The Wisdom of Menopause

by Christiane Northrup

  TOPICAL APPLICATION OF HORMONE THERAPY: Skin contains receptor sites for hormones, and it is well documented that estrogen, which also has antioxidant effects, helps preserve the collagen layer of the skin. Declining hormone levels are one of the reasons for the thinning of the collagen layer during the perimenopausal years. Many women who’ve undergone surgical or medical menopause notice skin changes within a few months of the loss of their hormonal support unless they take steps to replace those hormones or take phyto hormones.

  Research has shown that topical application of estrogen can increase collagen thickness, decrease pore size, and help the skin hold moisture. In Europe, estrogen is often prescribed to help beautify the skin. You can get these same benefits by using hormones topically.

  If you are already on bioidentical hormone therapy (see BIOIDENTICAL HORMONES:

  NATURE’S IDEAL DESIGN), ask your doctor to prescribe your hormones via a formulary pharmacist so that they can be put into skin lotion. In my experience, most women are delighted with this method of using hormone therapy. It improves the skin, enhances moisture, and provides the benefits of HT, all at the same time. As with any type of hormone therapy, it’s always best to use the lowest dose that does the job. Levels that are too high can result in excessive oil secretion, acne, and even excessive growth of facial hair.

  TOPICAL ESTROGEN: If you are not on hormone therapy already but want to try estrogen for its skin benefits, ask your health care provider to prescribe a small amount of estrogen just for this purpose. A formulary pharmacist can put a small amount of estradiol or estriol in an ointment or cream. Use of the cream is safe and effective, without the adverse side effects of too much estrogen. A 1996 study found that the use of dilute topical estrogen produced marked improvement of elasticity and firmness of the skin along with increased skin moisture, decreased pore size, and decreased wrinkle depth. The dose used in the study was 1 g of an ointment containing 0.01 percent estradiol and 0.3 percent estriol, applied daily to neck and face. Monthly determinations of blood hormone levels of estradiol, follicle-stimulating hormone (FSH), and prolactin failed to show any significant systemic hormonal changes using these dilute amounts on the skin.21

  TOPICAL PROGESTERONE: Many of my patients have seen skin improvement, including decreased midlife acne, greater moisture, and fading of age spots, by using a 2 percent natural progesterone cream on their skin. This may be all you need without resorting to a prescription for estrogen cream.

  Beautiful Skin from the Inside Out:

  The Right Foods and Supplements

  Good skin isn’t just an outside job. The skin is a mirror for the health of your insides as well as your outsides. Take antioxidant vitamins (more about that on page 428) and eat at least five servings of fruits and vegetables daily. Many of the hundreds of substances present in these foods, such as lycopene in tomatoes, lutein in dark green and yellow vegetables, and the antioxidants in berries, have been clinically proven to help prevent and heal sun damage to the skin. Since antioxidants work in concert with one another, the greater the variety of fruits and vegetables you eat, the better.

  The insulin-normalizing diet I recommend for balancing hormones at midlife also helps keep your skin in good shape. Limit caffeine, and cut down as much as possible on high-glycemic-index foods such as cookies, candies, pies, cakes, and non-whole-grain breads, all of which can cause fluid retention from excess insulin secretion. They are devoid of skin-nourishing vitamins and minerals, and quickly break down into sugar, which, as I explained above, causes collagen to lose its flexibility. (This is one of the reasons why diabetic individuals whose blood sugar is not tightly controlled often develop cataracts in the collagen-rich lenses of their eyes and have difficulty with wound healing. It is also why oral supplementation with antioxidants has been shown to alleviate some of the side effects of diabetes.)

  FIBER: Make sure that you’re getting enough fiber. Nothing shows up on the skin faster than chronic constipation! I’ve seen many cases of acne clear beautifully once bowel function is normalized. One of the most effective ways to do this is simply by eating ¼ cup of ground golden flaxseed each day. In addition to the 11-plus grams of fiber you’ll get, flaxseeds are also loaded with skin-beautifying omega-3 fatty acids and phytoestrogens. Fruits and vegetables are rich in fiber, too. You can also use fiber supplements such as psyllium.

