Menopause is a time when a woman transitions into the next chapter of her life; it is a time when almost everything about her physically, mentally, and physiologically may transform. The population of menopausal women is rapidly increasing. There are approximately 6,000 women in the United States daily that reach menopause, estimating at over 2 million per year. Although menopause is an inevitability for women, it is not something that is typically discussed. For example, not many people know that in the first 38 years of a woman’s life, her skin does not age as much as it does during five years of menopause. Menopause is a natural progression for a woman, but the experience may be radically different; it may be relatively easy for some and difficult for others. The greatest impact a woman can have in the face of menopause is empowering herself through education and knowledge and managing the changes through healthy and appropriate lifestyle choices.
In the early 1800s, Dr. Charles Pierre Louis de Gardanne, a French physician, created the word “ménopause.” This term is rooted in ancient Greek and was later translated to Latin, which is still the primary language used to name terms in the field of medicine and science. In Latin, “menopausis” came from the Greek word “men,” meaning moon – a point of reference for measuring the months – and “pauein,” meaning to pause or come to a stop.
Menopause is a period in a woman’s life when her menstrual cycles gradually cease, typically over a several-year period. From the ages of 48 to 55, women can expect to experience menopause, which is accompanied by erratic hormone behavior, dramatic skin aging, and a plethora of other symptoms. The lower production of estrogen and progesterone, female sex hormones, are the culprits. The percentage of menopausal women is consistently increasing. Women today are entering this period earlier than ever before, perhaps because of increased stress factors, diet, or even environmental effects. Many women begin experiencing menopausal symptoms in their early 40s.
There are three stages of menopause: pre-menopause, perimenopause, and post-menopause. Pre-menopause is the beginning stage accompanied by early signs and changes, perimenopause is the most severe period, and post-menopause is the last stage where hormones begin to level out and the symptoms settle down.
Perimenopause is the period before menopause when estrogen and hormone levels begin to drop. A woman typically reaches this stage in her late 40s. In this stage, women will experience vasomotor symptoms (hot flashes, night sweats, and flushes), sleep disturbances (insomnia and night sweats), elevated heart rate, mood changes (irritability, depression, and anxiety), vaginal dryness or discomfort during intercourse, and urinary problems. Women typically enter menopause between the ages of 51 and 52. A woman is officially in menopause when she has missed a period for 12 straight months. This transition can take up to three years.
Post-menopause begins after 12 months of the absence of a period. During this time, the symptoms are the same as perimenopause, but may increase in intensity. There is also an increased risk of heart disease, osteopenia, and osteoporosis. These symptoms can range from uncomfortable to life-altering.
Menopause can be confirmed medically by a blood test that evaluates hormone concentration. Hormone concentration in the blood alters significantly at the onset of menopause. During the early stages of menopause, there is a sharp drop in progesterone, with the levels remaining low. Estrogen levels decline as well, but have random surges. These irregular hormone fluctuations instigate the many changes in a woman’s mood and in her body before she reaches the post-menopausal, stable hormonal state. Overall, symptoms of all three stages proceed over a three-to-seven year span, which should be an adjustment period devoted to creating suitable skin care and wellness habits.
The human body is made up of many hormones and receptors. In young people, there is a constant biological flow of hormones activating receptor activity. To illustrate how this balancing act works, picture a lock and key. The hormones are the keys and the receptors are the locks. During menopause, the sharp hormone drop causes a decline in available keys, which leaves a growing amount of open locks. The insufficient amount of hormones causes involuntary receptor inactivity and an exponentially increasing biological lag to develop. As a result, there is a noticeable slowdown in the body’s self-regenerating potential and regression in overall appearance.
Menopausal symptoms are not just an end of the monthly cycle. As a woman approaches menopause, her levels of estrogen begin to drop significantly in a short time frame. The hormone decline causes an internal hormone imbalance, which is a primary contributor to skin aging. It is a difficult process involving many rapid skin changes, including wrinkles, dryness, flakiness, sagging, and thinning.
