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Menopause is not a period of life but just the point in time twelve months after a woman's last menstrual cycle. Traditionally we use the term menopause to speak about changes such as hot flashes, changes in bone density, skin or vaginal dryness, insomnia, etc., because it sounds easier. We should actually call this period menopausal transition or perimenopause.
Perimenopause affects every woman of a certain age uniquely and in a variety of ways. One woman could gain weight, another could lose weight, one could experience insomnia, and another somnolence; all of these are normal and physiological changes in the women's health and bodies.
Natural menopause is age-related but exactly in the same way that puberty is a change related to the transition from childhood to adulthood. We go through life changing constantly, like water traveling from the mountains to the ocean.
Life is based on adaptation, and stability exists only after death, so let's start to see menopause as a positive event, celebrating a long, eventful life and not as a catastrophe to be avoided.
Nowadays, postmenopausal women live longer in this state than in the fertile period of their lives. So, let's help them prepare and adapt to this natural process.
Women are not going to feel the symptoms of menopause immediately. As was mentioned before, there is no sudden feeling, and this is a process. The average age for the transition is between ages 45 and 55.
It usually lasts about 7 years but can be longer than 10 years for some women. The duration, age it begins, and symptoms of menopause can depend on lifestyle factors such as smoking, diet, sun damage, sleep schedule, physical activity, stress management, mental health, and many others. Nonetheless, it's also genetically determined and family history plays a significant role. So, if the mother went through early menopause, her daughter has a greater chance of experiencing the same.
Menopause transition is a normal part of female life, but how does it happen? The easiest explanation, which you can see on many popular online resources, is as follows - "ovaries have stopped releasing eggs and the female hormones estrogen and progesterone."
Hormonal production doesn't stop in one day. This is good news because such dramatic change can kill the body. Progesterone's production decreases gradually, but changes in estrogen hormone levels are more complicated.
It goes through the temporary but significant increase of oestradiol production following a gradual decline in inhibins A and B, both major regulators of follicle-stimulating hormone (FSH), and an increase of follicle-stimulating hormone level itself. Also, free androgen levels rise, but testosterone levels stay relatively stable – (to be honest, there's not enough information about 'normal' levels of testosterone in women, so androgen changes are not fully clarified).
The fall in inhibin B and the increase of FSH constitute markers of ovarian aging, and the disappearance of both inhibins is an important predictor of approaching menopause. One year before menopause, neither inhibin A nor inhibin B can be detected. Hormonal changes are not strictly degressive but mostly fluctuating, going up and down like a rollercoaster. The more "rollercoaster" in style it is, the more symptoms a woman can experience.
Perimenopause may begin as early as the mid-30s or as late as the mid-50s. Some people experience symptoms for only a short time, but for most women, it lasts four to eight years.
During perimenopause, fertility declines, but it's still possible to become pregnant even if the body is preparing to stop releasing eggs. Biochemical changes leading to menopause start about eight to ten years before menopause is completed.
Completing the menopause before age 40 is called premature or early menopause. Medical or surgical causes can trigger it, but it can also happen with no evident triggers. In this case, it's called primary ovarian insufficiency. Some infectious diseases, like mumps, autoimmune conditions, and smoking, are well-known early menopause triggers.
Generally, the first signs of perimenopause are irregular menstrual periods. Most women will go from having predictable to unpredictable menstrual cycles.
Usually, many women experience the most common mild symptoms like hot flashes or vaginal dryness and atrophy fairly early in the menopausal transition. While the body is adjusting to the changes in estrogen levels, symptoms may vary, but most women experience at least one of the following:
Also, menopause changes can lead to thinning in bone mass, development of osteoporosis, changing cholesterol levels, and higher risk of heart disease.
The menopausal transition can be a difficult period for women, especially if it's going in a rollercoaster style. It's important to have regular check-ups with a medical professional to keep an eye on changes and be ready to intervene if needed.
There is no treatment to stop perimenopause even if some interventions are presented as such. Perimenopause is effectively cured when menstruation stops, and woman enters menopause. Some women go through this transition smoothly, but some need help to manage symptoms to get a better quality of life.
One of the most unpleasant symptoms of menopause is hot flashes, affecting about 75% – 85% of women. It lasts on average 7 years and can be explained by the change of thermal regulation of the body, leading to specific vasomotor reaction with a sudden increase of body temperature, face and neck redness along with profuse perspiration followed by chill.
Night sweats are also typical and can be part of the hot flash experience. Frequent hot flashes make life difficult, and obviously, it's one of the indications for pharmaceutical intervention, but the first thing to do is to eliminate triggers.
Trigger control and elimination could help to minimize or even stop hot flashes and soften other symptoms, so it is worth trying. Fortunately, hot flash triggers are well known.
Amongst them are smoking, an excess of caffeine, alcohol, hot weather (or saunas), spicy foods, and stress. Tight clothing can trigger hot flashes in some women, so better to avoid it. Some medications, e.g., osteoporosis treatment, could trigger hot flashes as well. Interestingly, symptoms are experienced differently according to ethnic, educational, and sociocultural backgrounds.
Asian American women report a low frequency of physical and psychosomatic symptoms compared with black women; Brazilian women have a higher prevalence of vasomotor symptoms (hot flashes) compared to women in all Western countries etc.
Skin changes are obvious in the perimenopause and the menopause, but the skin changes more or less gradually. Estrogens are essential for skin hydration and elasticity because they increase and maintain the production of glycosaminoglycans and proteins, such as natural hyaluronic acid, collagen, elastin, and others.
Female hormones also promote sebum secretion and the synthesis of lamellar lipids of skin barrier. The decrease of the hormone production leads to skin dryness.
Another face of hormonal change is a degradation and fragmentation of skin elastin, change of hyaluronic acid structure, a reduced microcirculation, and thinning of the epidermis.