  WATER: You may also see a dramatic improvement in your skin if you drink eight 8-oz glasses of water per day. Hydration also helps prevent constipation.

  FISH: Fish, especially salmon, sardines, and swordfish, is rich in omega-3 fats, which are important for building healthy cell membranes everywhere in the body.

  SOY: One of the most common benefits women notice after several months of supplementing their diets with significant amounts of soy protein (100–160 mg of soy isoflavones per day) is improvement in their skin tone, hair, and nails. In a recent study of forty postmenopausal women taking Revival soy, 93 percent showed significant improvements in skin (namely, skin flaking and discoloration were reduced after three months, and wrinkling was reduced after six months). The women also reported significant improvements in hair roughness, dullness, manageability, and overall assessment as well as in nail roughness, ridging, flaking, splitting, and overall appearance.22 One woman who takes the soy supplement Revival wrote, “Within two months of beginning this soy drink, my nails became stronger and more resilient than ever, my hair has taken on more body, and my skin has never looked more radiant. I’m thrilled.” Soy’s phytoestrogen content helps strengthen collagen everywhere in the body, whether in facial skin, vaginal tissue, or bone, while soy isoflavones may act as antioxidants to protect skin from free-radical damage.23 Soy also provides high-quality protein needed for building and maintenance.

  LINOLEIC ACID: This omega-6 fatty acid, found in nuts, whole grains, most vegetable oils, eggs, and poultry, has been shown in clinical studies to keep skin from drying out and thinning.

  SKIN-AIDING SUPPLEMENTS: Though all of the various supplements that I recommend at midlife help the skin (see chapter 7), the antioxidants, such as coenzyme Q10, vitamin C, vitamin E and tocotrienols, and proanthocyanidins, are particularly important.

  Research has shown, for example, that proanthocyanidins from pine bark or grape pips help protect skin from the damaging effects of too much ultraviolet radiation. In one study, this powerful antioxidant was shown to prevent ultraviolet activation of a certain area in the nucleus of skin cells, reducing the inflammation that occurs after a sunburn.24 Many individuals have reported healthy changes in their skin, nails, and hair as a result. The usual dose is 40–120 mg per day; I personally take 60–80 mg per day and even more when traveling or under stress.

  Coenzyme Q10, which is found in every cell of the body, is fat soluble and concentrates in the plasma membrane of cells, where it protects against free-radical damage. This antioxidant is used up when skin is exposed to ultraviolet radiation and other environmental insults, so it makes sense to supplement your diet with it or apply it topically. It is also found in red meat, salmon, and nuts. Coenzyme Q10 assists in cellular metabolism. The usual dose in supplement form is 30–100 mg per day.

  Vitamins E and C taken as supplements have also been shown to help protect against the UV-generated free-radical damage that can lead to skin changes. The dose of vitamin C used was only 200 mg; for vitamin E, it was 1,000 IU.25 The results are apt to be even more impressive with the newer, more potent forms of vitamin E—the tocotrienols. The supplement regimen recommended in chapter 7 will give you all the skin-nourishing nutrients you need.

  PUERARIA MIRIFICA:This herb, which contains the unique phytoestrogen known as miroestrol, has also been shown to improve the skin. It contains isoflavones similar to soy. (For more information about this herb, see the discussion on Pueraria mirifica in chapter 6.)

  SKIN CARE FROM YOUR REFRIGERATOR

  Once or twice per week, if you have the time, you can give your face a healthy dose of antioxidant
s, fruit acids, and plant hormones by using ingredients that you can find right in your refrigerator. Choose the food that most appeals to your sense of smell; you’ll be getting aromatherapy benefits as well as direct benefit to your skin. Plain yogurt applied to your face makes a nourishing mask that gives your skin the benefits of lactic acid and also the hydrating effects of milk proteins. You can add pureed fresh fruit to it. (Don’t use sweetened yogurt. The sugar is harmful to the skin.)

