Caring For Your Maturing Skin: Here’s Exactly How To Approach Your Skin Care Routine

Menopause. Let’s Talk About It.

We need to talk more about our skincare during menopause. This year (2020) 50 million will reach the average age of menopause, yet conversation around the physical changes that happen during this time in a woman's life are limited at best.

We're here to help shift the conversation. Here's why?

• While the average age a woman begins menopause is 51, women generally being this transition in life in their 40's.

• It is estimated that up to a third of your dermal collagen, which is the matter that keeps your skin plump and lifted, will be lost in the first five years after menopause and will continue to decrease approximately 2% per year.

• Social media feeds, website, books, marketing campaigns, etc. target and service young women whose collagen is flourishing.

• There are not many products formulated to target the general degradation of skin during this pivotal time.

• Education to support women treating their skin during this time is scarce.

Skin Health 201: Understanding Menopause

What is Menopause

Menopause is the end of a woman’s menstrual cycles. The term can describe any of the changes you go through just before or after you stop having your period, marking the end of your reproductive years.

What Causes Menopause?

You are born with all of your eggs, which are stored in your ovaries. Your ovaries also make the hormones estrogen and progesterone, which control your period (menstruation) and the release of eggs (ovulation). Menopause happens when the ovaries no longer release an egg every month and menstruation stops.

How Does Menopause Diagnosis Work?

Like many women you might suspect that you’re going "through" menopause. It's likely that your doctor will suggest menopause as a possible diagnosis based on a discussion of any symptoms you may be experiencing and from there they will (or should) test your blood levels for:

• Follicle-stimulating hormone (FSH), this usually goes up as you near menopause.

• Estradiol, which tells your doctor how much estrogen your ovaries are making.

• Thyroid hormones, shows problems with your thyroid gland, which can affect your period and cause symptoms that look like menopause.

• Anti- Mullerian hormone (AMH), your body makes this in its reproductive tissues and it can help your doctor learn about the reserve of eggs in your ovaries.

What Happens During Menopause?

We have a tendency to talk about menopause as though it is one overarching concept, but in reality menopause happens in three phases: perimenopause, menopause, and postmenopause. Let's take a look at each phase:

• Perimenopause can begin 8 to 10 years before menopause when the ovaries progressively produce less estrogen and can start as young as your 30s.

• Menopause is the year-long period when a woman doesn't have her menstrual period.

• Postmenopause comes after menopause and can last for up to a decade or longer.

What Are The Symptoms of Menopause?

There are a number of systems that occur while you near and during menopause. In popular conversation we typically talk about hot flashes where feelings of warmth spread over the upper body and can range from mild in most women to severe in others. However, there are other symptoms as well:

First signs of menopause you may notice:

• Uneven or missed periods

• Vaginal dryness

• Sore breasts

• Needing to urinate more often

• Trouble sleeping

• Emotional changes

• Dry skin, eyes, or mouth

Later symptoms of menopause often include:

• Fatigue

• Depression

• Crankiness

• Racing heart

• Headaches

• Joint and muscle aches and pains

• Weight gain

• Hair loss

• Change in sex drive

How Long Do Symptoms of Menopause Last?

Menopause is different for every woman, however the symptoms of perimenopause last about 4 years.

Are There Any Treatments for Menopause?

As menopause is a natural process, many symptoms will go away over time. However there are other treatments available and they include :

• Hormone replacement therapy (HRT). This is also called menopausal hormone therapy, where medications are used to replace the hormones that your body isn’t making anymore. Certain drugs or combinations can help with hot flashes and vaginal symptoms, as well as making your bones stronger.

• Topical hormone therapy. This is an estrogen cream, insert, or gel that is placed in the vagina to help with vaginal dryness.

• The depression drug paroxetine (Brisdelle, Paxil) is FDA-approved to treat hot flashes. The nerve drug gabapentin (Gralise, Neuraptine, Neurontin) and the blood pressure drug clonidine (Catapres, Kapvay) might also ease them.

• Medicines called selective estrogen receptor modulators (SERMs) help your body use its estrogen to treat hot flashes and vaginal dryness.

• Medications for osteoporosis. You might take medicines or vitamin D supplements to help keep your bones strong.

Skin Health 301: How Your Skin Changes With Menopause

During perimenopause you'll begin to see thinning, sagging, wrinkling, and poor wound healing. Once you reach menopause, skin changes are much more pronounced.

