The Wisdom of Menopause

by Christiane Northrup

  ROSACEA

  Rosacea is a common condition at midlife (forties and fifties) and occurs equally in women and in men. Rosacea is, in essence, a neurological disorder of the facial blood vessels, which makes them hyperresponsive. This results in dilated blood vessels in the blush area of the face and upper chest. It is accompanied by facial flushing, a burning sensation in the face, and also papules and pustules. Rosacea clearly demonstrates the seamless connection between emotions and skin, for it always gets worse when women are under significant emotional stress. Psychological studies have linked rosacea with a disordered blushing reaction. Though blushing is a normal response to the emotions of excitement, shame, or embarrassment, in those with rosacea the body’s normal response goes too far because the emotion is held too frequently or too long. Studies have shown, for instance, that people prone to this disorder are likely to be perfectionistic and have a strong need to please others. They also have a predisposition to excessive feelings of guilt and shame.29 Rosacea “triggers” are numerous and include changes in temperature, certain foods, stress, changes in emotions, exercise, and several skin care products. Rosacea generally begins between the ages of thirty and sixty, though it can start as early as the teenage years and, although rare, in childhood.

  CHERYL: Rosacea and Shame

  Cheryl first came to see me when she was forty-two and having problems with irregular periods. She also had persistent reddening of the skin around her nose and cheeks, which her dermatologist had diagnosed as rosacea. Though she was on various topical antibiotics for the problem, they didn’t help much. Her problem always seemed to be exacerbated premenstrually, but with such irregular periods, which sometimes came every two weeks, she never knew when her skin would look good and when it would flare up.

  As I worked with Cheryl over the next year, we both noticed what a barometer her skin reddening was for emotional turmoil. And Cheryl had plenty. During the year that her rosacea first appeared, she was in the middle of an affair with a married professional—an affair that took place in his office. Over time she discovered that she wasn’t the only woman with whom this man was sexually involved. When she discovered this, she felt deeply ashamed. Her childhood history revealed that she had been the victim of incest by her father, something she had also kept secret for years. But Cheryl had a great deal of courage. She began to go to groups for incest survivors and also started individual therapy. At the same time she committed to improving her diet and lifestyle on all levels. Over the next several years Cheryl became stronger and more independent. Eventually she even had the courage to forgive herself for becoming involved with an unscrupulous man in the first place. As Cheryl connected with her inner wisdom and supported herself physically through diet and exercise, her rosacea cleared up, slowly but surely. She now notices flare-ups only occasionally, and only when she reverts to old emotional patterns of shame and neediness, feelings that she now has the skills and self-esteem to work through effectively.

  Treatment Options

  The standard treatment for rosacea includes both oral and topical medications that are anti-inflammatory (antibiotics or Accutane) and a topical anti-inflammatory (such as a metronidazole-based product). The treatment protocol is generally followed for four to six months until the rosacea is under control. (Often, antibiotics don’t help—there’s no evidence that rosacea is caused by abnormal skin bacteria.) After that, just topical treatment is continued. The obvious problem with oral antibiotics is that taking them over so many months can result in an imbalance of normal bowel flora. That’s why I always recommend taking a probiotic (for example, acidophilus) if you’re on an antibiotic. Cellular inflammation aggravates rosacea (and just about every other disease as well), so if you really want to control rosacea, you must follow a low-sugar diet that keeps insulin levels normal. This means eating minimal amounts or eliminating “white” foods, including white bread, white potatoes, products containing sugar, and soda. It’s best to include lots of fresh fruits and vegetables, which are also loaded with antioxidants to help fight inflammation. It’s also helpful to use skin care products that are self-preserving and do not contain parabens and other irritants. (See Resources.) Be sure to avoid products with alpha-hydroxy acids, as they can be irritating. Hydrocortisone, benzoyl peroxide, and topical retinoids should also be avoided.

