The Wisdom of Menopause

by Christiane Northrup

  About half an hour later I met another woman. About fifty-five years old, she had a plain but lively face, unadorned by any makeup, and she was at least thirty or forty pounds overweight. Since we were discussing medical topics, she told me about a mastectomy she’d had years before that had left her chest quite disfigured. In the course of the conversation, she said, “I think we underestimate men, don’t you? They can be so sweet.” It turned out that she was dating three different men, one of whom she felt was the one she was destined to marry! This woman’s inner beauty and sense of humor made me feel happy just being around her. When I compared her energy and attitude with that of the show-stoppingly beautiful woman I’d met earlier, I realized how transient the impression of mere physical beauty can be when it’s not lit from within by a beautiful soul. Since then, I’ve seen this phenomenon repeatedly: midlife women finding wonderful life partners online, and everywhere else, simply because they’ve decided to stay in the game.

  Remember this when you are tempted to succumb to the cultural and media-driven notion that after thirty-five it’s all downhill for women, our best years are behind us, and no one will ever love us again because we are no longer twenty-five. I’ve come to see that nothing could be further from the truth. In fact, many men have told me that it’s a woman’s enthusiasm for her life, her self-acceptance, and her sense of fun that they find most attractive.

  A Primer on Skin: Our External Nervous System

  To prevent unnecessary aging of the skin—which manifests as dullness, sallowness, uneven pigmentation, dryness, and wrinkles—you first need to understand what your skin does for you and how it does it.

  The skin is derived from the embryonic layer known as the neuroectoderm, the same tissue layer that becomes the brain and the peripheral nervous system. It functions as a kind of external brain, gathering information about our outer environment through its ability to sense pressure, temperature, pleasure, and pain. The skin is also the largest and most important part of the immune system.

  The research of Tiffany Field, Ph.D., on the striking immune-system-enhancing benefits of massage is compelling evidence of just how intimately our skin is connected with and affected by every aspect of our health, from our emotions to our nutrient intake. Our skin is, quite literally, the boundary between us and our environment. As our first line of defense against the vagaries of that environment, including bacteria, viruses, excessive ultraviolet radiation from the sun, wind, air pollution, and secondhand smoke, it is not only vulnerable to what’s going on outside of us, it’s also affected by our internal environment, both emotional and nutritional.

  The condition of your skin says a great deal about how well you’re fitting into and feeling supported by your current environment. There’s an unmistakable glow emanating from women who are happy and satisfied with their lives that no amount of cosmetic surgery can create. It comes only from connecting with Source energy. If, for any reason, you feel as though you cannot be safe or true to yourself in your environment, and you are not particularly aware of this, then your skin may react for you. That’s why it is well known in dermatology that patients may need simultaneous treatment of their skin and their mind and emotions for best results. Dermatitis and hives, for example, are two of the conditions known to be caused by a mixture of psychological and physical factors, while disorders such as psoriasis, hair loss, and eczema may also be affected by psychological factors. Almost everyone has had the experience of developing a large pimple in a prominent area of her face just when she was most concerned about looking her best for some big social event, or breaking out in oral herpes (cold sores) just before going out on a date, or getting itchy hives on taking a new job or moving to a new city. Sooner or later all of who we are and have been shows up on our faces.

  The Anatomy of the Skin

  The skin consists of three layers: the outer epidermis, the middle dermis, and a fat layer underlying both of those. The paper-thin epidermis is a protective layer of dead skin cells that holds in moisture and oil. It is constantly being shed and replaced as fresh cells push their way up to the surface, get flattened, and then die. As we age, the sloughing process tends to slow down, which is one of the reasons why skin tends to lose its “freshness.”

  At the base of the epidermis are the basal cells, which contain the melanin-generating cells known as melanocytes. The amount and type of melanin determine the tone of your skin—a trait that is inherited from your parents.