All layers of skin (epidermis, dermis, and the subcutaneous layer), become progressively thinner. Typically, estrogens are responsible for stimulating fat deposits in the female body and supplying blood flow to the skin. There is loss of supportive fat under the skin of the face, neck, hands, and arms, which makes way for sagging wrinkles to appear. The skin over these areas becomes less easily compressed and starts to lose its mobility. Other major symptoms include sporadic hot flashes, anxiety, irritability, depression, weight gain, joint pain, and even a reduction of muscle mass.
A decline in estrogen also lowers the skin’s natural collagen and elastin production, which is essential in the skin’s ability to self-repair. There is an even greater risk of collagen breakdown and photoaging when skin is exposed to ultraviolet rays, making it particularly important for menopausal women to wear sunscreen daily because of the harmful effects. Ultimately, a person is at their healthiest when their hormones are balanced. After all, these chemicals are responsible for regulating immunity, reproduction, mood, metabolism, growth, and overall physical development. A lack of equilibrium can result in acne, dry skin, hyperpigmentation, and other physical changes.
Undoubtedly, skin begins to age more rapidly at the onset of perimenopause. The inflammation genes become more active, causing certain skin disorders to develop or exacerbate, such as rosacea, pigmentation, and eczema. There is also greater risk of skin cancer, so regular and careful self-examination is crucial.
The production deficit of elastin and collagen fibers goes hand-in-hand with decreased skin elasticity. This equates to loss of volume in the lips, a concave appearance surrounding the eye area, wrinkles, and sagging skin. There is also a significant drop in hyaluronic acid in the intercellular layers, which is key to keeping skin looking plump. The overall slower cell turnover rate contributes to thinning skin and a reduction in the barrier function of the epidermis, leading to increased transepidermal water loss and a lack of skin lubrication.
A slowdown of the sudoriferous (sweat-producing) glands impairs the natural detoxification process through facial sweating. In conjunction, the sebaceous (oil-producing) glands are no longer efficient at moisturizing the skin with the body’s own oils. Skin continues to become dry, dehydrated, and lifeless if left untreated.
Women experiencing the hormone fluctuations of menopause also often see an increase in cellulite. This increase occurs when waste products, like fatty deposits, toxins, and fluids, get between the layers of the connective tissue. The worsened blood and lymph circulation is also a contributing factor.
Hyperpigmentation is often the skin’s response to its external environment. Exposure to ultraviolet radiation initiates a defense response from the body, causing a greater production of melanin to absorb the radiation. The increased amount of melanin moves closer to the surface and is identifiable by the dark pigment on the skin. During menopause, there is typically a reduction of melanin production because of the decline in melanocyte activity. As a result, women may begin to notice a pale appearance due to fading skin tone and a loss of luster and glow.
Although there is a decline of all hormones in the body, there is an overwhelming imbalance of androgens over estrogens because estrogens decrease with greater velocity. With the drop of estrogen, the male androgen hormones may become more pronounced. This domination can result in a sudden development of adult acne. The prominent androgen activity stimulates sebaceous glands to over-produce oils that can clog pores. The excess oils also sit on the surface of the skin and potentially attract bacteria that causes breakouts and acne.
Testosterone, an androgen hormone that dominates during this period, directly relates to menopause-related hair changes. Side effects associated with hair changes run the gamut between the two extremes of hair loss and hair growth. Balding or thinning hair is one side of the hormone issue. The other is growth of new hair in unwanted areas, such as the upper lip and chin.
Menopausal women have to go to great lengths to overcome the multitude of physical reactions from the body. The obstacles for each woman may vary, although headaches, backaches, hot flashes, weakened bones, loose teeth, gum problems, and increased risk of cardiovascular disease are some of the chief concerns.
Heart disease is the leading killer of women in the United States. Cardiovascular disease and stroke are responsible for one-in-three women’s deaths every year, with an estimated 44 million affected. In fact, after age 50, nearly half of all deaths in women are due to some form of cardiovascular disease. On the bright side, 80 percent of heart disease and strokes can be prevented through lifestyle changes, such as avoiding or quitting smoking and secondhand smoke, maintaining a healthy body weight, exercising regularly, and eating a diet low in trans and saturated fats.
