My So Called Menopause: Modern Ways to Navigate the ‘Change’

My So Called Menopause: Modern Ways to Navigate the ‘Change’ featured image
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This article first appeared in the Winter 2024 issue of New Beauty. Click here to subscribe

Hormones affect so many aspects of our health, from our mood to our weight, our sex drives and sleep schedules, our skin, hair and even our focus, yet they remain a topic that is largely ignored. But that is changing. “Menopause and hormone therapy are hot topics right now,” says Oakland, CA OBGYN and advisor for Luna Daily Cheruba Prabakar, MD. “More and more mainstream media outlets are focusing attention on this important and largely neglected topic.” Celebrities are also contributing to the rebranding of menopause thanks to A-listers investing in menopause-related products and services. Drew Barrymore is among a group of famous female celebrities investing in the menopause telemedicine company Evernow. Actress Naomi Watts founded the menopause wellness brand Stripes, and WILE, a hormonal supplement line, is founded by actor Judy Greer and backed by Serena Williams.

Signs of Imbalance

While hormone changes occur over time, we typically notice the symptoms first. “The most common are irregular periods or heavy bleeding, fatigue, mood swings, anxiety or depression,” says New York gynecologist and chief medical officer of VSPOT medspa Dr. Monica Grover. “Other indicators include acne, skin changes, changes in sex drive, weight loss or gain, hot flashes, night sweats, hair loss, vaginal dryness and urinary incontinence.” If you’re experiencing these symptoms, Dr. Grover suggests proper diagnostic testing: “Request a hormonal blood test from your provider. It is important that they test the full panel.” Dr. Grover also recommends additional tests, such as thyroid-function tests, follicle-stimulating hormone tests, pelvic ultrasounds, anti-mullerian hormone tests, inhibin A and B tests, testosterone levels, as well as TSH and Free T3.

Hormonal Shifts

In the realm of hormones, estrogen is essential. “Estrogen is a hormone that is naturally produced by the ovaries during the premenopausal years,” says Beverly Hills, CA OBGYN Mickey Karram, MD. Estrogen plays a role in maintaining normal menstrual cycle regulation, bone health, cardiovascular function, mood, cognitive function and vaginal and skin health. “Estrogen also helps maintain skin elasticity and collagen production,” says Dr. Karram.

“The loss of estrogen also triggers hot flashes, night sweats and increases our forgetfulness, foggy thinking and the risk of dementia,” adds Southlake, TX dermatologist Janine Hopkins, MD. At the same time, progesterone production decreases, leading to irregular periods and mood swings. “Progesterone loss also leads to poor sleep and fatigue,” says Dr. Hopkins. We also need it to help calm the skin and reduce acne, notes Dr. Karram.

When our testosterone levels decline, it also takes a toll on our bodies. “A drop in testosterone slows metabolism, decreases muscle mass and leads to decreased libido, which can affect us emotionally,” says Dr. Hopkins.

Treatment Options

The treatment options for hormone imbalances typically include hormone replacement therapy. There are three different types of hormone replacement therapies: estrogen-only HRT for those with a hysterectomy, combined HRT involving estrogen and progestogen, and body identical HRT using hormones identical to those naturally produced in the body. Testosterone replacement therapy is also available. “Hormone therapy is the gold standard for treating symptoms,” says Dr. Prabakar. “Women experiencing hot flashes, sweats, mood changes and poor sleep will see improvement with the aid of hormones. Most women enjoy a significantly improved quality of life once they start treatment.”

Is HRT Safe?

HRT should be administered by a qualified physician after a thorough discussion of its risks, benefits, and alternatives. “It can be administered orally, transdermally or vaginally. Each comes in several doses and can be adjusted according to what provides the patient relief,” says Dr. Karram. He notes that some delivery methods are more convenient than others, like the estradiol patch. “This is one of the most popular approaches,” he adds.

He also notes there are known side effects of oral pills. “Long-term safety of HRT is a subject of ongoing research, with a focus on its effects on breast cancer, cardiovascular health, and cognitive function. Bioidentical hormones, which are identical to those produced by the body, are gaining popularity as a potential alternative to synthetic hormones, aiming for more precise hormonal balance and fewer side effects.” However, recent studies have shown that the risks of serious side effects from HRT are very low, and the benefits of HRT usually outweigh the risks.

