How do you feel about your skin?

As we are spending more time at home in our familiar surroundings, are you becoming more aware of the changes to your skin?

Have you ever considered that some of those changes are not because you might not be keeping up with your skin care routine or getting enough sleep or trying not to kill the children, but maybe changes in hormones. Many women will just look at their skin and think this is the normal ageing process. That it is genetic, just like their mother, but around the menopausal years it is purely down to hormonal changes.

Menopause to some is a hard topic to get your head around. Even more so when you realise you can see the effects of it starting from as young as your late 30’s and early 40’s.

Around 13 million women within the UK are either peri or post-menopausal. 80% of these women can experience symptoms. There are 34 general signs of menopause that are known but this list is still growing.

I have put the above list in not to upset anyone but to normalise what we as women may go through. This information is also can give men an insight into what a partner could be going through.

But what does any of this have to do with a salon talking about menopause, what else could it effect?

Well, your skin is the largest organ of the body and can show the decline of Oestrogen through

• Dryness
• Epidermal Thinning
• Laxity
• Dullness
• Increase of Wrinkles
• Uneven texture

But what is oestrogen and why does it dropping, effect our skin.

Oestrogen (female sex hormones) is very important to the female body. It is a word used for a group of 3 steroid hormones mainly produced via the ovaries. These are Estradiol, Estriol and Estrone.

• Estrone – This is predominantly made by body fat and is the oestrogen that remains after menopause.
• Estriol – Produced by the placenta during pregnancy, it isn’t found in measurable amounts in the body and is considered the ‘weakest’ of the group.
• Estradiol – This is the work horse hormone out of the 3 that women produce from puberty and play a role in over 400 functions of the body. (start thinking of the above lists). It is not only responsible for the female reproductive organs to develop, aid in egg fertilisation and implantation and early embryo nutrition.

Oestrogens not only control your menstrual cycle but have an effect on the skeletal system and skeletal muscles, your liver and circulatory system. Adipose tissue that effects glucose metabolism and gastrointestinal system. The skin and central nervous system.

Our body consists of more than 200 different types of cells. We are interested in skin cells and how Oestrogen interreacts with them and over our life time. A standard structure of a skin cell consists of a plasma membrane (cell membrane) which gasses and water can pass. Cytoplasm that surrounds the cells’ nucleus (that holds the cells DNA), and suspends organelles. You will also find oestrogen receptors inside the cytoplasm and bound to the cell membrane.

Oestrogen receptors are part of a family of nuclear hormone receptors, ERa and ERβ that activate when oestrogen enters the cell. These receptors will alter their shape as they pass into the nucleus and bind to areas of DNA, it will have an effect of gene expression and protein production. This is known as ‘classic’ signalling.

2 of the main cell structures you will find ERa and Erβ are:

• Keratinocytes – forms skin cells
• Fibroblasts – produce collagen, elastin and hyaluronic acid

Even though the receptors are found throughout the epidermis (top layers of skin) and dermis (the structural layer) they are concentrated more around the face, scalp and vagina.

When good level of Estradiol binds to ERa and Erβ receptors they can create a positive feed-back loop. Meaning it will increase both keratinocyte and fibroblast production, giving the skin a fuller, firmer, heather texture. If the estradiol levels drops (menopause or medically induced menopause) the receptors sit dormant and stop binding to areas of DNA slowing down the production of skin cells. This leads to a dryer, more paper like skin structure.

So what is Menopause?

It is the permanent cessation of menstrual periods for the span of 1 year. So no periods for 1 year. This is not a sudden event.

Usually between the ages of 45-55 the ovary's produce less and less oestrogen. This reduction in oestrogen is refereed to as the peri-menopause (a woman can experience some, none or many symptoms initially list above).

This means the actual menopause just marks a moment in time that periods have stopped for 1 year. The menopause is considered as just a day. After that you are considered as post-menopausal. This is where the ovary's are producing a minimal amount of estradiol.

