drop to nearly zero. This stimulates Menstruation to begin.
11. And the "cycle" continues.What happens to our hormones during menopause?
First, there is a change in the GnRH secretion pattern. The ovaries cease to respond to FSH and LH, possibly because their blood supply decreases. In addition, most of a woman's stock of germ cells (potential egg cells) in her ovaries is depleted or gone by this age. Because the ovaries degenerate, the production of (-Estradiol decreases to very low levels. This means that the average woman in the USA spends about one third of her life without estrogens, which influence over 300 bodily functions.
The adrenal glands and ovaries of post-menopausal women also secrete increased androgens. These hormones, in the absence of estrogens, cause some menopausal symptoms such as voice deepening, enlargement of the clitoris, and appearance of facial hair. It had long been thought that hot-flashes were caused directly by the abrupt lowering of estradiol levels; we now know that a woman's sympathetic nervous system is more active after menopause because of low estrogen, causing the dilation of skin arterioles and sweating, as well as a 1(C rise in body temperature and an increase in heart rate during the flashes. Hour-to-hour changes in the secretion of LH from the pituitary gland of post-menopausal women have also been associated with hot-flashes. Because estradiol levels are so low, there is little if any negative feedback on GnRH secretion, and the pituitary gland secretes 10 times as much FSH and 4 times as much LH as in younger women.
Symptoms of menopause:
Before and after a woman reaches menopause, about 85% of women may have symptoms, the occurrence and intensity of which vary from woman to woman. For most, these symptoms stop within a year, but for some they can last up to 3 years or more. Symptoms associated with menopause include dizziness, numbness, heart palpitations, insomnia, pigmentation spots, backaches, and dry mouth. Another symptom is "hot-flashes", which are intense feelings of warmth in the skin (particularly the face), accompanied by profuse sweating. About one fourth of all women undergoing menopause experience hot-flashes; of these, 67% experience them for more than a year, and 25% for more than 5 years. Hot-flashes are caused by dilation (widening) of blood vessels in the skin, which results in warm blood being carried to these regions. Hot-flashes may occur as often as ever 10-minutes per day and night or may be less frequent.
Other physical symptoms of menopause could include slight shrinking of the external genitalia, breasts, and uterus. The vagina can decrease in size, and its lining becomes drier. Chronic inflammation of the urethra (urethritis) is common. A woman may gain weight, and fat may accumulate in her abdomen. Her skin may become wrinkled, her voice may deepen, and hair may appear on her chin and upper lip. Calcium and phosphorous are lost from the bones at a greater rate, and a condition called osteoporosis can develop. In this condition, the bones become weak and prone to fracture, and a woman may lose height because her vertebrae compress. In the USA, about one-in-four women over age 50 develops osteoporosis. This means that today about 25 million American women have this disease. The phrase "female climacteric" is used to refer to all of the changes (hormonal & physical as well as psychological and emotional) of menopause. Menopause can be a period of psychological adjustment for some women. Emotional symptoms that can occur include irritability and depression.
Hormonal changes of menopause: Effects on skin
The hormonal changes that occur during and after menopause tend to change the skin's physiology in new and different ways. The decline of (-estradiol during menopause is one of the culprits in the accelerated aging of the skin. A woman should take special care of her skin after she reaches 40 years of age. As you get closer to menopause, the following changes begin to occur in the skin:
Oily skin: During the reproductive years, (-estradiol stimulates a more-fluid sebaceous gland secretion ("anti-acne" effect). During menopause, as estrogen levels decrease, testosterone (produced by the Adrenal glands) is no longer masked in the woman's body. Testosterone reveals itself by stimulating sebaceous glands to secrete thicker sebum, giving the appearance of oily skin (and the tendency toward adult acne in some women).
Facial hair: Also due to the unmasking of testosterone, some women may develop facial hair, particularly in the chin area. Sagging skin and wrinkles: Estrogens stimulate fat deposits over the female body; as estrogen levels drop during menopause, fat deposits tend to become redistributed and often concentrated over the abdomen and/or on the thighs and buttocks. The result is loss of supportive fat below the skin of the face, neck, hands and arms: allows sagging wrinkles to appear and the skin over these areas is less easily compressed and it loses its mobility. Also, fat deposits are reduced in the breasts resulting in loss of turgor which causes the breasts to begin to sag and flatten.
Elastosis: Protein synthesis, particularly that of collagen & elastin, are partially controlled by estrogens. Thus, during menopause, the lowered estrogen levels result in less production and repair of collagen & elastin in the dermis of the skin. This lack of repair is particularly pronounced if the skin is exposed to Ultra Violet rays (sunlight). UV rays are very destructive to collagen and if we lose our repair mechanism, then we lose our skins resiliency. The result: elastosis.
Thinning epidermis: The growth and maintenance of blood capillaries in the dermis is partially under the control of the estrogens. Thus, blood flow through the dermal capillaries is reduced during menopause. The result: less nutrients and oxygen are available to the stratum germinativum or basal cell layer of the epidermis; this contributes to the thinning of the epidermis and slower cell turnover rate . This is accompanied by a reduction in the barrier function of the epidermis which leads to increased trans-epidermal water loss and dry skin. (An interesting note: The cells that make up the surface of the skin are similar in structure to those of the urinary tract and vagina. Often times when a woman begins to notice changes in her skin (e.g., wrinkling, sagging, dryness, flaking and loss of resiliency), there are similar changes occurring in the lining of the urethra, bladder and vagina. Thus, the skin may be revealing other tell-tale signs of menopause.)
