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Managing the Skin During Menopause

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Menopause is defined as the point in time when a female’s menstrual cycles permanently cease due to the natural depletion of ovarian follicles/oocytes from aging. During a woman’s cycle, the ovaries release a mature egg called an ovum (oocyte). The onset of menopause displays biological changes within the entire endocrine system, in particular with decreased levels of reproductive hormones, especially estrogen and testosterone.

Therefore, it is not uncommon that a woman begins to experience hot flashes and night sweats, psychological changes, insomnia, mood swings, difficulty in concentration, urinary incontinence, and even loss of sex drive. Moreover, the reduction in estrogen skin begins to result in thinning and decreased elasticity in the dermis. The mitigation of reproductive hormones also may cause an increase in the risk of osteoporosis, bone fractures, and cardiovascular disease.

THE ENDOCRINE SYSTEM – A SHORT REVIEW
The endocrine system is made up of the pituitary gland, thyroid gland, parathyroid glands, pineal glands, adrenal glands, pancreas, and ovaries (females) or testicles (males). Derived from the Greek words “endo” (within) and “crinis” (to secrete), a gland selects and removes materials from the blood, processes them, and then secretes the finished chemical product (hormones) via the circulatory system for use somewhere in the body.1 The endocrine system affects cells and organs in the entire body. Hormonal secretions are chemical messengers and regulators and affect skin physiology, the brain and its functions, including neurotransmitters, the heart, the immune system, and more. Hormones travel throughout the body looking for target cells where they bind to specific protein receptors inside or on the surface of a cell. There are approximately 50 different known hormones that vary in structure, action, and response. Hormones play a complex and essential role in skin physiology, including conditions such as rosacea, dihydrotestosterone (DHT) acne, and barrier disorders like eczema.
Cell-to-cell signaling is essential to the function and effectiveness of all cells. Transmembrane protein receptors are found on cell surfaces. They span the plasma membrane performing signal transduction, the transmission of molecular signals from a cell’s exterior to its interior. The effectiveness of a hormone is also dependent upon the viability and health of a cell membrane. A protein receptor reads a hormone message and carries out its instructions by either influencing gene expression or altering protein activity.

THREE HORMONE GROUPS2
Hormones are highly complex, yet are vital to the health and balance of the entire body. They are briefly summarized below.
Amine hormones are synthesized from the amino acids tryptophan or tyrosine. Secreted by the pineal gland, melatonin is an example of a hormone derived from tryptophan. It helps to regulate the circadian rhythm. Tyrosine derivatives also include metabolism-regulating thyroid hormones and the catecholamines such as epinephrine and norepinephrine that play a role in the fight-or-flight response. Dopamine inhibits the release of certain anterior pituitary hormones.
Peptide and protein hormones are water-soluble and require a receptor in order to enter a cell. They are also called glycoproteins. Examples of protein hormones include growth hormones, produced by the pituitary gland and the follicle stimulating hormones (FSH). FSH helps to stimulate the maturation of eggs in the ovaries and sperm in testes. Peptide hormones include antidiuretic hormone, a pituitary hormone essential in fluid balance. Atrial natriuretic peptide, produced by the heart, assists in blood pressure regulation.
Steroid hormones are oil soluble and diffuse through the lipid-rich phospholipid bilayers of cell membranes. Steroid hormones are derived from the lipid cholesterol and eicosanoids manufactured from linoleic acid, arachidonic acid (omega 6), and phospholipids. Moreover, steroids include cortisol and the reproductive hormones: estrogen, progesterone, and androgen. The adrenal cortex and the gonads are primary sources of steroid hormones.

HORMONES PROGESTERONE, ESTROGEN, AND TESTOSTERONE
Progesterone is a precursor to important hormones such as estrogen, testosterone, and all important steroid hormones. Estrogenic hormones provide female characteristics and the androgenic hormones control the development of the male-like characteristics. Progesterone deficiency is responsible for many symptoms associated with menopause, given that it influences essential functions associated with sleep, balancing of body fluids, metabolism, bone formation, and the nervous system. Be mindful that all hormones affect the body and skin.

Estrogen
Estrogen is made up of a class of hormones that include estriol, estradiol, and estrone. Estrone is produced in larger amounts during pregnancy. Estradiol is the predominant sex hormone found in females and required for reproductive and sexual function. Estrone is secreted by the ovaries and adipose tissue and is the least abundant of the three hormones.
Estrogen plays a significant role in skin function and physiology regulating cell turnover within the epidermal basal layer. It helps modulate epidermal keratinocytes, dermal fibroblasts and melanocytes, the hair follicle, and sebaceous secretions.3 It also reduces the size and activity of the sebaceous glands keeping the sebaceous secretion thin and less fatty.
Estrogens are necessary for wound healing and improvement in inflammatory skin disorders, especially during pregnancy. They also offer a degree of protection against photo aging.
Estrogen’s effects on the skin are shown during studies of the changes between the child-bearing years versus post-menopausal in women. Skin thickness has been shown to vary during the menstrual cycle, with the skin thickness lowest at the start of a menstrual cycle 3 and during the time that estrogen and progesterone levels are low. It then increases with the rising of estrogen.
Post-menopausal women, instead, notice an accelerated rate of skin aging through epidermal thinning caused by the mitigation of estrogen in the body. Skin firmness and elasticity are affected along with skin dryness, an indicator that there are changes within the skin barrier function. Estrogens influence skin thickness by stimulating fibroblast cells required for collagen synthesis, hyaluronic acid synthesis, and support of the dermal water content. Hyaluronic acid is a main component of the base or ground substance in the dermis that enables it to hold moisture. Estrogen helps keep the skin firm and softer. Conversely, androgens stimulate collagen production resulting in the stronger, coarser skin of a male.
Moreover, estrogen appears to influence the regeneration and growth of hair within the hair follicles that cycles between regeneration of hair growth and then dormancy. It is suggested that it decreases the resting phase and prolongs the growing phase of the hair cycle 3. Estrogen has a regulatory effect on the size and action of the sebaceous gland and influences pore size.
Estrogen has been found to help prevent photo aging in the skin. Increased exposure to UVB is associated with up-regulation of matrix metalloproteinase production causing a decrease and degradation of collagen types I and II.