Body fat in a woman increases at this time to produce estrone. To achieve this the woman's body starts to change shape and they become heavier around the mid drift. Estrone being a weaker hormone than estradiol, doesn't interact or bind with the ERa and Erβ receptors as well, not just effecting the skin but all the other systems mentioned above. 

Between 18-48 women loose 1% collagen per year. That is a loss of 30% collagen over a 30 year period. We may notice small changes in the skin but from the onset of menopause and the 5 years following we will lose a further 30%.

5 years is a very short period of time to lose 30% of your skins collagen as opposed to 30% over 30 years. This is why many women say they feel a sudden drop in their skin. This is the fastest acceleration of skin aging that a woman will experience.

Each year that follows the skin will lose a further 2% of collagen each year.

Many skin treatments that promote the rebuilding of collagen will not be as effective once post-menopausal. If oestrogen receptors are dormmate, you will not stimulate the keratinocyte and fibroblast calls to build new collagen and skin cells.

So what help is out there, are there any side effects? 

There are several clinical options open to women that all have a positive effect on the skin but they don’t just target the skin and can have some systemic side effects throughout the body.

• HRT (Hormone Replacement Therapy ~ Oestrogen with or without progestin)

The primary function of HRT is to treat or minimise the effects or symptoms post menopause. This prescription only medication was approved by the FDA in 1945. It was a very effective treatment for women who suffered post menopause including positive effect to the skin. By 1970 support for HRT wavered as it was linked to an increased risk of uterine cancer. In 2002 a study preformed by the WHI (Woman's Health Initiative) established a link between HRT and increased risk of breast cancer, strokes and coronary artery disease. Years following the WHI study the numbers of women using HRT has declined along with an understanding of the drug among women in general. The issue with this study, when you look at it properly, is the age bracket of the women in the study (68-79). By 2014 and later, newer studies are testing other age brackets and the findings are showing many women under the age of 70 decrease in the risk of stroke, coronary heart disease and breast cancer. It is important that you ask questions and discuss the pro’s and con’s of HRT with a medical practitioner or endocrinologist that you are comfortable with.

It is still thought that the benefits that HRT has on a woman's quality of life out weighs the risks.

~ Bioidentical Hormones

Bioidentical Hormones are a man made synthetic hormone that very closely mimics hormones produced by the body. They have a similar chemical structure to our naturally occurring hormones and were designed to try and manage some of the negative effects of HRT. Bioidentical Hormones are classified as unlicensed prescription medications. Clinicians who use the drugs in practice have reported benefits to patients with hormone imbalances or tried other hormonal drugs including HRT and experience unwanted side effects. Currently Bioidential Hormones have not been put through large scale testing so their efficiency and safety are considered unknown.

• Topical Oestrogen

Topical oestrogen is another prescription only product for use with post menopausal or hormone imbalances with symptoms of vaginal or vulva atrophy. All tho this is a topical drug designed for intimate areas the off label use of topical oestrogen has been of the décolletage and face. It has shown to have an active effect on post-menopausal skin but concerns have been raised about the development of Telangiectasia (widening or dilation of small blood vessels in the sun) and a potential risk systemic oestrogen absorption.

Systemic absorption is considered a concern just like HRT an associated risk of endometrial cancer, coronary artery disease, stroke and breast cancer. It has not been proven as study's have shown contrasting results.

• Selective Oestrogen Receptor Modulators (SERMS)

Depending on the target organ SERMS are molecules that can bind to oestrogen receptors that can either be an

~Oestrogen Agonist (promotes) This is where the molecule binds and activates oestrogen receptors.

~Oestrogen Antagonist (inhibits) This is where the molecule binds to oestrogen receptors but doesn't activate them.

So SERMS can either block or active oestrogen receptors. (Tamoxifen blocks oestrogen in breast tissue but can activate in uterine tissue).