  The dermis layer, which makes up about 90 percent of the skin, is where the nerve receptors and blood vessels are located. It also contains sweat glands and sebaceous glands; the latter produce oil and are attached to hair follicles. Blackheads and pimples inevitably arise from clogged sebaceous ducts at the root of hair follicles. The sweat and oil secretions from the dermal layer help protect the skin from infection by creating a protective acid mantle, but this mantle is easily disrupted by using harsh detergents and non-pH-balanced soaps.

  Two proteins known as collagen and elastin, which give skin its elasticity and flexibility, are also located in the dermis layer. On average, collagen production starts to diminish at a rate of 1 percent per year starting in our twenties. By midlife we may have lost up to 20 percent of our collagen layer, though there is enormous variation among different individuals and this is not inevitable. The darker your skin tone, however, the more collagen and elastin it has—which is why the skin and bones of dark-skinned women tend to be more resistant to the wear and tear of aging compared to women of Caucasian descent. It is also why black-and brown-skinned women are less apt to have wrinkled skin compared to white-skinned women. The television personality Star Jones put it this way: “Black don’t crack.” Those with yellow skin tend to fall somewhere in between.

  FIGURE 15: THE ANATOMY OF THE SKIN

  In addition to the thinning of the collagen layer of our skin with age, our oil glands tend to decrease their secretions, resulting in a greater tendency toward dryness. By about age fifty, the capacity of the skin to repair itself tends to slow down, for reasons that aren’t entirely clear but may be related to free-radical damage. (See the next section.)

  Free Radicals and Skin Aging

  If you take a look at the skin on your buttocks and lower back, you’ll notice something important: skin that has been protected from environmental pollutants and excessive sunlight is smoother and more wrinkle-free than elsewhere on our bodies. That means that skin aging is related to more than simply chronological age. It’s also related to our environment—both inside and outside our bodies.

  Premature aging of the skin—and of every other cell in our body—is related to the production of what are known as free radicals, oxygen molecules that have become unstable because they have lost an electron in the course of interacting with other molecules in our body during such basic metabolic processes as breathing and digestion. Free radicals are also produced when sunlight hits the skin, by repeated bouts of high blood sugar and insulin (glycemic stress), and by toxins of all kinds, including cigarette smoke and air pollutants. Emotional stress also results in free-radical damage secondary to the effects of cortisol and adrenaline. In the body, these unstable free radicals bounce around, attaching themselves to the cell membranes of virtually any tissue that is available in order to stabilize themselves with an electron from that tissue. If they take an extra electron from collagen in our skin, for example, this can damage the collagen. Over time the skin becomes stiff and discolored and loses its elasticity. It’s much like the process by which iron rusts when left out in the open air.

  Wrinkles result from the breakdown of elastin and collagen fibers in the deeper layers of the skin. Collagen and elastin are responsible for the resilience of the skin, allowing it to stretch and contract. When collagen gets broken down, skin tends to sag and wrinkle.

  Free-radical damage can also harm and break down the fats within our cells and cell membranes, and the DNA of the cells, where the genetic code resides. Over time, cell membran
es become stiff instead of fluid and flexible. There’s no doubt that free-radical damage is one of the primary causes of aging, including skin wrinkling, and age-related diseases such as heart disease, Alzheimer’s, arthritis, and so on. Glycemic stress from eating too many refined foods also contributes to premature aging.

  Since some free radicals are produced as an unavoidable part of daily living, it’s not surprising that our bodies have developed defense systems for dealing with them. This defense system is based on the effects of molecules known as antioxidants. These include vitamins C and E found in foods, and others produced in the body, such as glutathione, catalase, and superoxidedismutase. Antioxidants work by donating electrons to the unstable free radicals, thus rendering them harmless by preventing them from combining with other molecules and damaging our tissues.