Skin Changes

• Dryness: As estrogen levels decrease, you will experience increased dryness due to decreased sebum (or oil) production.

• Dehydration: As we age, our hyaluronic acid levels that keep the skin hydrated decrease.

• Enlarged pores: Your pores will appear larger due to weaker collagen and elastic tissue.

• Acne: Due to hormonal changes, you may see an increase in breakouts.

Skincare Tips 101: Revamping Your Skincare Routine

Invest in Quality Products

• While menopause-specific products may not be available in large numbers, there are a few brands that are moving the needle by developing formulas targeted at menopausal women.

• There are brands that are great for menopausal women with ingredients at the "level" your skin needs to see the most impact.

• This is not the time to go with a cheaper brand, but to research brands that may have a higher price point. Remember the most expensive price tag does not mean the most effective, or that a cheaper price tags means just as good.

For Dryness

• Swap your foaming, soap-based cleansers for something more gentle and nourishing like cream cleansers, because soap-based formulas tend to pull oil from the skin.

• Moisturize with cream moisturizers that contain ceramides, glycerin, or hyaluronic acid, but not lotions as these are water and/or alcohol-based and don't lock in hydration as much as an emollient-rich, oil-based moisturizer.

For Acne

• As your skin is thinner and drier during this time, avoid harsh acne remedies. Use a soap-free cleanser with salicylic acid to unclog pores as well as topical adapalane gel 2 to 3 times per week.

For Wrinkles and Fine Lines

• While most over-the-counter products are difficult to evaluate, topical vitamin A in the form of retinoids or retinol and topical Vitamin C have consistently shown to have a noticeable impact.

• If your skin doesn't respond well to retinoids, you can try bakuchiol, a naturally-derived plant extract that offers the same benefits as a retinol but is less irritating and better tolerated by sensitive skin.

• Vitamin C, is essential as it helps boost collagen and protect the skin from oxidative damage.

• Consistently use sunscreen. You need sunscreen more than ever after menopause, as the skin is thinner and more fragile.

Exfoliation

• Aging skin will see more dead skin cells accumulating on the top layer, but because the skin is thin and more sensitive, you'll need to tread lightly with trying to slough them off.

• Exfoliation can help remove dead cells quickly and easily, encouraging cell renewal, but you have to be extra careful and choose a gentle at-home exfoliating product and use it no more than twice a week.

• Use a cream containing 12% lactic acid to help to chip away at the dead skin layer while moisturizing at the same time.

Skincare Tips 201: The Order Right To Apply Skincare Products

Sequence Matters.

Why? Because you skin’s job is to keep things out and skin care products have ingredients you want to get in. But, only a very small amount of these key ingredients can penetrate the skin, even when perfectly formulated and perfectly applied. So, if you don’t apply products in the correct order, you will not see the best results.

A Daytime Regimen

Step 1 : Cleanse

• Splash your face with warm water or wash with a gentle face cleanser.

Step 2: Toner

• Apply a small amount to a freshly cleaned face.

• This is a personal preference for many women because there’s an assumption that most toners are harsh and irritate the skin. If your routine has not included using a toner and you have had positive results there may be need to add a toner at this point.

• Toners can serve multiple purposes, such supplying antioxidants, vitamin B derivatives and even toning acids. Each type of toner is intended for a different skin issue.

Step 3: Antioxidant Serum

• Use a dime size of an antioxidant serum.

• Antioxidant serums boosts your skin’s inflammatory response to neutralizing damage from UV rays and environmental pollutants.

Step 4: Eye Cream/Gel

• Dab a small amount of eye cream to maintain the health and thickness of the delicate skin around your eyes.

Step 5: Spot Treatment

• Apply prescription medications and over-the-counter acne spot treatments by dabbing the targeted area only. These treatments need to be applied as close to the skin as possible to maximize their benefits.

Step 6: Moisturizer

• Apply moisturizer while the skin is still damp, the quicker you apply your serum and/or spot the sooner you can lock in hydration with your moisturizer.

• Everyone needs a moisturizer, even if you have oily skin. If using an acne spot treatment, skip those areas when applying moisturizer to make sure that it will not interfere with the active ingredients in the spot treatment.