  Some women report that supplementing their diets with betaine hydrochloride, which increases stomach acidity, helps rosacea, for reasons that aren’t entirely clear. If you decide to take this supplement, which is available in natural food stores, make sure you take it with food. Otherwise it creates a sensation like heartburn. The usual dose is 500–1,000 mg with meals. IPL (intense pulsed light) can also be very effective.

  MIND-BODY APPROACH TO SKIN PROBLEMS

  Did my description of the psychological profile of a rosacea patient or someone suffering from midlife acne strike home? If it did, then next time you feel yourself becoming overwhelmed by emotions of shame, anxiety, or anger, try the following.

  1. Take a full, deep breath—all the way down into your belly. (We often stop breathing when we feel a strong emotion, as a way to stop feeling it.) Exhale and continue to breathe fully.

  2. Close your eyes.

  3. Identify where in your body you are feeling the emotion.

  4. Describe what you are feeling. Does it have a shape, a color, or a sound?

  5. Don’t try to change your feeling. Allow yourself to feel it fully, exactly as it is. Love yourself for it.

  6. Keep breathing and moving around while doing this—breathing and moving will help you move the emotion right on through.

  Here’s what you’re apt to notice: the minute you give your emotion a chance to be felt fully, it goes away. You can use this technique anytime you feel any difficult emotion. And guess what? You’ll find that you have the ability to deal with it without outside help.

  HAIR IN THE WRONG PLACES

  Many women notice an increase in coarse or dark hair on their chins and upper lips starting at midlife. Although this can be quite distressing, it is perfectly natural and is the result of the higher androgen-toestrogen ratio that prevails beginning in perimenopause. Androgen can transform fine peach-fuzz-type hair (known as vellus hair) into coarser hair (known as terminal hair). Sometimes, however, excessive facial hair can be a sign of an underlying hormonal imbalance, such as in the condition known as polycystic ovary syndrome. Coarse facial hair is also common in women whose diets are too high in refined carbohydrates, which shifts the hormones in the direction of androgens. Usually, however, the growth of facial hair at midlife is not a sign of hormonal or nutritional problems, just the normal result of proportionally higher levels of androgens.

  The same androgenic hormones that are associated with thickening and darkening of hair on your upper lip and your chin may cause hair loss on other areas, such as the head. Androgenic hormones affect the hair follicles of the scalp by shortening what is known as anagen (the growth phase of the hair growth cycle), which causes the hair to regress to a finer, thinner texture. But how androgen affects the hair depends in part on where the hair is located. The androgen receptors in the hair follicles of other areas of the body vary in terms of numbers and sensitivity. That’s the reason why excessive androgen can thin out the hair on your head while increasing the amount and thickness of the hair on your face. Of course, not only are there differences in androgen sensitivity in different bodily sites within the individual, but there are differences between individuals. Thus a relatively low level of androgen may result in facial hair growth in some women and not in others. Amount of body and facial hair also varies among different racial groups. Dark-haired, darkly pigmented Caucasians of either sex tend to be hairier than blondes or fairskinned individuals.

  Hair Removal Techniques

  As normal as it may be, excess facial (or body) hair may be something you wish to deal with cosmetically. In general, I don’t recommend plucking, waxing, or shaving, because over time thi
s can distort the hair follicle, making permanent hair removal more difficult if you decide on that later. (Okay, I admit that almost all women, including me, have to pluck chin hairs from time to time—sometimes even before the age of forty!) But before opting for permanent removal, you may want to try the insulin-balancing diet suggested in chapter 7. As an interim cosmetic intervention, it’s best to simply cut the hair as close to the skin as possible or bleach it. If you do decide on permanent hair removal, keep in mind that fine, nonandrogenized hair (the peach-fuzz type of hair that is present everywhere on the body) may undergo androgenization at any time during perimenopause or beyond. So even though you may have had your existing coarse hair removed, you may be producing new hair regularly, especially during times of stress, when androgenic hormone levels increase. Sometimes hair growth will also be encouraged by the hormones you’re using or your diet and stress levels.