  Given this defense system, one might wonder why we age at all. As with all things, it’s a question of balance. Though our bodies manufacture antioxidants and we ingest them in foods and as supplements, sometimes our antioxidant systems become overwhelmed by the sheer number of free radicals produced by such things as cigarette smoke, air pollution, sun exposure, diets that are heavy in trans fats or other suboptimal ingredients, high blood sugar, and emotional stress of all kinds. The resulting free-radical damage in our bodies is known as oxidative stress. Hundreds of research studies have now documented that we can keep the oxidative stress in our bodies to a minimum by ingesting antioxidants, applying products that contain them, avoiding environmental toxins, eating a low-glycemic-index diet, and maintaining emotional equilibrium.

  How Smoking Damages the Skin

  Midlife is the time when the ill effects of smoking become as plain as the nose on your face. Women who smoke heavily have a paler skin tone and more lines and wrinkles than nonsmokers. Some of this effect is from the decrease in circulation to the skin caused by nicotine. Decreased skin circulation results in fewer nutrients getting to the skin and a decreased ability of the skin to release the toxic waste products of cell metabolism. This results in a slowing of skin growth and rejuvenation.

  In addition to this, smoking directly poisons the ovaries, leading to decreased levels of estrogen, which is necessary to help maintain elastin and collagen fibers.

  How Excessive Ultraviolet Radiation Damages the Skin

  It is estimated that about 70 percent of the change we see in our skin as we age is the result of damage done to collagen fibers in the dermis. Sun damage, in particular, causes the skin to lose its resiliency and elasticity.1 Skin that is chronically overexposed to the sun without optimal antioxidant levels in the body to counteract this is in a constant state of mild inflammation. Though we’ve all been brought up to feel that a tan makes us look more youthful in appearance (not to mention the fact that new evidence shows the use of indoor tanning beds in certain young adults can actually be addictive), these presumed health benefits are an illusion: the mild inflammation and swelling of tanned skin plumps the skin up, temporarily minimizing wrinkles, and gives the appearance of a more youthful look.2 But once the tan goes away, the wrinkles reappear, and what you’re left with is skin that has lost its normal architecture.

  Excessive exposure to ultraviolet radiation results in tissue inflammation that begins with free-radical damage to skin cell membranes followed by the release of harmful inflammatory chemicals that ultimately damage collagen and elastin fibers. Eventually collagen and elastin fibers that were originally flexible and fluid become stiff and hard. The aging process that your skin collagen goes through is much the same as what happens to a flexible and clear egg white when you drop it on a hot griddle: the fluid protein in the egg white is transformed into denatured protein, a dense, hard, inflexible type of protein. Ultraviolet radiation also damages the blood vessels in the skin, thus decreasing the flow of blood and other nutrients to this organ. This is in part the reason for those pesky dilated blood vessels on the cheeks and nose. Uneven pigmentation, roughness, and thickening of the skin result from disruption of both immune and cellular replication processes as we age. They are not inevitable but are brought about by DNA damage and oxidative stress from stresses of all kind, in particular UV damage from the sun.

  How Excess Blood Sugar and

  a Nutrient-Poor Diet Damage the Skin

  No one doubts the health benefits of nutrient-rich fruits, vegetables, lean proteins, healthy fats, and enough fiber. What most don’t realize is that exactly the same diet that prevents diabetes and heart disease also provides you with a radiant complexion. A study of data taken from the first National Health and Nutrition Examination Survey (NHANES I) of 4,025 midlife women showed that women who avoided high-carb diets and ate foods that contained plenty of vitamin C and linoleic acid (an omega-6 essential fatty acid) had fewer wrinkles, less dry skin, and less thinning of the skin.3 This makes perfect sense because a diet too high in refined carbohydrates raises blood sugar too quickly, and too much sugar in the blood results in a process known as glycosylation (or glycation), in which the sugar actually combines with proteins in the blood and the body—including the skin. When this happens, the collagen becomes stiff and inflexible—like the cooked egg white I mentioned earlier.