The severely increased risk of heart disease in menopausal and post-menopausal women is possibly because of the estrogen decline. Normally, estrogen works to help keep blood vessels flexible and relaxed to easily accommodate and help regulate blood flow. According to Dr. Nieca Goldberg, a cardiologist and volunteer for the American Heart Association, there are other reasons for the increased risk of cardiovascular disease during menopause and post-menopause. For example, the rise of LDL, the unhealthy cholesterol, not being counteracted by the decline of HDL, the healthy cholesterol, in conjunction with increased blood pressure may play a role.
Menopause also puts women at greater risk of osteoporosis, a decrease in bone density and strength, causing higher risk of fractures. This disease often has no symptoms and is not discovered until a painful fracture, which it is known to cause. It is possible to treat and prevent osteoporosis if the person is aware and knows where to look for it. Similarly, osteopenia occurs when bone density is reduced and lower than normal; it is not severe enough to be diagnosed as osteoporosis. Increased risk of osteoporosis and osteopenia in menopause is directly linked to the lack of estrogen that naturally occurs.
It is important to exercise, find time to do the enjoyable activities, and generally be physically active. It will improve overall quality of life while generating the release of endorphins. This source of positivity will help to relieve the hardships associated with menopause.
NEW GENERATIONAL APPROACH
For decades, menopause was the unmentionable period a maturing woman went through alone and in silence. Luckily, today, the Baby Boomers generation, now menopausal, has brought light to the conversation, creating a comfortable, public environment for discussion and support. They are characteristically proud of their pasts and journeys and few are in denial once menopause approaches. They are the target demographic for skin care professionals offering menopausal, age-reversing skin-management treatments.
Many medical professionals have become accustomed to recommending hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) to their patients right off the bat when menopause approaches. The pharmaceutical “traditional” medicine approach of HRT or ERT works to stabilize jumpy hormone levels and helps ease many symptoms of menopause, but is accompanied by certain risks and potential side effects. HRT or ERT is the process of taking hormone prescription pills that contain artificial estrogen and progestin similar to hormones that are naturally made by a woman’s body. Estrogen medication comes either as a patch, daily pill, vaginal ring, gel, or spray, depending on personal preferences.
Some studies show that the overall risks of long-term use outweigh the benefits because the imitation hormones are foreign to the body. Recently, the Fred Hutchinson Cancer Research Center revealed that antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can provide similar benefits in comparison to low-dose estrogen and decrease menopausal hot flashes without the inflated risks.
When it comes to easing the rapid hormonal changes of menopause and the havoc they wreak, stabilization is key. Phytohormones are plant-derived compounds that possess estrogen-like characteristics that naturally and gently promote internal balance. Genistein, also known as an aglycon, is a phytohormone acquired through a hydrolysis process of soy isoflavones and has a chemical structure similar to real estrogen. It is not an actual hormone however, so the potential adverse side effects that exist with HRT are virtually eliminated.
Soy isoflavones are made up of large glycoside molecules. When soy is eaten, it is naturally hydrolyzed by hydrochloric acid that exists in the stomach, allowing isoflavones to be absorbed and effective. Skin, on the other hand, does not have any hydrolytic capabilities; in order for soy isoflavones to be beneficial through topical application, they must be in the form of an aglycon. Aglycons are soy isoflavones that have undergone the hydrolysis process, releasing the long sugar molecule originally attached to the glycoside, making the molecule small enough and bio-available to penetrate the epidermis.
Soy-derived phytohormones are smart plant hormones that have a self-sensing ability to influence changes in the body by either initiating estrogen receptor response or blocking androgen receptor sites when necessary. Referring back to the lock and key analogy, estrogen and genistein are so chemically similar that when genistein is introduced to the skin or body, it is accepted as its own “key.” The skin simply responds, once-again commencing the normal “key to lock” or “hormone to receptor” biological flow.
Genistein has tremendous skin benefits, including the unique ability to generate cell membranes. It rebuilds collagen and elastin, increases skin thickness, and hydrates and improves overall wellness while smoothing fine lines and wrinkles. Furthermore, phytosterols, phospholipids, and saponins in soy help increase skin’s immunity and resistance to both environmental effects and inflammation. The saponins’ molecule can absorb toxic buildup, boosting the energy and rejuvenation level of every cell.
