Updated: Feb 14
Recently I came around an excellent blog post titled “My Menopause Skin Story” that a peri-menopause lady named Pauline wrote a true story about her own menopausal journey and her skin issues during the menopause transition. She wrote that the dryness and itchiness in her skin as her primary skin issue during her menopause. She explained about dullness of her skin and lack of luster, appearance of fine wrinkles and her helpless own ideas of not feeling herself, not being as feminine and attractive as she used to be and how her self esteem and her confidence was negatively affected by the changes that she was seeing in her skin appearance. However, later on, she realized it was the hormonal effect on her perception of herself, that was the true issue. Anyway, she continued that how disappointed she was with her different makeup stuff and all expenses she endured on purchasing different skin care products that never worked and stayed in her cupboard.
What I liked best about her blog post was how she described her true experience, her own feelings, her disappointments, and her eventual successes in order to illuminate the path of women who are just beginning or are in the middle of their menopausal journey. I recommend that you check it out! Thank you, Pauline!
What Are the Functions of Skin?
SKIN, the mirror of your inner health, is the largest organ in your body, covering about 20 square feet and reflecting your inner wellbeing. Skin amazingly acts as a crucial part of many different organ systems in your body. You Skin is a highly functional part of your endocrine system, as it has widespread responsive receptors for estrogens, progesterone, androgens, cortisol, thyroid, and prolactin. Your skin is a part of your immune system which is designed to keep you safe from outside invaders such as chemical agents, physical traumas, pathogenic microbes (bacteria, viruses, fungi and protozoa), and many more. Skin is a part of your nervous system as it has nerve endings that allow for the feelings of touch, heat, cold and vibration. Skin is part of your vascular system. It has widespread microvascular distribution which in collaboration with its nerve endings it regulates your body temperature through change of diameter of the micro vessels, sweating and controlling the pores. It's no surprise that a variety of medical disorders can manifest themselves on the skin and that’s why we believe that your skin problems have at least one root cause originating from your inner body imbalance.
How Menopause Can Affect Your Skin?
Menopause, and its hormonal fluctuation has a huge impact on skin and its very diverse functions. However, the common presentations of menopause such as skin dryness, itchiness, lack of luster and plumpness, thinning hair, hair loss, growth of unwanted hair, wrinkles, laxity, and thinning skin are not getting as much attention as other symptoms of menopause. These changes are visible and affect women’s self esteem and their self perception of beauty and femininity which in turn becomes a root cause for anxiety and depressed mood during this transitional period. Not to mention that the cosmeceutical industry has targeted these increasing population of perimenopause and menopausal women to encourage them increase their daily expenditure and include buying cosmetic products in order to conceal those inevitable visible changes in their appearance. These factors have huge impact on menopausal women’s acceptance of self, and as a result their quality of life can be affected, and not to mention the financial burden of purchasing unnecessary, highly advertised skin care products that doesn’t work.
Pic; Courtesy of upsideofdownsizing.com
As I mentioned in other articles menopause is a process, which starts about 10 years before your actual cease of menses. These ten years which is your most active and demanding phase of your life and career, is called premenopausal transition which most women have different types of experiences due to decline in function of ovaries and gradual hormonal imbalance. During this period women go through irregularity in menses, different digestive issues, from gas-bloating to constipation and change in taste and appetite, temperature dysregulation and hot flashes, mood fluctuations, wake-sleep pattern disruptions, skin issues and the list goes on and on! The last 12 months before cease of your menses is called perimenopause which all these symptoms become very prominent and noticeable and, in some cases, it has disruption in your daily living life and even your work performances. The twelve months after cease of your menses is called menopause and the decades after that is called post-menopause.
Menopause is a lengthy process that takes a decade or more to complete, although it occurs during a woman's most active era of life. She is at a point in her life when she must perform significant roles in her family, workplace, and society as a whole. It explains why menopause has such a significant impact on women's lives, from a physical to a psychological and social standpoint.
What Does Happen to Skin During Menopause transition?
