Chapter 8

Examining Your Skin and Hair on Menopause

In This Chapter

Ironing out the hormone-induced wrinkles and other skin changes

Putting a cap on thinning hair

Telling substance from snake oil

No, you’re not going crazy or losing your mind if you think that your skin has gotten drier over the years. Face it — dry skin happens. And it’s likely to be related — at least in part — to menopause. Depending on which scientists you believe, the sags and wrinkles in your face may or may not be due to lower levels of estrogen. Don’t worry — we give you both sides of the story in this chapter.

Dealing with your hair can get a little, well, hairy, too. If you’re like us, as a child, you watched an aunt or grandma in total amazement, wondering how that one hair on her chin got so long. Does grandma have to shave? Read on to find out why the hair on your head seems to get thinner even as it pops up in unwelcome places like your face.

We’ll be the first ones to admit that no one is going to win a Nobel Prize for discovering a pill to relieve the conditions described in this chapter. In the grand scheme of things, these conditions may be mosquito bites in relation to the other issues that women face during and after menopause. But they’re really annoying, and they vex our vanity! So it’s nice to know why they happen and what you can do about them. We’re also here to help you figure out what you can’t do (and thus avoid those sounds-too-good-to-be-true products you see on the late-night infomercials or the shelves of your local drugstore). That’s what this chapter is for.

Getting the Skinny on Skin

Usually, during perimenopause (the years leading up to menopause) and menopause, you’re on a heightened state of alert, looking for the changes you know are happening. You expect your periods to change, and you’re probably not all that surprised by vaginal and urinary changes. But one day you look down and realize the texture on the skin on the back of your hands has become less like satin and more like crepe. Suddenly you have a few extra laugh lines or crow’s feet around your eyes. You may also notice dry skin or dry scalp that you never had before. But wait — menopause can’t affect the outside of you, too, can it?

Making the skin and hormone connection

Menopause (more specifically the associated decline of estrogen levels) probably accelerates many of the little annoying changes that accompany aging. But separating the skin changes due to low estrogen from those that come as a result of being on this planet for a long time can be difficult. Think about it. Forty plus years of gravity is going to contribute to sagginess. No matter whether you’re a woman or a man, your skin has been fighting gravity’s weight ever since you could sit upright. By the time you approach your 70s, you’re left with jowls instead of cheeks and a turkey wattle instead of a nice, tight neck, and you’ve learned never to look down into a mirror.

Placing blame for skin woes

Besides gravity, a lot of other things contribute to the aging of your skin. The first one is age itself — simple wear and tear. We just can’t expect to go on looking like dewy skinned children forever. Muscle movement, sun damage, inflammation, medications, and other medical treatments can all take the bloom off the roses in our cheeks.

But estrogen (and its loss during menopause) does play a role in the great skin caper. The collagen and elastin fibers that keep your skin supple, pliant, and nicely molded to your frame slowly deteriorate as the active form of estrogen declines. The degeneration of collagen and elastin fibers leaves room for wrinkles. Wrinkles (creases in your skin) show up where muscles contract. For example, when you smile, several facial muscles pull tight, forming one or more lines in the skin adjacent to your mouth. With age, these lines stay behind even when you’re not smiling. Other wrinkles resemble straight or branched lines finely etched all over the weakened skin. These wrinkles are also the result of the double dip of low estrogen levels and aging.

The fatty layer under your skin disappears over time as well, and your skin loses its flexibility — which leads not only to facial wrinkles, but to a loss of firmness and smoothness to your whole birthday suit. If your skin were clothes, you’d probably go to the tailor to have it taken in. (In fact, some women do go to the tailor, also known as the plastic surgeon, to have the sags tucked.)

Medical folks are divided on how much blame to apportion to gravity and how much to assign to declining levels of estrogen. Some scientists claim that skin changes are just part of aging, but others feel that low levels of estrogen during the years leading up to and after menopause hasten a lot of these changes in your skin.

The hormone-imbalance crowd points out that estrogen helps bring moisture to body tissue. Menopause causes lower levels of estradiol (the active kind of estrogen), which causes tissues and mucus membranes all over your body to act strangely. How strangely? Some women develop pimples and dry skin at the same time.

But the bottom line here is that during perimenopause and menopause your skin loses its elasticity and tightness — it becomes thinner and saggier. As the fatty layer under your skin thins out over time, it will be easier to see your blood vessels, and you’ll bruise more easily. Because your skin is less pliant, it tears more easily than it used to — so you may encounter more minor cuts and scrapes.

Also, the skin-maintenance process slows down as part of the normal aging process in both men and women, so your body doesn’t regenerate skin as quickly as it used to — another reason you may bruise and cut more easily and heal more slowly.

Slowing the process down

Whether estrogen treatments are effective in slowing the skin-aging process in menopausal women is still debatable. (Especially because some experts don’t believe that shifting hormones has anything to do with skin changes in the first place.) Experts sit on both sides of the fence.