  ELECTROLYSIS: Electrolysis is a procedure done by a trained professional that involves sending an electric current into the hair follicle via a carefully placed needle. It can take several treatments per hair follicle to truly destroy that follicle and prevent the hair from regrowing. Electrolysis is uncomfortable, so you may want your doctor to give you a prescription for a topical anesthetic known as EMLA (lidocaine and prilocaine), which must be put on the skin an hour before the treatment. Over time—usually a few weeks to a few months—regular electrolysis sessions will result in far fewer dark hairs. But you’ll probably have to continue to go for treatments every month or so, as new vellus hairs are transformed into terminal hairs. Make sure that your electrolysis professional is well trained and certified.

  LASER HAIR REMOVAL: Laser technology for hair removal is improving all the time and can be very effective. Like electrolysis, it is painful, so a topical anesthetic (EMLA) is used before the procedure. Make sure you go to a physician who is well trained in laser technology, because it is a rapidly evolving field.

  PRESCRIPTION MEDICATIONS: The medications mentioned on page 442 for the treatment of hair loss on the head may also, ironically, be effective for treating hair growth on the face, since both may be a result of the hormonal shifts that occur at menopause. Spironolactone in particular is a potent antiandrogen that is sometimes effective when used topically.

  Alopecia Androgenica:

  Midlife Hair Loss from Hormonal Imbalance

  Though some women begin to experience some hair loss at menopause secondary to hormonal shifts in the body, most do not. Saying that significant hair loss is secondary to menopause would be like saying that dementia is a normal part of aging. Nevertheless, hair loss at perimenopause is a relatively common problem that erodes self-confidence and self-esteem and makes it difficult to enjoy yourself fully in a social situation.

  Alopecia androgenica, which results in what we call male pattern baldness, is by far the most common cause of hair thinning and loss in women at midlife. Typically, the hair becomes finer and thinner and may eventually recede, though in women usually the front hairline is preserved. Up to 13 percent of premenopausal women and 37 percent of postmenopausal women suffer from hormone-associated hair loss to some degree.

  I recently received the following illustrative letter from Evelyn, one of my e-letter subscribers.

  I am writing in an attempt to get some clarification on natural hormone therapy. I had a complete hysterectomy last July at the age of forty-four—fibroids. My doctor started me out on Premarin, and I had no problems that I was aware of. However, I had read many books on natural hormone therapy and decided to go with a formula my doctor prescribed for me. I have been using four drops of the hormone lotion to control hot flashes. I noticed after a while that my skin became oily and I am having problems with acne. Also, and what concerns me the most, is that my hair is thinning quite rapidly.

  I have had a blood test for hormones and thyroid—everything was within normal limits. The test showed that my hormone levels were higher than in a young, healthy female. I am trying to lower my dose to see if it will have an effect on my hair. I understand that too much estrogen can cause hair loss. My doctor encourages me to go back on the pharmaceutical alternatives, which he tells me he has used successfully for more than twenty years. At this time I am very confused and would do almost anything to keep my hair from falling out. Please, give me some advice on how to pursue this problem.

  Clearly Evelyn is converting estrogen to androgen, and the androgens are having an effect at the level of her hair follicles. That’s why her skin is getting oily, she’s getting acne, and her hair is thinning.

  Although the hormone regimen she is on works well for many women, transdermal hormones go right into the bloodstream and as such can give higher levels with lower doses than when the hormone is given orally. I suggested that Evelyn either switch to an oral estrogen-progesterone preparation or cut way back on her topical estrogen and progesterone. For reasons that aren’t entirely clear, some women simply do better with oral hormones. I also suggested to Evelyn that she make sure she is following an insulin-lowering diet so that excess insulin from refined carbohydrates isn’t pushing her body toward higher androgen production. She could also use a high-dose soy supplement or one of the herbal preparations mentioned in chapter 6 to help her hot flashes and to keep her bones healthy. This infusion of phytohormones might allow her to cut her dose of estrogen, so there would be less of it around for her body to convert into androgen.