  I love thinly sliced cucumber applied to my eyelids and cheeks to help me relax and get ready for evening. Green tea bags, moistened and applied to the eyelids, also give your eyes a soothing antioxidant life. And mashed-up fresh fruits such as peaches, strawberries, or apples can all be mixed with finely ground oatmeal to form a nourishing facial mask. You can also use parsley or even fresh basil, rosemary, or thyme. Remember, the skin will absorb the nutrients from these foods in about fifteen minutes, so you don’t need to lie down any longer than that to benefit from a rejuvenating facial mask.

  MIDLIFE ACNE

  Anything that compromises the immune system, whether emotional stress or nutritional deficiency, will tend to exacerbate the underlying conditions that lead to acne. So will hormonal imbalances in which the body produces too much androgen. Anytime you are under stress, your cortisol and insulin balance is likely to be upset; this, too, can affect your skin—and the rest of you as well. At perimenopause, the same stormy emotions that were present at adolescence often arise again, along with the hormonal swings that exacerbate the situation. It’s no wonder that skin breakouts are so common during this life stage.

  Are You Thin-Skinned and in Need of Individuation?

  Both adolescence and midlife are key developmental periods of our lives when we go through the process of individuating and defining who we are in relationship to others. The skin is the first contact surface between the mother and the infant, and for our entire lives it represents a boundary between us and other people. Some researchers believe that skin disease may be thought of as an attempt to define who we are in relationship to other people and what a healthy boundary between us should be.26 I agree.

  When I was in my early thirties, a time in life when hormones are relatively stable and skin is usually at its best, I developed a very troubling case of acne. It took me a while to understand what was going on. I’d never had much in the way of skin problems in my teenage years, and since I was exercising regularly, taking vitamins, and eating a whole-food diet, it seemed strange to me that I should suddenly be experiencing acne at my age. However, I was working at the time in an office where my ideas on nutrition, emotions, and the mind-body connection were not well accepted, a fact I dealt with by way of a lot of self-deprecating humor, hoping this would enable me to stay safe and fit in as best I could. I desperately wanted the approval of my colleagues and was so thin-skinned that I was constantly trying to forestall any criticism of my ideas and beliefs. Finally, at the age of thirty-five, I realized that I couldn’t continue using so much of my energy to try to blend in, and so after a good deal of soul-searching, I took a leap of faith and left to co-found Women to Women. My four-year-long skin problem cleared up within three months and has never returned, even when I was in the middle of midlife hormonal changes!

  THE ANATOMY OF ACNE

  1. Androgenic hormones such as DHEA and testosterone increase production of sebum by the sebaceous glands.

  2. Sebum makes the hardened outer layer of skin (the keratinrich cells known as the horny layer) turn over faster. This results in pores and hair follicles that are clogged with dead skin cells and oil.

  3. Skin bacteria of the type known as Propionibacterium acnes feed off the sebum and break it down into free fatty acids.

  4. Free fatty acids attract white blood cells and other inflammatory molecules (eicosanoids) from the immune system.

  5. An acne pimple or blackhead is the result.

  Hormones and Midlife Acne

  There are numerous studies showing that sebaceous gland activity is heightened by androgens such as DHEA and testosterone and reduced by estrogen or removal of the ovaries, which reduces androgen levels.27 This is the reason why birth control pills often help clear up acne. But whether or not higher levels of hormones result in acne is an individual matter. Women with the most severe forms of acne generally have a genetic predisposition to androgen sensitivity in their skin, even at hormone levels that are normal.

  When sebaceous glands are small, as in children and the elderly, acne does not occur. It is usually first seen in adolescence, when sebaceous gland development begins to take place. It occurs primarily on the face, back, and chest. Endocrinologists have long theorized that acne is an endocrine disease resulting from abnormal androgen production. Hair follicles and attached sebaceous glands contain a specific enzyme known as 5-alpha-reductase, which can convert estrogen into the androgen testosterone. That’s why some women experience an increase in acne when their estrogen levels rise, due either to perimenopause or to being put on overly high levels of HT. But two women who are on identical HT regimens, eat exactly the same diet, and have the same amount of stress in their lives may have skin reactions that are entirely different. That’s why all treatments, including prescription medications, have their place and can be useful.