If you want to try an estrogen treatment, skin creams (you can call them transdermal estradiol therapies if you’re feeling pretentious) seem to be more effective than oral estrogen in preserving skin collagen. But don’t get overly optimistic about the results. When you see those smiling, wrinkle-free faces on the estrogen-cream advertisements, you can be sure that it’s not the estrogen skin cream that gives those women their smooth skin, big breasts, and girlish figures.

Shining a light on the sun’s dangers

The sun is public enemy number one for the skin. Sun exposure can cause wrinkles when you’re in your 20s or early 30s, and it can cause your skin to become leathery and unevenly colored years before perimenopause.

Working on wrinkles

Nothing prevents wrinkles like staying out of the sun. But if the damage has already been done, you can check out products that claim to retard the wrinkling process:

Retinoid creams: These products often make use of the terms retinoic acid, tretinoin, and the trademark Retin-A. Retinoids are vitamin-A acids. To the extent that they work, they do so by smoothing out skin pigmentation (color), reducing brown spots and wrinkles, and giving skin a rosy appearance. Usually, several months of use are necessary before you notice any improvement.

Alpha-hydroxy creams: Alpha-hydroxy acids work like a skin peel. They help remove surface skin cells, making your skin look rosier and smoother. Some advertisers claim that alpha hydroxy helps your skin produce new collagen and elastin. If this were true, alpha hydroxy would actually improve the layers under the skin, filling the wrinkles in from the inside out and reversing the aging process. Yeah, we wish. Some of the side effects of alpha hydroxy include burning, itching, and general skin pain. Newer products that contain beta-hydroxy acids incorporate a mild aspirin-like substance into the product, which is supposed to eliminate skin irritation.

Botox: Wrinkles are caused by contraction of facial muscles (as we discuss in the “Making the skin and hormone connection” section earlier in this chapter). Botox, a purified form of the botulism toxin, is injected into the facial muscles. It temporarily removes the wrinkle because the toxin temporarily paralyzes or weakens the affected muscles. When the muscles relax, the wrinkle disappears. After several months, the paralysis wears off and the wrinkle returns.

Reining in UV rays

The sun’s ultraviolet rays (UV) inflict the greatest harm on your skin. UV rays from the sun destroy collagen fibers. Remember, the collagen fibers hold the skin tight and keep it from sagging and wrinkling. The skin has a normal maintenance process in which old skin is sloughed off and new skin is rebuilt. UV radiation messes up this process so that the collagen fibers become disorganized and form “solar scars.” Just 5 to 15 minutes of sunbathing for fair- to moderate-skinned people can trash the skin-maintenance process for a week. UV radiation from the sun also causes a buildup of a substance that causes the skin to stretch (abnormal elastin ).

If you use skin creams containing AHA (alpha-hydroxy acids) in an effort to combat wrinkles, you can create another reason to be careful in the sun. These substances increase your skin’s sensitivity to the sun, and thus heighten your risk of sun damage. If you’re using products containing AHA, shield your skin from the sun and wear a sunblock with an SPF of at least 15 or higher.

SPF, or sun protection factor, is described as a number that tells you how long you can remain in the sun, while wearing the product, without beginning to burn. Other factors (such as sweating, swimming, or friction from playing sports) can shorten sunblock’s period of effectiveness.

Taking extra-large doses of vitamin A in an effort to improve your skin won’t work. Mega-doses of vitamin A are toxic — don’t try it!

Being a skin-savvy consumer

If snake oil were an effective moisturizer, thousands of women who’ve spent hundreds of thousands of dollars on questionable anti-aging skin care products would have absolutely radiant skin. Aging and menopause aren’t for sissies, but feeling good about our appearance is important. That’s why it’s so upsetting that a number of companies prey on our fears about aging and losing our youthful good looks.

Many of the creams and lotions and potions we hear about every day do give at least the temporary appearance and feel of smoother, younger looking skin. Some of them just make us feel good. And if you think all the claims you hear and read are legitimate, that would be understandable. After all, doesn’t the government regulate stuff like this for our protection?

Well, yes and no. The U.S. Food and Drug Administration doesn’t have the authority to regulate what goes into cosmetics. They can only get involved if they’ve received reports that a product has caused harm, or if the sellers of a particular skin product makes claims that it works like a medicine or actually changes the structure of a part of your body — such as curing wrinkles. When in doubt about a particular product, ask your doctor or a dermatologist about how realistic its claims are.

Be wary of products that claim to use “scientific” or “high-tech” breakthroughs to make your body produce more collagen (creams and lotions can’t get inside your skin to make this happen), turn back time, restore aging skin, or permanently cure wrinkles. You may get plumper (and thus less visible) wrinkles, but you could also end up with a much thinner wallet.

Caring about skin cancer

Along with lesser problems, UV radiation can cause skin cancer — a serious side effect of too much sun. Skin cancer can show up years after long-term exposure to the sun.