More prone to sundamage: The maintenance of Melanocytes (cells that manufacture the pigment, Melanin) is under control of estrogens. As menopause progresses, the number of melanocytes in the skin is reduced (they degenerate). With less melanocytes, we produce less of the protective melanin and skin appears lighter. Menopausal skin is therefore, more prone to sun damage making it is even more important to protect the skin with a sunblock.
Hyperpigmentation/age spots: Melanin production is also tempered by estrogens. That is, estrogen exerts a regulatory effect on the production of melanin...it keeps production under control. In areas of the skin that have been exposed to UV rays over the years, as menopause arrives, melanin synthesis increases (due to lack of regulation by estrogen). This can result in brown, "age spots" appearing on the face, hands, neck, arms and chest of many women.
Hot flashes: Lowered estrogen during early menopause causes dermal and sub-dermal arterioles to dilate, sporadically (due to effects on Sympathetic Nervous system), resulting in an increased flow of warm blood. Results: hot flashes.treatments for menopause: professional skin care treatments
The greatest challenge for the skincare professional in addressing the needs of the menopausal client will be to provide professional expertise on how to meet the ever- changing skin care needs during this critical time. As discussed earlier, the effects of fluctuating hormones on the skin's physiology and structure will require new professional treatment remedies, as well as, a revision to the at home skin care regimen. An overview of symptoms, recommended treatments and ingredients to look for is outlined in Chart 3.
It is important to remember that we must treat the body as a whole not just the symptoms. That being said, it is essential that we consider alternative therapies along with classic treatments as part of the overall professional service. Simply helping to reduce stress in the menopausal client will contribute to their overall well being.
Alternative therapies that may help to restore balance and alleviate stress include, reflexology, ayurvedic treatments, oriental acupressure, spa body treatments, la stone therapy and aromatherapy.
Aromatherapy in particular has been used for many years to treat menopausal symptoms. Consider incorporating aromatherapy treatments that use the following essential oils: bergamot, chamomile (Roman), clary sage, jasmine, fennel, frankincense, geranium, hops, lavender, melissa (true), neroli, rose otto, sandalwood, and ylang ylang. Both cypress and clary sage are recommended for hot flushes and night sweats.
Regardless of what therapies you incorporate into your professional service menu it is recommended that you obtain post graduate education to ensure that you are fully cognizant of the theory, as well as, correct application and the contraindications of each of these treatments.
The International Dermal Institute, the largest post graduate training facility for skin care and body therapy has locations in Los Angeles, San Francisco, New York, Washgington D.C., Ft. Lauderdale, Chicago, London, England and Sydney, Australia. All locations offer extensive hands-on classes in all of these alternative therapies, as well as, a full day class on the effects of hormones (including pregnancy) on skin and appropriate treatments for menopausal skin. For complete details call 1-888-29CLASS.
References:
1. HUMAN PHYSIOLOGY. 6th Edition. 1994. Vander, Arthur J., Sherman, James H., Luciano, Dorothy S. Mc Graw-Hill, Inc., New York.
2. MENOPAUSE. 1994. Stoppard, Miriam. Dorling Kindersley, New York.
3. HORMONES. 2nd Edition. 1997. Norman, Anthony W., Litwack, Gerald. Academic Press, New York.
4. ANATOMY AND PHYSIOLOGY. 2nd Edition. 1992. Seeley, Rod R., Stephens, Trent D., Tate, Philip. Mosby-Year Book, Inc.,Inset Summary Chart: to be accompanied by diagram of brain & ovaries (labeled 1A)
Chart 3
Menopausal symptom How to treat it Ingredients to look for Thicker sebum or adult acne Exfoliation: Hydroxy acid professional treatments
Manual Lymph Drainage (MLD)
Oil absorbing masques
Electrical: desincrusta-tion, direct high frequency
Oil control products
Vitamin A treatmentsMicrosponges for oil control
Balm mint, tea tree oil, witch hazel
Salicylic acid, lactic acidDry (alipoid) skin (lacking oil) Exfoliation: hydroxy acid treatments
Galvanic with nutrient rich serums
Nourishing masques
Paraffin masque
European Massage
Hydrating masquesVitamin A treatments;
Hydrating masques;
Vitamins A, E, C, F
Alpha & beta hydroxy acids
Sodium PCA
Hyaluronic acid, glycolipids, panthenol
Hydrocotyl, allantoin, licorice
Beta glucanFacial hair Facial bleach
waxing
electrolysis
laserPost treatment anti-inflammatories: Green tea extract , licorice, allantoin
Sagging skin; lackluster
Loss of tone and resiliencyExfoliation: non abrasive, hydroxy acid treatments
Skin firming treatments
Sunblocks
Galvanic with regen-erating serums
Pressure point massage
Vitamin A treatments
No European MassageVitamins A, C
Grapeseed extract, coneflower, cucumber, hydrocotyl, horsetail, wild yam, bioflavonoids, gingko bilobaThinning epidermis
Couperose/sensitiveExfoliation: non abrasive, hydroxy acid treatments;
Treatments to enhance cell turnover rate;
Vitamin A treatments;
Galvanic with hydrating serums;
No heat treatmentsVitamin A
Ginkgo biloba
Squalane
Red raspberryAge spots; hyperpigmentation Exfoliation: hydroxy acid
De-pigmentation treatments;
Galvanic with tyrosinase inhibitorsLactic acid, licorice, yeast, bearberry, vitamin C, sunblocks (minimum SPF 15) Diana L. Howard, PhD, is the vice president of technical development for The International Dermal Institute. She earned her doctorate degree from the University of California, Los Angeles, where she specialized in plant biochemistry. Howard has worked in research and development, as well as marketing, for major cosmetic companies. She has lectured extensively on the topics of therapeutic body spa trends and skills for achieving full business potential.
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