In menopausal women, the decrease of estrogens promotes a reduction in type I and III collagen as well as a reduction in the ratio of type III collagen to type I. Type I collagen is responsible for the strength, and type III for the elasticity of the skin, both of them are called “youth collagen”. So when skin loses both types in significant amounts, it leads to age-related changes in the skin, such as sagging or wrinkle formation.
The deficiency of estrogen levels is associated with an increased activity of substances destroying skin structure such as collagen, elastin and hyaluronic acid destroying enzymes. It leads to impaired barrier function, loss of skin elasticity and decreased antioxidant capacity. Another phenomenon is the fragility of postmenopausal skin to abrasion related to the decrease of estrogen-induced ezrin in the epidermis. Ezrin is responsible for the interlinking of epidermal cells that maintain the integrity of the epidermis, and the lack of it makes skin more and more fragile. Most of the aforementioned changes are realized in the first years of post-menopause.
About 30% of the total loss of dermal collagen happens in the first 2-4 years, but after it is significantly slowed.
Today there is a lot of discussion around menopause, and sometimes it creates an impression that it is necessary to delay menopausal changes using hormonal replacement therapy (HRT). The aim of hormone therapy is not to delay menopause but to manage it, relieve menopausal symptoms, and maintain physical and mental health.
Despite the anecdotal evidence of hormone therapy showing a positive effect on skin thickness, wrinkles, moisturizing, etc, randomized and blind trials are hard to find, if any even exist. Most formal studies show that race, sun exposure, smoking, and lifestyle are confounding variables that have more influence on the skin than hormone therapy.
Very probably, the menopausal changes of the skin are related not only to the decreased level of oestrogens but also to the down-regulated expression of estrogen’s receptors (ER). Non-responsive ERs in the skin cells explain the lack of significant therapeutic response to estrogen replacement in the skin.
Topical hormonal treatment can partially reverse or slow down menopausal changes in the skin, but the effects of low-dose, long-term systemic hormone therapy are not well established and are uncertain. New cosmeceutical agents such as selective estrogen receptor modulators (SERM) are now a big trend in the cosmetic industry.
Phytoestrogens and other compounds addressing estrogen-deficient skin are helping to manage skin changes and make them more gradual and delicate, preventing the dramatic loss of skin elasticity and moisture. SERM compounds send estrogen-like skin health signals via estrogen receptors as estrogen itself does, modulating processes of proteins and glycosaminoglycans synthesis as well as others. The target is the estrogen receptor molecules that are abundant in most skin cells, so the use of SERM has a general effect affecting all skin layers and structures.
Plant-derived polyphenols and isoflavones are known as phytoestrogens, which act as SERMs, possessing ER-agonist properties without any known adverse effects after long-term topical usage. Probably, the best-known ingredient is resveratrol derived from grapes, scientifically proven to have anti-inflammatory and antioxidant properties.
A new form of bio-fermented resveratrol (metabiotic resveratrol) can increase collagen I and III production, activate sirtuin 1 (anti-aging cellular factor), and reduce NF-kB signaling as one of the key factors involved in skin aging. Metabiotic resveratrol is epigenetically active and even mimics the anti-aging effects of retinol, which makes it an "ideal anti-age" molecule.
Other phytoestrogens are used for SERM-based menopausal skin therapy, such as clover extract, soya bean-derived isoflavones and proteins, genistein, equol, daidzein, coumestrol derived from clover or alfalfa, clover-derived biochanin, etc. New soy-based probiotics, like soy milk ferment filtrate are used for topical application as well.
Many SERMs are used as an alternative to HRT, as a natural menopausal supplementation, or alongside HRT treatment.
SERM-based skincare can be used as early as the first signs of perimenopause are noticed by a woman, alongside skin products helping to improve the skin barrier, improve water-holding skin capacities, and increase collagen, elastin, and hyaluronic acid synthesis. One of the most promising ingredients is a new version of EGF (epidermal growth factor) derived from Australian wild tobacco leaves, which is amazingly more bioidentical than a lab-designed version used previously.
Remodeling peptides, such as Matrixyl, Rigin, Syn-TC, and others, are largely used to strengthen the skin. Plant-derived stem cells rich in cytokines help to restore the regenerating abilities of the skin as well as its integrity. Finally, moisturizing agents, including hyaluronic acid itself, carrageenan, glycerine, polylactic acids, and other water-holding molecules, should be used on a daily basis to maintain menopausal skin health.
Recently, the role of microbiome in menopausal skin was described as crucial in the maintenance of skin barrier function and immunity. Nowadays, there is a wide choice of prebiotics, and some prebiotics, such as Bioecolia (alpha-oligosaccharide), Inulin or Aquaxyl, are known to be efficient in restoring the skin microbiome diversity in estrogen-deficient skin.
A daily skincare routine for menopausal women should include at least a gentle cleanser, followed by a SERM-based serum or concentrate, and then a moisturizer rich in antioxidants and essential fatty acids. All products should be microbiome-friendly and enriched by prebiotics or probiotics.
Despite stereotypes, it's not mandatory to use retinol or its derivatives, as well as salicylic acid or hydroxy acid, to maintain menopausal skin health and promote collagen synthesis. A new generation of SERM microbiome-friendly skincare helps achieve better results safely without affecting the photosensitivity and/or sensitivity of the skin globally.
Lifestyle, stress management, physical activity and healthy diet are still the pillars of skin and body health in menopause. Skincare complements while all of them play an important role in the maintenance of skin appearance, psychological health, and comfort to women.
This new generation of menopause skincare products based on a deeper understanding of molecular mechanisms of skin aging related to hormonal and facial changes can be used freely and safely by women of all ethnic and social backgrounds.
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