  If you have hair follicles that are particularly sensitive to androgen, like Evelyn, any hormone therapy regimen that has too much androgen for your body can result in hair loss. The problem goes away once you stop the drug. Most hormonally associated hair loss is not caused by hormone therapy regimens, however; it is the result of an imbalance in your own body’s hormonal production.

  Androgen-associated hair loss can be likened to the canary in the mine. It is a symptom that often signals a much more pervasive hormone imbalance that affects many women to one degree or another. Though, as I mentioned, up to 37 percent of menopausal women will have some hair thinning from increased androgen production at menopause, about 10 to 15 percent of women have full-blown androgen-excess syndrome, characterized by facial acne, male pattern hair loss, upper-body obesity (apple-shaped figure), insulin resistance, increased facial hair, and adverse changes in lipid profile.

  This syndrome, which overlaps with insulin resistance, which I’ve outlined in chapter 7, is associated with polycystic ovary syndrome, a high-sugar diet, adrenal hypersecretion, genetic factors, excessive body fat, or unknown causes. Because all of these factors set the scene for early-onset cardiovascular disease and diabetes, your hormone-associated hair loss needs to be seen as only one aspect of a much larger systemic imbalance that you can do a great deal to help alleviate.

  How to Get Your Hair Back—and Improve

  Your Health at the Same Time

  First, have your health care provider test you to see if there is a systemic cause for your hair loss. Diagnosing the type of hair loss you have will help clarify which options are most likely to work.

  Make sure your hormone levels are normal. Even though the vast majority of women with hair loss will be found to have normal androgen levels, it’s important to rule out the occasional rare abnormality, and also to remember that it’s usually not your body’s absolute level of androgen that’s the problem, but your hair follicles’ heightened sensitivity to androgen. Have your doctor check your TSH (thyroidstimulating hormone) as well as your free triiodothyronine (T3) and free thyroxine (T4) levels. The TSH should be no higher than 3.0 mIU/l, although many experts (including myself) prefer setting the limit at 2.5. (Higher levels indicate subclinical hypothyroidism; a little natural thyroid replacement, such as Nature-throid or Armour Thyroid, could help.) Also have your doctor check your levels of DHEA and androstenedione. If you do fit the description of someone with full-blown androgen-excess syndrome, have your lipid profile, blood pressure, and blood sugar checked as well.

  Even if your hormo
ne levels come back as normal, do the following.

  ~ Follow the low-glycemic-index hormone-balancing diet outlined in chapter 7.

  ~ Lose any excess body fat. If your body fat percentage is above 30 percent, as measured in your doctor’s office or fitness center, the excess fat is a factory for androgen and could drive your insulin levels, blood pressure, and blood lipids into unhealthy ranges. Excess body fat caused by a sedentary lifestyle and a diet too high in refined carbohydrates and trans fats is probably the key issue in combating not only androgen-associated hair loss, but also the health problems often associated with it.

  ~ Take a good vitamin and mineral supplement (see chapter 7) to help your new hair grow in fully.

  ~ Consider taking additional iodine. This helps balance the thyroid and may be all that’s necessary to stop hair loss (see The Role of Iodine in Thyroid Disease).

  ~ Reduce stress. Stress hormones skew hormone metabolism into the androgen range, so a regimen that includes meditation, aerobic exercise, regular massage, and a low-sugar, whole-food diet will help you to both dial down the stress and reduce your hair loss.

  ~ Try Chinese herbs. Shou Wu Pian is a Chinese herbal medicine that often works very well to help restore hair growth. My acupuncturist has used it for years, and I have seen wonderful results, including a reduction in gray hair. (See Resources.)