Androgens
There are three groups of androgens. Dehydroepiandrosteron (DHEA) is a principal hormone in men and women. It is converted into estrogen and androgen type metabolites only found in the skin.
Androstenedione is a metabolite of DHEA – a precursor in the biosynthesis of testosterone.
Testosterone is found in the ovaries and adrenals and is reduced during menopause. It helps with the strength and resiliency of skin, muscle, and bone.
Both men and women produce androgens and their subgroups that can vary in different quantities. It is during these fluctuations and elevations that can cause things to go awry, especially with the influence of increased activity of the sebaceous glands. Furthermore, with the onset of puberty in both men and women, the epidermal keratinocytes are influenced, as well as the increased activity in the follicle, leading to hyperkeratinization, comedones, and pustules.
Sebaceous secretions are extremely hormonal, controlled through the presence of androgen that binds to the sebaceous gland receptors. Consequently, it stimulates sebum production –especially over secretions during times of elevation.
Androgens increase the rate of keratinocyte cell turnover in the basal layers. The size and activity of sebaceous glands are also influenced. Collagen production is influenced by the stimulation of the fibroblasts to produce the proteins required for collagen synthesis. Androgens also increase hair growth and the transformation of vellus hair to terminal hair during puberty. Both sexes can suffer from hair loss and receding hairline.
Numerous endocrine diseases and disorders can influence the hormonal balance that affects the skin’s appearance. Too much androgen causes the epidermis to become coarse and thick through keratin differentiation – this is the leading reason men’s skin is denser than women’s.
Too little androgen can result in a thinning epidermis, beginning with atrophy of the spinosum layer. There is also deterioration of the papillary layer leading to fine wrinkles. Moreover, the skin becomes dry with little facial, pubic, or axillary hair. The skin begins to look dull through fewer blood vessels and decreased pigment levels.

UNDERSTANDING MENOPAUSAL CONDITIONS AND TREATMENT
It is essential that professionals understand clients from a cellular and biological perspective.
Treatment begins with a total assessment that includes a health intake profile and the use of diagnostic equipment to fully grasp internal and external conditions. Understanding client history is essential. The rate of biological aging varies from person to person. As pre- and post-menopausal skin fluctuates, it is important to develop a long term care program that will support the skin during these changes from the onset of menopause and beyond. Moreover, it is always advised that clients visit a physician specializing in endocrinology and integrative and functional medicine so that there is a better synergy between the internal hormonal systems and what should be done to support skin care.
Noting that there are numerous changes within the barrier function – skin texture (dermis), circulatory system, nervous system, the mind, and more – take gentle care of the client by providing nourishing facials that replenish the acid mantle and skin barrier. Incorporate the use of LED therapy or microcurrent (unless contraindicated), along with serums and a mask to address the skin condition. Biological mimetic skin care can also be incorporated for homecare, promoting optimal results. Write out a program that may include facials more than once a month. When the skin is really compromised, offer a facial “boot camp” – twice a week for five weeks and charge 10 sessions for the price of eight. If there are time constraints, at least once a week can help as well.
A goal is to continue to help correct the skin through menopausal changes. Aging may also bring inflammatory conditions such as rosacea, arthritis, autoimmune diseases, and conditions arising from long time environmental exposure. Encourage massage therapy, yoga, meditation, and practices that support relaxation and healing. It is also time to slow down, if that is ever possible in a frenetic world. Sometimes in the realm of wanting instant gratification, clients resort to more aggressive treatments, including over-peeling, exfoliation, and laser. While, indeed, there is a place and time for everything, be mindful of how to retain clients and promote long-term results.

References
1 Zimmermann, K. A. (2016, March 11). Endocrine System: Facts, Functions and Diseases. Retrieved from https://www.livescience.com/26496-endocrine-system.html
2 Barrett-Hill, F. (2014). Symposium Lecture conducted at Las Vegas Program for Skin Care Professionals.
3 Thornton, J., & Stevenson, S. (2007). Effect of estrogens on skin aging and the potential role of SERMs. Clinical Interventions in Aging, 2(3), 283-297. doi:10.2147/cia.s798

Alexandria-ZaniAlexandra J. Zani is an international educator, researcher, and author with a background in cell biology and medical. Her passion for education resulted in receiving numerous advanced certifications, both in the United States and abroad. Zani earned an instructor license for aesthetics/cosmetology, is NCEA certified, certified in Oncology Esthetics®, and the Pastiche Method® of Skin Analysis. She is a member of the International Association for Applied Corneotherapy (IAC). Zani presents education for advanced aesthetic technology, including microcurrents, LED, and non-ablative laser. She is a specialist in the anti-aging sciences, including the effects of nutrition, lifestyle, and the mind/body connection.

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