By the time you’re menopausal, your risk of skin cancer is higher because you’ve been exposed to UV radiation for quite a few years. Malignant melanoma is a rather rare but deadly form of skin cancer. It’s most commonly diagnosed in folks in their early 50s.

When you’re in the sun for too long, the sun’s UV radiation penetrates your skin and gets down into the DNA inside the skin cells. It zaps and damages the DNA — serious stuff because cell reproduction is based on DNA. Any mistakes in the DNA can have serious ramifications down the line. Sometimes, genetic mutations produce cancerous skin tumors. UV rays also suppress the skin’s immune system, leaving your skin susceptible to cancer cells.

Preventing premature skin aging

If you worry about the appearance of your skin, you’re probably wondering how you can combat the skin changes that accompany the aging process and menopause. Well, here you go. These are a few ways to keep your skin looking youthful and firm for as long as you can:

Don’t smoke. On average, smokers have thinner skin and more wrinkles than non-smokers. A heavy smoker is five times more likely to have a wrinkled face than a non-smoker of the same age. A 40-year-old, heavy smoker has the face of a non-smoking 60-year-old in terms of wrinkles.

Drink plenty of water. Internal hydration can help your skin look plumper (which makes wrinkles look less evident) and more youthful.

Follow a regular and sensible skin care regimen. Cleanse your skin daily with a mild cleanser suitable to your skin’s level of oiliness, follow with a mild toner, and finish with a good, basic moisturizer (no need to break the bank). You may not turn back the clock, but you’ll probably be happier with how your skin looks and feels.

Avoid exposure to the sun. Exposure to ultraviolet radiation accounts for 90 percent of the symptoms of premature skin aging. It’s also the most significant cause of skin cancers.

An awful lot of products that claim to reverse the aging of our hair and skin are advertised by “Dr.” this and “Dr.” that. Sometimes they’re real medical doctors and sometimes they’re not. Some legitimate doctors even market their own skin care product lines. Even some of these may cross a different line — an ethical one — when they claim to cure wrinkles or restore youth. Shame on them — be skeptical and take your questions to your own doctor.

Handling Hairy Issues

Gray hair has nothing to do with menopause, except that both tend to occur in women over 40. But menopause does bring about changes in hair patterns in ways you may never have imagined, including losing hair on your head and growing it on your face.

The hormonal imbalances of menopause can be responsible for those few hairs on your chin or other spots on your face. Hormone therapy helps restore some of the balance between hormones in your body, thus helping to preserve your hair (on your head) and protect your chin from hair growth.

Here’s why hair loss is more likely to happen after menopause: Hair follicles are receptive to hormones. Female hormone (estrogen) levels decrease faster than male hormone (androgen) levels, so where you once had very high levels of active estrogen and very low levels of androgen, you now have low levels of androgen but much lower levels of active estrogen. These lower levels of estrogen aren’t enough to block the effects of the androgen, one of which is hair loss.

Losing it — your hair, that is

We all lose a little hair every day. As hair grows, a few of the older strands jump ship every day. You see them in your hairbrush, but you might not think much about them until you wonder whether some day there will be more in your brush than on your head. As you age, hair growth slows, and the hairs that fall out aren’t replaced as rapidly. About one-third of women between the ages of 40 and 80 find their hair thinning all over their scalp but more so on the crown of the head. This is called female pattern baldness. The amount of hair loss varies from woman to woman.

Hair loss in women tends to be hereditary. There are other causes of hair loss in gals, too. These include thyroid disorders, pituitary tumors, stress, polycystic ovarian syndrome (PCOS), lupus, stress, and chemotherapy. So if your hair begins leaving you at an alarming rate, check with your doctor before you assume that it’s “just” a normal symptom of aging.

Taking care of your hair

Some women have had success using minoxidil, the same treatment recommended for balding men. This medication is better at preserving hair than retrieving what was lost, so if you’re going to try it, seek help quickly.

Let’s face it — our hair is important to us. It’s one of the first things people notice about us. It’s a built-in accessory. There are things we can do, though, to minimize the impact of lock loss:

Be kind to your hair. Use soft brushes with gentle bristles. Only brush your hair as needed and treat your hair tenderly when you do. Avoid styles that involve pulling the hair back tightly.

Get a great haircut that makes the most of what you have. Soft layers maximize fullness. Shorter is better than longer — extra length can pull hair down, making it look even thinner.

Use a mild shampoo and don’t over-condition. Heavy conditioners can also weigh hair down and emphasize thinness.

After styling your hair, hang your head down and use your fingers to fluff hair up before righting yourself. This adds height and the illusion of fullness to your hair.

Work with your stylist to find products that add height and texture to your hair. Light piecing waxes or gels can work well if you take a few minutes to learn how to use them.

Unless you use a physician-prescribed medication such as minoxidil to stop falling hair, or resort to hair transplants (some women do, with varying results), restoring the lush look of your crowning glory may be a little like using anti-aging creams to fight wrinkles. Although you may not be able to reverse the effects of aging on your hair, you may succeed at keeping up appearances.