Non-Hormonal Alternatives

“Despite their safety, there is a very small subset of women who cannot use hormone therapy safely,” notes Dr. Karram. There are several non-hormonal medications available to treat symptoms such as hot flashes and night sweats. New on the market is Veozah, which works by blocking the brain chemical that triggers hot flashes. “These novel medications offer hope for patients who face challenges with traditional hormone therapy.”

In addition to lifestyle changes, plant-based and herbal supplements can also help. “Some women turn to natural remedies like phytoestrogens found in soy and other plants or herbal supplements like black cohosh,” adds Dr. Karram. “While they may help some, their efficacy can vary, and they are not without risks or side effects.

Skin Solutions

Clean cosmetic chemist Krupa Koestline says acne and dry skin are the top two skin concerns when hormones run amok. “Estrogen promotes collagen and elastin production,” she explains. “Progesterone has a calming effect on the skin and can help reduce acne and inflammation.” She also highlights the influence of androgens testosterone and dihydrotestosterone. “These stimulate oil production and can contribute to acne. Stress caused by the rise in cortisol can also lead to skin issues like acne, eczema and psoriasis.”

“Use ingredients like ceramides, hyaluronic acid, squalane, collagen, elastin, rosehip seed oil and sea buckthorn oil to help stimulate collagen and elastin,” she advises. “Keeping skin moisturized is the key. Retinoids are also beneficial for fine lines and wrinkles, but you also need a really good sunscreen.” Koestline says to also incorporate soy-based products into both your diet and skin care. “Soy is known to help with reduced estrogen levels.”

“Maintaining a healthy diet, using skin care for your skin type, exercising regularly, stress reduction, and getting adequate sleep all help,” adds celebrity aesthetician Veronica Barton Schwartz. “Another way to naturally balance hormones and clear skin is by taking Omega-3 fatty acids. They soothe our skin’s inflammatory response to excess sebum and bacteria, and help balance acne-causing hormones, like testosterone.”

Dr. Hopkins advises using hyaluronic acid for hydration, ceramides to replenish lipids, niacinamide for aging protection, and retinoids for enhanced cell turnover. “Specifically, for estrogen-deficient skin syndrome, I suggest Emepelle. It contains a peptide that mimics estrogen by binding to estrogen receptors on keratinocytes.”

Mastering Meno

Around the world, transformative menopause retreats are reshaping the narrative of this significant life transition. One such haven is The Retreat Costa Rica, where founder Diana Stobo introduces the “Mastering Menopause” package, a holistic journey designed to guide women through this transformative period. Stobo emphasizes a hormone- balancing diet, coaching, and emotional- support programs. “Our guests meet with our female Ayurvedic doctor, holistic healer and emotional support practitioner, and immediately feel seen and heard.”

On the island of Sylt, the renowned Lanserhof luxury wellness clinic offers a tailored program. Dr. Christina Haeggberg, a clinician at Lanserhof, explains, “We provide a range of therapies, including physio- and balneotherapy with water and cold therapy, thalassotherapy on Sylt’s West Beach, nutritional and sports medicine with personalized guidance, and psychological coaching covering sleep, self-efficacy, and stresses, and restoring chronobiology.”

In Lenox, MA the Wise Women retreat at Canyon Ranch delves into the physical and emotional facets of aging, addressing the impact of hormonal changes on various aspects of health. Across the pond, Menoheaven in the UK embraces the menopausal transition as a “Second Spring,” offering naturopathic sessions, yoga, pelvic floor strengthening, and deep healing practices. Co-founder Tania Smith says, “Women gather in circles to share and discuss their journeys‚ which can be some of the deepest work of all.”

In Spain, the SHA Wellness Clinic addresses the sexual aspects of menopause, with Cinthya Molina, head of the sexual health unit noting, “This is an area that has not been paid attention to, but we now have the tools to improve the sexual health of our patients.”

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