  Natural Treatments for Acne

  If your acne is mild to moderate, I’d recommend that you use the natural treatment program I outline below. If your acne is severe, you may also want to add one of the medications I discuss below, or follow the advice of a skin care specialist.

  ~ EAT A GOOD DIET. Follow the high-fiber, insulin-lowering diet outlined in chapter 7, because a diet too high in high-glycemic-index carbohydrates, as I’ve already stated, is associated with excessively high levels of insulin, which in turn can cause higher-than-normal production of androgens. For many women, this is all that is necessary to completely clear up acne.

  ~ TAKE SUPPLEMENTS. Take a comprehensive vitamin and mineral supplement daily. (See chapter 7.) It is well documented that zinc, vitamin C, and the B vitamins are essential for healthy skin functioning. Many women notice that their hair and skin improve dramatically when they start on a good supplementation regimen.

  ~ LOSE EXCESS BODY FAT. Get your body fat percentage into the healthy range. Excess body fat is associated with higher-thannormal androgen levels. Even a small fat loss of five to ten pounds can make a significant difference in insulin and androgen as it affects the sebaceous glands.

  ~ FOLLOW THE SKIN CARE REGIMEN FOR THE GENERAL CARE OF MIDLIFE SKIN (pages 415–418). Remember that the fruit acids alone often work very well for acne. A good antioxidant skin care program usually helps reduce or completely eliminate acne scars. Intense pulsed light (IPL) treatments can work wonders for old acne scars.

  ~ TRY HOME REMEDIES FOR PIMPLES. When you notice a pimple that hasn’t come to a head yet, apply tea tree oil at night. The anti-bacterial properties in the oil will often result in significant regression of the pimple by morning. Some women use tea tree oil daily.

  Another effective treatment is to make a paste of baking soda and lemon juice and apply it to the pimple. Baking soda also makes an excellent exfoliating agent unless your skin is sensitive.

  ~ REMOVE BLACKHEADS. For blackheads, get a professional facial with blackhead removal about once per month until your skin has cleared. After that, you can use one of the readily available blackhead removal strips, such as Bioré. Limit use to once per week to avoid overdrying the skin.

  Acne Medications

  VITAMIN A DERIVATIVES: Tretinoin (in Retin-A, Retin-A Micro, and Renova, applied topically) and Isotretinoin (Accutane, taken systemically) are prescription medications that increase skin cell turnover and allow sebum to be released more easily so that it doesn’t get trapped. Accutane is an oral vitamin A derivative that powerfully inhibits both sebum production and growth of acne-causing bacteria. It is the single most effective treatment for severe acne that doesn’t respond to other measures. However
, it is very irritating and should never be used by anyone who is pregnant or trying to get pregnant, because it can cause birth defects.28

  BENZOYL PEROXIDE AND SULFUR-CONTAINING PRODUCTS: Various lotions, creams, or gels containing benzoyl peroxide or sulfur are often used for their antibacterial and drying properties. Benzoyl peroxide penetrates the hair follicle and produces oxygen, thus suppressing the growth of acne-causing bacteria, which thrive in an anaerobic (oxygen-free) environment. Although often effective, these treatments can be very irritating for the skin. I recommend the Acne Recovery System Kit from Trienelle (www.trienelle.com), which allows users to adjust their dose of benzoyl peroxide and other effective anti-acne preparations to minimize irritation and maximize effectiveness.

  ANTIBIOTICS: Tetracycline or erythromycin work by preventing the acne bacteria from breaking down the sebum into the free fatty acids that result in pimples. I do not recommend the use of antibiotics because they kill off the healthy bacteria in the bowel, which can lead to suboptimal absorption of nutrients, diarrhea, and repeated yeast infections. It can also lead to antibiotic resistance.

  BIRTH CONTROL PILLS: Oral contraceptives are often used to reduce sebum production. They do this by decreasing the brain’s signal to make hormones from the ovaries. I’d avoid these synthetic hormones unless you feel you have no other choice and are unable or unwilling to follow a healthier diet or use one or more of the topical treatments recommended above.