  New, healthy skin starts with healthy blood vessels. But when your fibroblasts (the cells that make collagen) don’t get the nutrients they need and your collagen is damaged from glycosylation, your skin simply doesn’t look its best. You also need the right kinds of omega-3 fats to replenish your skin. The effect of a low-glycemic-index, nutrient-rich diet on the skin is the basis for The Wrinkle Cure (Rodale, 2000), by Nicholas Perricone, M.D., which provides the sound dietary advice that will also help prevent cancer and heart disease. (See chapter 7.) Another great source of research on this is The Paleo Diet (Wiley, 2010) by Loren Cordain, Ph.D.

  PREVENTING OR TREATING WRINKLES

  The key to younger-looking skin at perimenopause is to avoid smoking and overexposure to the sun (the earlier the better), follow a low-glycemic-index diet, and use antioxidants, both topically and internally. Uneven pigmentation, roughness, and hyperkeratinosis are the direct consequences of disruption of the cellular replication and immunological processes. As discussed above, these are brought about by DNA damage and oxidative stress resulting from absorption of UVR photons. Some women, by virtue of their genes, simply seem to have wrinkle-free youthful skin for a lifetime, regardless of how much sun exposure they get. But most of us have to give our skin a helping hand when it comes to midlife preservation or improvement. Over the past decade or so, a huge amount of research has been done on the role of antioxidants in both preventing and even reversing the free-radical damage and tissue inflammation that are the root cause of skin aging. Excess sun exposure combined with the effects of a nutrient-poor diet and too much stress are what cause the kind of skin deterioration that we begin to notice during perimenopause. But these same factors can be addressed so that a great deal of the damage that has already been done can be stopped and even reversed.

  Midlife Skin Care Regimen

  ~ CLEANSE YOUR SKIN REGULARLY. The skin has been called a “third kidney” because it removes almost as much waste material from the body each day as the kidneys themselves. If your skin is dry, you need to cleanse it thoroughly once per day. If it’s oily, then twice per day may be better. Remove all makeup every night. When you care for your face, don’t forget your neck—it’s the first place you notice the effects of aging. Cleansing your skin thoroughly will clean out your pores and allow your skin to remove waste products efficiently from your body as you sleep, a time when your body is rejuvenating itself.

  Use a cleansing lotion or soap that preserves the acid mantle of the skin, because it’s one of your body’s natural defenses against infection and breakouts. Look for the term “pH balanced” when shopping for a soap or cleanser. Many good brands are available.

  If your skin is oily, be sure to avoid overuse of astringents, which usually contain alcohol. They can actually make an oil problem worse a
nd also damage your skin over time.

  ~ CLOSE PORES AFTER CLEANING. Use a toner to close the pores after cleansing, especially if your skin is oily. Or simply use cool water to close the pores—it works well for all skin types.

  ~ RENEW SKIN WITH EXFOLIANTS AND TOPICAL ANTIOXIDANTS. One of the reasons that skin starts to look dull and old at midlife is that the rate of skin growth and cell turnover slows down. As a result, the plumper new skin cells that give your complexion a glowing appearance tend to stay below the surface. In order to help remove old dead skin from the surface, open your pores, and speed up new skin growth, you’ll need regular exfoliation. This can be done either mechanically, with a washcloth, or with products that contain fruit acids, which include alpha hydroxy, beta hydroxy, and glycolic acids. (See Exfoliants and Antioxidants.)

  Avoid using abrasive cleansers such as those made from the hulls of nuts, which is like cleaning your skin with sandpaper. This can lead to breakage of capillaries and microabrasions of the skin that raise the risk of infection and even acne.

  If your skin is oily, apply a mild cleanser to a washcloth, and use that to exfoliate each night. Use a clean washcloth each time to decrease the amount of germs that your skin comes into contact with. Follow this with an application of a mild alpha hydroxy, beta hydroxy, or glycolic acid product and/or one of the antioxidant products I recommend below. Many products on the market today contain both antioxidants and fruit acids. If your skin is dry or sensitive, skip the washcloth and simply use an alpha hydroxy acid (AHA) or antioxidant preparation to do your exfoliating for you.