Diosgenin is a phytohormone derived from wild yams and has similar traits to progesterone. Diosgenin, like progesterone, stimulates sebaceous glands to encourage greater oil production. Given that a menopausal woman’s skin becomes progressively dry, diosgenin works to improve skin appearance by facilitating the skin’s self-moisturizing action.
DIET AND NUTRITION
A balanced nutritious diet is essential at any stage in life, but especially one that is in line with the growing sensitivities that develop in women during menopause. There are certain types of foods, those that contain gluten, monosodium glutamate (MSG), processed sugars, and trans fatty acids, that can trigger an inflammatory response in the body. Furthermore, omega-6 fatty acids, which are traditionally known to be beneficial, also lead to inflammation. Inflammatory foods raise the level of cortisol, a steroid hormone. In response, histamines are produced in the body to counter the inflammation. During menopause, because of the hormone imbalance, women are especially reactive to histamine-rich foods. This reaction forces all-time high histamine levels and, ultimately, an intolerance.
Some of the common symptoms women have expressed include sleeplessness, crankiness, more frequent hot flashes, and severe itching throughout the body. Diet is critical in promoting healthy moods and wellness. Selecting foods that are low in histamines is important. Antioxidant-rich fruits and vegetables and other anti-inflammatory foods, such as green, leafy vegetables; tomatoes; and most berries are especially great to counter the body’s histamine response.
Taking an omega-3 supplement daily will have anti-inflammatory qualities for the entire body. Omega-3 is rich with essential fatty acids. It also improves bone density, along with foods that are also rich in calcium and vitamin D. Synergistically, they fight the vulnerability of developing osteoporosis by working to strengthen bones and reducing the risk.
Substances rich with phytoestrogens encourage hormone and receptor balance. A few types of phytoestrogen examples include isoflavones, diosgenin, and lignans. Examples of foods rich with isoflavones include soy, clover, and kudzu root. A diosgenin-rich food example is wild yams. Some common lignin-containing foods include flaxseeds, legumes, whole grains, peaches, strawberries, prunes, pumpkins, and squash.
The Asian population living in Asia is the perfect example of how an isoflavone-rich diet enhances vitality. They have dramatically lower incidences of people with skin conditions; cardiovascular disease; osteoporosis; and prostate, uterine, and breast cancers. With a primarily soy-based diet, they consume an estimated 300 milligrams of soy daily.
Soy is a superfood that contains the richest concentrations of isoflavones, phospholipids, phytosterols, saponins, vitamins, omegas, minerals and protein of any food source. It is becoming a staple in leading a holistic lifestyle. Simply eating soy offers a clean and pure source of protein rich in iron, manganese, phosphorus, magnesium, calcium, zinc, potassium, copper, and folic acid. In the United States, the highest quality non-genetically modified form of soy is grown in the Midwest.
Besides soy-based foods, a daily soy supplement is also recommended as it will provide additional support in the time of transition. Soy isoflavones supplements will help ease hot flashes and promote clearer, younger-looking skin.
Staying hydrated by drinking a sufficient amount of water is another way to encourage menopause wellness. Water boosts skin hydration and elasticity, facilitates detoxification by forcing toxins to pass more frequently through urine, and improves circulation and metabolism. It also offers a gateway to maintaining a healthy weight.
Certainly, exercise and all forms of physical activity will stimulate the mind and body through the release of endorphins. This forced state of positive emotions will counterbalance the mood swings or possible sadness. Maintaining a personal healthy weight is another tool to being constructively affective during this time.
SPA AND SKIN CARE
The experience of menopause varies from woman to woman and the journey for some may be a difficult one; for others, it is simply the next chapter. One thing is certain for skin care professionals, there is immense market growth and opportunities as Baby Boomers grow older. It is strategically wise for spa owners to offer treatments that support and manage menopausal skin aging.
Treatments incorporating phytohormones, especially soy isoflavones, are ideal for clients distressed by hormonal imbalances. Soy isoflavones work to naturally remedy hormone-associated aging and acne skin changes in synergy with the body’s own processes, as described earlier with the lock and key description of receptor and hormone behavior. The adaptogenic characteristics of soy isoflavones allows for it to be effective in treating both spectrums of skin concerns: wrinkles and dryness or acne-troubled skin.