Menopause comes with hormonal imbalance due to decrease in your ovarian function and ovulation, as a result the production of sex hormones fluctuates and eventually declines. This fluctuation in hormonal level leads to many changes in different compartments of skin. As Sex hormones, estrogen more than progesterone have important role in producing collagen, decrease in serum hormones results in reduction in skin collagen content and in turn, decreased skin thickness, moist and suppleness. Besides due to lack of structural collagen, healing process become prolonged, leading to delayed wound healing. These changes in amount and quality of skin collagen leads to lack of elasticity and extensibility of skin which gives the aging appearance to your skin.
During the menopausal transition the production of androgen in ovaries declines as well. However, the speed of reduction of ovarian estrogen is drastic and for androgens is steady and happens gradual. Therefore, during years of transition hormonal balance is in favor of hyperandrogenism relative to amount of estrogen in circulation. This extra androgen contributes to acne formation, the thinning hair and male pattern hair loss in menopause women in addition to growth of few unwanted hair in the face. I need to emphasize that despite the physiologic pattern of mild hyperandrogenism during and after menopause, there are many important other reasons for this phenomenon. That’s why we always recommend women to seek medical advice and do the specialized lab exams to rule out other reasons of hyperandrogenism during menopause before attributing these symptoms to only physiologic menopausal hormone change.
During and after menopause due to decrease in sex hormone, many changes happen in genitourinary tract lining, structure and function. The mucous membrane become thin and lose its secretory capacities. The vulvar tissue loses its thickness and the overlying skin become thin with much less elasticity. Due to these atrophic changes, mucus and acid secretory glands in the skin of area either are atrophied or totally disappeared. The result is reduction of local immune function and increased chance of repeated infection, either urinary or genital or both. Intercourse in this phase due to structural changes, less lubricating capacity and atrophied vagina, becomes more painful and less pleasurable.
Pic, Courtesy of sixtyandme.com
During the 10-15 years of menopausal transition, it is recommended that women be mindful about consumption of sugar and insist on eating healthy fats instead on a daily basis. The diminished sex hormone and their close relationship with cortisol, leads to visceral fat deposit, skin fat redistribution and cellulite development. Sex hormones as I mentioned above have a crucial role in collagen production in skin and its microvascular system. As a result, the micro vessels in skin become thin and lose their tone. This weak microcirculation and vascular increased permeability lead to cellulite accumulation.
Moreover, the low amount and quality of collagen in the wall of micro vascular of skin affect the blood circulation and lymphatic drainage responsible for nourishing the appendages of skin such as skin’s sweat glands and fat producing glands. The result is atrophy of these crucial glands and as a result lack of moist and oil on skin. This explains the resultant skin dryness and itchiness after menopause.
Additionally, the microcirculation in your skin which is responsible for nourishing the sensory neurons scattered in skin, due to diminished integrity, do not provide adequate nutrition to your skin’s neural network. The result is overactivity of this network, and you may feel sometimes crawling sensation under your skin.
How can naturopathy help you with your skin issues?
The naturopathic approach is always looking at you as a whole person, who has some symptoms pointing to deeper root cause of the problem. My strategy is first knowing you in your context of health and wellbeing. In order to do so, when you book your first appointment, my first step is sending a “Health Questionnaire” to you to fill it up and return it to me for my review before visit. This will give you a chance to explore your present concern/s from different perspectives. Often time the patients finds the questionnaire very user friendly and mind organizing.
We start from assessing the root, then we move up step by step, eventually to the leaves, your
What are four main functions of skin?
1. Sensation: skin has sensory receptors to feel touch, pain, pressure, temperature, etc.
2. Protection: skin covers you from sun & UV radiation, environmental pollution and mechanical trauma.
3. Regulation: skin has microvascular and pores to regulate heat through water output.
4. Endocrine activity: skin has varieties of hormone receptors and hormonal functions.
What are six main elements impacting your skin?
