I remember the call from my mom: “I think I’m going through the change,” she said, detailing her erratic temperature shifts, her lack of sleep and the “pooch” below her belly button that used to shrink with exercise, but no longer budged. I could hear the uneasiness in her voice, like she couldn’t believe she’d reached this point in her life. Duxbury, MA plastic surgeon Christine Hamori, MD hears this often from patients: “The topic of menopause has been under a shroud of shame and guilt for too long,” she says. “All women experience it, and it’s important that we discuss it,” especially as studies reveal that more than 50 million women in the U.S. will enter this phase of life by 2020.
THE 3 STAGES OF MENOPAUSE
The “Ovarian Retirement Plan,” as Louisville, KY OB/GYN Rebecca Booth, MD calls it, has three unique phases. Here’s the scoop on each.
This is considered the winding down of a woman’s biological clock in her late 30s or early 40s. “Menstrual cycles begin to shorten, periods often change and PMS may become more dramatic,” says Dr. Booth. Perimenopause is also not to be confused with “Premature Ovarian Failure (POF), which is the loss of ovulation before age 40 and affects as many as 1 percent of women,” she adds. “The cause is usually unknown, but diabetes, autoimmune diseases and smoking often contribute.” (“Smoking has been found to put women into menopause two years earlier on average,” says Hamilton, NJ OB/GYN Omnia M. Samra-Latif Estafan, MD.)
Rochelle Weitzner, CEO of Pause Well Aging, a menopause-centric skin-care line, says that in certain circumstances, women can be thrust into menopause early. “Induced menopause can result from chemotherapy, radiation, autoimmune or thyroid diseases, and IVF treatments; surgical menopause occurs immediately after a woman has her ovaries removed,” she explains. “In this case, her symptoms may be more severe because of the rapid change to her body.”
This marks the cessation of ovulation—going a full year without a period. “We are born with all of the eggs we will ever have, and they deplete as we age, with all of them disappearing around age 51,” says Dr. Booth. A sharp drop in predominant sex hormones—estrogen, testosterone, progesterone—causes troublesome symptoms for many women (more on that later), but some don’t experience them at all.
This stage begins immediately after menopause. Per the U.S. Department of Health and Human Aging, because baby boomers are past the midlife point, an unprecedented number of women are currently in this stage.
The significant drop in estrogen during phases of menopause can manifest both internally and externally. “Like pregnancy, menopause can be a wonderful transition or a complete upheaval of normalcy,” says Dr. Samra-Latif Estafan. “Everyone’s journey is different, so it’s important not to believe everything you read online.” These are the side effects that can arise, and what to do when they throw you out of whack.
“The skin on a woman’s face has the second highest concentration of estrogen receptors in her body—the reproductive area has the most—which means that changes in hormone levels directly impact her skin,” says Nashville, TN dermatologist Jill Fichtel, MD. The estrogen decline leads to slower skin cell turnover, which “causes light to reflect off the skin differently, affecting the color and brightness of the skin, and making natural irregularities like wrinkles, oil glands and hair follicles more noticeable as bumps and depressions,” she adds.
One of the most dramatic effects is the acceleration of loss of elasticity and formation of wrinkles. “A study on the decrease of skin collagen in postmenopausal women found a decrease of 2.1 percent per year in the first 15 years after menopause,” says Dr. Booth. “Thus, on average, from age 50 to 65, more than 30 percent of skin collagen will be lost.” The collagen plummet then contributes to sagging, “especially around the cheeks, jawline and neck,” notes New York plastic surgeon B. Aviva Preminger, MD. For those wanting to restore a more youthful contour, in-office skin-tightening treatments such as Ultherapy and AccuTite, as well as facelifts and necklifts, can provide long-lasting results.
Dry and dehydrated skin are also concerns: “Moisture levels of the dermis are no longer regulated, and the skin isn’t able to effectively defend itself against oxidative stress,” says Weitzner. “When this is the case, look for products containing hydrating ingredients that also promote collagen production and support skin’s structural integrity, such as niacinamide, peptides and hyaluronic acid.”
Skin-care products made with plant-derived molecules called phytoestrogens—red clover, soy, grape seed—also help reverse signs of aging in the skin. “They mimic the effects of estrogen, and when applied topically, they activate estrogen receptors in the epidermis, promoting the skin’s ability to hold onto water, as well as increasing collagen and elastin production,” says Dr. Booth, who’s also cofounder of VENeffect, a phytoestrogen-based skin-care line. “Over time, lines and wrinkles become less visible, overall texture improves and skin recovers its glow.”
Metabolism is affected by estrogen, too, so for many women, menopause triggers weight gain. “The weight seems to settle around the abdomen, hips and thighs, and is very resistant to diet and exercise—the average woman gains between 10 and 15 pounds,” says Dr. Preminger. Breast size can change as well, but whether this is due to weight gain or changes in breast density is not clear, Dr. Hamori says, adding that many of her patients experience this during their 40s and 50s.
“A major side effect many women suffer from but don’t talk about is achiness in the muscles and joints—in some countries, it’s the number-one complaint,” says Mary Jane Minkin, MD, OB/GYN and clinical professor of obstetrics at Yale School of Medicine. “We really don’t know what brings it on—likely dryness in the joint capsules—but it’s being studied.”
A high rate of osteoporosis is associated with menopause as well: According to the National Center for Biotechnology Information (NCBI), more than 250,000 menopausal and post-menopausal women have this form of bone loss (or decreased bone density) due to estrogen deficiency. “During menopause, women experience an accelerated rate of bone loss of 3 to 5 percent per year for the three to four years after their last period,” Dr. Minkin explains. “We continue to lose bone after that point, but not at such a fast rate.” Prescription medications such as bisphosphonates and denosumab, and supplementation with calcium and vitamin D, can help minimize symptoms.
According to Dr. Minkin, hair loss is not an “official” side effect of menopause, but many women experience it, in addition to an increase in the brittleness of their hair and a lack of shine. “The hormonal changes decrease how long anagen—the growth phase of the hair cycle—lasts, leading to thinner, finer, shorter hairs that can even reach the point of being vellus hairs—the barely there hairs you see on your forehead or ears,” Dr. Fichtel says. To strengthen fragile strands, fill your routine with products that promote a healthy scalp and stimulate hair growth, such as essential oils and minoxidil.
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