Menopause can cause a lot of skin problems
At 20, Melanie saw her mom go through menopause. She often noticed her mom Miriam gazing at the mirror and musing over her once-beautiful, youthful-looking skin. Miriam would tell how her skin was flawless, soft and fair, and how Melanie’s dad adored her skin. Then she would lift her skin to the side of her face to show Melanie how she looked when she was Melanie’s age. Sometimes, Melanie would notice the flushed look on her mom’s face especially if she was angry. Oftentimes, Miriam would complain of restlessness, about her very hot surroundings, excessive sweating and recurrent itching. She became moody, too, and would often get mad at simple things. Melanie would often hear her mom say that her vulnerability to getting annoyed was because of menopause. Looking back, Melanie realized she was going through the same menopausal changes her mother experienced many, many years ago.
At 50, Melanie was convinced menopause was in sight. It felt worse than a kid on a car trip asking, “Are we there yet?” In Melanie’s case, a nanosecond of nausea heralded its arrival. Intense heat described as slow, long heating up of the body ended with slow cooling, accompanied by a flood of sweat that sent one scurrying for lots and lots of tissue paper. Melanie was watching Fatal Attraction (a Michael Douglas and Glenn Close starrer) when her heart started to thump for a terrifyingly long time and so she decided to see a specialist who told her it was probably related to menopause. Apparently, estrogen also messes up with how our bodies react to the perception of danger, excitement or stress. As estrogen levels diminish, it makes a few errors in judgment and sends our heart racing.
Menopause is the cessation of menstrual periods due to loss of ovarian function and is a normal physiologic process in women that occurs after the fifth decade of life. Ovarian failure and the resulting hormonal changes during menopause affect almost all aspects of women’s health and may present with signs and symptoms in nearly every body system.
Hormonal changes caused by menopause can lead to a lot of skin problems. Estrogens are essential for skin hydration because they increase the production of glycosaminoglycans (supports and promotes collagen and elastin’s ability to retain moisture in the skin), promote increased production of sebum, increase water retention, etc.. The lack of this produces rough, dry, flaky, pigmented, wrinkled skin.
Changes in circulating androgens are more complex and controversial. However, the androgen level steadily diminishes during the transitional period and is partially responsible for the reduction in sebum secretion which aggravates xerosis (dry skin) and skin thinning or atrophy, accompanied by reduction in blood vessels, oxygenation and nutrition (resulting in slow healing), increased transepidermal water loss and reduction in elastic fibers as well. The latter leads to loss of firmness and skin elasticity (skin sagging). Decrease in estrogen causes a reduction in axillary and pubic hair. Moreover, with a relative predominance of androgenic hormones, vellus hair (baby hair) may be replaced by thicker hair.
In women, hormonal changes during menopause are the main source of alterations in hair characteristics that lead to the change in pigmentation (graying of hair), growth and diameter. Also, up to 50% of women experience female pattern hair loss (FPHL) and senile alopecia (reduction in follicles). The clinical distinction between these two can be challenging as the conditions may coexist. Fibrosing alopecia, another entity, is a slow, progressive cicatricial alopecia (scarring alopecia) characterized as a pale, atrophic patch surrounded by hyperpigmented skin due to long-term sun damage and producing symmetrical balding in front and at the sides of the scalp but rarely affecting other areas. It is often associated with nonscarring alopecia of body hair or eyebrows.
Telogen effluvium is the premature transformation of hair from the anagen (growing phase) to telogen phase (resting phase). It is usually associated with endocrine, nutritional and autoimmune disorders but may be secondary to hemorrhage, high fever, surgery, drug use, diet or great psychological stress. Chronic telogen effluvium (CTE) is hair fall lasting more than six months. It predominantly occurs in women aged 40 to 60 years old. CTE is assumed to result from a shortened duration of the growing phase in the absence of the shrinking of hair follicles.
Brittle nails syndrome involves factors that affect adhesion of the superficial layer of the nail plate (resulting in nail splitting) and altered nail formation from its matrix (results in easy breakage of fingernails). Low estrogen levels in menopause lead to dehydration of the nail plate and other problems as well as the likes of: cardiovascular, urogenital (frequent urination, cystitis. and incontinence are more common), osteoporosis, teeth (menopause blamed for numerous dental/oral issues, including dry mouth and desquamative gingivitis but often aging itself is the cause. Disruption of an entire chain of biochemical activities affects the production of mood-regulating chemicals, including serotonin and endorphins, resulting in mood swings, temper tantrums, depression, surprising highs, followed by equally unexpected lows), vasomotor instability (hot flashes), altered menstrual function, vaginal atrophy (the genital tract is highly estrogen-dependent so that body changes during menopausal transition and post-menopause include vaginal and vulval dryness, painful sex, post-coital bleeding/ spotting and thinning of the labia).
A sizable number of treatment procedures are now available for skin, hair and nail problems. Access to creams, peeling agents that remove pigmentation, state-of-the-art laser therapy, antiaging injectibles, oral supplements and medications are your best bets to maintain or restore whatever menopause has stolen away from you.
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