1) Environmental factors like pollution, too much sun exposure, UV radiation, dry environment, too much humidity,
2) Mood, like overthinking, too much worry and stress, depressive mood
3) Digestive function, like improper gut activity for digestion, absorption, hydration and elimination of toxins
4) Inflammation, dermatitis, acne, eczema, or autoimmune diseases presenting on skin
5) Defence and immune system, like anti oxidant and anti microbial defence and autoimmune diseases
6) Hormonal impact like effect of estrogen, progesterone, testosterone, thyroid hormone, cortisol, etc
Now that we reviewed all the system organs, and different root causes, we can start setting up a strategy tailored specially for you and your current concern according to the well determined root causes. We set our treatment goal and targeting the root cause of your disorder and we draw a stepwise strategy to achieve the treatment goals.
Naturopathic Approach to Your Skin Health:
Fifteen easy lifestyle adjustments which help improve your skin issues:
1- Choose a mild to moderate weight bearing exercise adjusted with age (Yoga is good).
2- Avoid stress.
3- Stop smoking.
4- Reduce alcohol intake.
5- Protect your skin from the sun
6- Improve skin hygiene habits
7- Wash with mild cleanser
8- Avoid extreme temperatures (cold or heat).
9- Avoid dryness
10- Snack on fresh vegetables and fruits during the day
11- Develop a regular healthy diet habit
12- Reduce toxin exposure
13- Practice breathing excise 2-3 times per day
14- practice ways to promote more effective elimination.
15- Start journaling to find out triggers and provocative elements
Next step usually is exploring nutritional adjustment to help with reducing inflammation, promoting healthy gut bacteria, boosting immune system to function in balance and improving cleansing activity of bowels to help with detoxification. Herbs and botanicals are very close to heart of all naturopaths! Regarding skin issues, there are varieties of ways to use herbs. You can use herbs orally as a capsule, as a tea, as an extract or even as a gum to get benefit from their systemic effects. You can use botanicals as essential oils to get benefit from their aromatic healing capacity. It involves your smell neural pathway to enhance mental clarity, calmness and improve system function overall. You can use herbals topically, as a salve, ointment creams, gels, lotions, and spray to reduce inflammation, redness and swelling, relieve itchiness and help with your skin dryness, etc. An important note is that you need to consult with your health care provider before using herbs and follow your practitioner’s advice on the best route of use of that special herb. Keep in mind that herbs regardless of route of use, may have cross reaction with your prescribed medication and other herbs as well.
What I want you to understand is that symptoms appear after a period of whole-body efforts to adjust to the hardships of health irregularities, and the maladaptation becomes a habit just to survive. As a result, in order to assist with chronic health issues, you must develop a long-term management strategy that addresses not only the current issue but also prevents recurrence.
What will happen when you come for a visit?
The first visit is a comprehensive medical history taking and can be in person or virtual video or phone call. During 1 – 1 ½ hours visit, we firstly go over your health concerns one by one and then we take a thorough medical history from all your organ systems to get a holistic understanding of your condition.
In the second visit which is 30-40 minutes visit we do a complete whole body physical examination. Either in first visit or in the second visit we will provide a *lab requisition to you to rule in or out underlying aetiologies. These useful functional tests like Oxidative stress analysis, metabolic analysis, cardiovascular profile, hormonal health assessment and female hormone profile, among other things, are very helpful in determining e the root causes of your current concerns.
In your third visit which is usually few days after receiving your lab exam we review the result of lab exam and setup a treatment plan for you. In each of your subsequent visit, we review your improvement and the probable obstacles to achieve the goals. I believe knowledge is the key and during our multiple sessions together, our stepwise approach let you learn how to be in control of your health and your wellbeing.
*The lab exam and blood draw are done by a lab technician in a life labs centre of your choice. However, there is a Lifelabs medical laboratory at 2050 Weston Road, conveniently walking distance to my clinic.
** Disclaimer: The information in this article is property of Dr. Masoumeh Shayesteh Manesh, Naturopathic Doctor and is not intended to diagnose, treat or cure any diseases or promote any products or services mentioned on this website. Naturopathic medicine is not to be used as a replacement treatment or as a replacement for prescribed medications. Please talk to your health care provider before starting any supplements or natural therapies.