Step 7: Apply Sunscreen

• Apply a sunscreen of 45 or more, be sure to use a sunscreen that is intended for the face.

A Nighttime Regimen

Step 1: Double Cleanse

• First remove your makeup using a cleansing oil to dissolve your makeup. If you have not worn makeup you can skip the cleansing oil, if you chose.

• Next, use a face wash to remove all the excess sebum, dirt and any makeup you loosened up during the first step.

• If you’re using a physical exfoliant, like a facial scrub, use it in place of your cleanser after removing your makeup.

Step 2: Toners and Skin Boosters

• Skin care boosters can be mists, essences, or hydrating (hyaluronic acid) serums.

• Apply skin boosters or essences after washing your face as you would a toner.

• If using a toner and a skin booster, apply the toner then the booster. Tip: Toners are to clean and boosters are about delivering a treatment.

• If using multiple boosters, apply them from thinnest to thickest.

Step 3: Eye Cream

• Apply your eye cream before your treatments to protect your eye area against potent ingredients that can cause irritation.

Step 4: Treatments, Serums and Peels

• Prescriptions (tretinoin, acne and rosacea creams), retinol creams, exfoliating treatments (peel pads and masks) and anti-aging serums (infused with peptides, growth factors and other biologically active ingredients) should be applied at night.

• Pick your evening treatment based on what your skin needs that night only.

• Choose between prescription meds OR exfoliative treatments (like AHA/BHA pads, peels or detoxifying masks). If you use both on the same night, you significantly increase your risk of irritating your skin.

• Don’t use retinol creams (over the counter or prescription) on the same night as exfoliative treatments.

• Use exfoliative treatments sparingly, one to three times a week.

Step 5: Moisturizer or Night Cream

• You can use the same moisturizer for day and night or use a night cream. Night creams are generally thicker, heavier creams designed to be absorbed over the course of several hours.

Skin Notes

These are just a handful of skin conditions and treatments skincare experts and dermatologists have found to impact and benefit skin during menopause.

Listen to your skin. No matter what experts say, it’s important to find what works for you and to always be kind to your skin.

It's best to keep track of all your products and when seeking advice share as much information as you can with a licensed expert who can take the time needed to help you find the right products and routine.

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Resources

• 1. Fletcher SW, Colditz GA, “Failure of Estrogen Plus Progestin Therapy for Prevention”, JAMA 2002; 288(3):366-368. Available online at: http://jama.ama-assn.org/content/288/3/366.

• 2. Raine-Fenning NJ, Brincat MP, Muscat-Baron Y, “Skin Aging and Menopause: Implications for Treatment”, Am J Clin Dermatol. 2003; 4(6):371-8. Available online at:http://www.ncbi.nlm.nih.gov/pubmed/12762829.

• 3. Wolff EF, “Skin Wrinkles and Rigidity in Early Postmenopausal Women Vary by Race/Ethnicity: Baseline Characteristics of Participants Enrolled in the Skin Ancillary Study of the KEEPS Trial”, American Society for Reproductive Medicine, 64th Annual Meeting, 2008. Available online at:http://www.kronosinstitute.org/research/current/skin_wrinkles_and_rigidity.pdf.

• 4. Phillips TJ, Symons J, Menon S, “Does hormone therapy improve age-related skin changes in postmenopausal women? A randomized, double-blind, double-dummy, placebo-controlled multicenter study assessing the effects of norethindrone acetate and ethinyl estradiol in the improvement of mild to moderate age-related skin changes in postmenopausal women.” J Am Acad Dermatol. 2008; 59(3):397-404.e3. Epub 2008 Jul 14.

• 5. Rittié L, Kang S, Voorhees JJ, et al., “Induction of Collagen by Estradiol: Difference Between Sun-Protected and Photodamaged Human Skin In Vivo”, Arch Dermatol. 2008; 144(9):1129-1140. Available online at: http://archderm.ama assn.org/cgi/content/short/144/9/11296.

• 6. Holzer G, Riegler E, Hönigsmann H, et al., “Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study”, British Journal of Dermatology 2005; 153(3):626–634.

• 7. Weiss JS, Ellis CN, Headington JT et al., “Topical Tretinoin Improves Photoaged Skin – A Double-blind Vehicle-Controlled Study”, JAMA 1988; 259:527-532. Available online at: http://jama.ama-assn.org/content/259/4/527.shor

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