A powerful way to combat skin aging is with products containing pure hydrolyzed genistein, which is derived from soy isoflavones, the most active and penetrable form. It initiates hormone receptor activity, which jumpstarts the biological lag. Every cell in the body has a memory and by reinitiating receptor action, the cells remember and behave as they did at a younger state. In turn, cells begin to better regenerate and boost overall skin vitality.
A phytoestrogen spa treatment rich with soy-derived genistein and wild yam-derived diosgenin, for example, is a great option for a wide spectrum of clients, depending on their specific skin concerns. Benefits include collagen and elastin renewal, increase in skin thickness, a boost in skin hydration, and smoothing in the appearance of fine lines and wrinkles. Genistein and diosgenin are both effective as a gentle, non-invasive way to reduce the severity and accumulation of cellulite. A phytoestrogen-rich treatment has both immediate and cumulative results, particularly when combined with a daily homecare regimen. Routine treatment and care truly provides a healthy, natural alternative to pharmaceutical-based treatments designed for problem and aging skin.
The recommended homecare routine for age management should include an appropriate daily cleanser, occlusive eye cream, serum, rich potent face complex, and sun protection. Depending on the personal maintenance commitment, an individual set of products for the day and night time may be optimal. In addition, using an exfoliant and a firming mask at least once a week will boost cell turnover and promote facial contour.
Massage is another effective treatment that improves menopausal symptoms. It improves blood circulation and lymphatic drainage. Massage not only helps purge toxins from the body, but also combats cellulite. It also promotes relaxation and is an uplifting experience.
Menopause in the past has been regarded as a negative occurrence in a woman’s life, making women want to run for the hills. Today, that perspective is changing. Menopause is a natural and necessary transition, but it is a time for a woman to adjust and continue to fully love herself. Although menopause is associated with many psychological difficulties, education about the physical and psychosocial needs helps to alleviate these difficulties. The latest in scientific developments, innovations, and knowledge, coupled with self-care, allows women to have power in the face of menopause to look and feel great.
- Gardanne, Ch. PL de. Menopause: The Critical Age of Women. 1821.
- Singh, A. (2002). A historical perspective on menopause and menopausal age. Bulletin of the Indian Institute of History of Medicine, 32(2), 121-135.
- Squadrito, F. et al. (2003). Effect of genistein on endothelial function in postmenopausal women: a randomized, double-blind, controlled study. The American Journal of Medicine, 114(6), 470-476. doi:10.1016/s0002-9343(03)00059-7
- Manson, J. E. et al. (2008). The menopause transition and postmenopausal hormone therapy. Harrison’s Principles of Internal Medicine, 17, 2334-2339.
- Smoller, Allison, J. W. et al. (2009). Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the women’s health initiative study. American Medical Association. Archives of Internal Medicine, 169(22), 2128-2139.
- American Heart Association. (2015, July). Menopause and heart disease. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Menopause-and-Heart-Disease_UCM_448432_Article.jsp#.WXa7p4jys2w
- Markman L., Shlyankevich, M., inventors; Hydrolysis and purification of active plant compounds suitable for topical application. U. S. Patent 20050037099. February 17, 2005.
- US Census Bureau. (n.d.). Projections of the population by sex and age for the United States: 2015 to 2060 (NP2014-T9). Retrieved from https://www2.census.gov/programs-surveys/popproj/tables/2014/2014-summary-tables/np2014-t3.xls
- Verdier-Sevrain, S. et al. (2006). Biology of estrogens in skin: implications for skin aging. Experimental Dermatology, 15(2), 45-46. doi:10.1111/j.1600-0625.2005.00377.x
- Kalaiselvan, V. et al. (2010). Current knowledge and future direction of research on soy isoflavones as a therapeutic agents. Pharmacognosy Reviews, 4(8), 111-117. doi:10.4103/0973-7847.70900
- Cornwell, T. et al. (2004). Dietary phytoestrogens and health. Phytochemistry, 65(8), 995-1016. doi:10.1016/j.phytochem.2004.03.005
Written by Victoria Tabak for Dermascope Magazine.
© All Rights Reserved. Published in October 2017 Issue