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By: Wulf Utian MD PhD DSc

Beyond hot flashes and the menopause-transition changes in the sex organs, a lot more can happen to the body. This week I will focus on skin, hair, and body weight.

SKIN: The skin actually ages remarkably well, with sun exposure producing much worse effects; compare areas on your body typically exposed to the sun with those areas that are always covered. But the hormones do have a significant role. There is strong evidence that estrogen loss has a far greater negative impact on skin than aging. One-third of the supporting matrix of skin (collagen) is lost in the first 5 years after menopause. This also occurs in collagen all over the body. The reduction of estrogen also thins the layers of skin cells.

Dry skin (Xerosis) and wrinkling are the most common problems with aging skin. Estrogen is a stimulator of the sebaceous glands. So aging and estrogen deprivation in combination will result in less blood flow to the skin, loss of the supporting fibers (collagen), and thinning of the skin cell layers. These together with the loss of sebaceous gland secretion produce dry skin that can be easily traumatized or bruised. Wrinkling is the other effect, particularly as the collagen is lost. The skin can get a sort of crinkled paper appearance from all this. Deeper wrinkles are largely due to age and gravity. Smoking accelerates skin aging.

Testosterone normally stimulates both the oil-producing glands (sebaceous glands) of the skin and the hair follicles. Remember the ovarian stromal cell compensatory effect I described in an earlier blog? As androgen levels become relatively higher than estrogen after menopause in those women with that ovarian change, the result can be acne and hair growth. Consequently, many women after menopause find a greater growth of hair on the upper lip, chin, and sideburn areas. This is perfectly normal.

Another important skin change results from estrogen’s effect on the sensory nerves in the skin – the higher the amount of estrogen, the more sensitive the skin. After menopause, this reduction of sensation can be felt in different ways. I have had patients tell me “my clothes don’t feel the same on me as they used to.” Others tell me, “I don’t get the same sensation when my partner touches me.” In other words, the reduced skin sensation can have a negative impact on sexual response.

HAIR: There are hair changes after menopause; some directly related to the altered hormonal environment, but age, genes, and other factors also play a role.

The tendency toward the predominance of male hormone over female hormone could account for growth on the lip, sideburns, and elsewhere on the body, as well as loss in the form of mild male pattern baldness. The latter is most likely to manifest as some loss on the crown and there may be slight recession at the temples.

Estrogen is known to stimulate hair growth, and even more important, to reduce loss. Reduced sebaceous gland secretion results in dry hair.

Hair changes can influence feelings about body image, and if a cause of concern should be part of the discussion with your clinician.

BODY WEIGHT: “Menopause makes you fat” is the commonest complaint heard in the clinician’s office. True or false?

In fact, menopause is associated with a loss of muscle mass and an increase in fat mass. Significantly, muscle is heavier than fat. The increased fat tends to gather in the abdominal cavity and waist region, as well as around the hips. So although technically there is no direct increase in weight caused by menopause, the change in body shape is what worries women most, and is often perceived as weight gain.

Here is an interesting observation. As men age and lose testosterone, they too lose muscle and gain fat in the abdominal region. It is almost as if men and women, unless they take effective preventive steps, begin to get a similar body shape as they age.

The critically important thing to know is that as body weight and fat mass increase, so does the likelihood of serious adverse consequences. These include cardiovascular disease, high blood pressure (hypertension), mature onset diabetes (type 2 diabetes), some cancers, arthritis, and premature death. Gaining just 15 to 20 pounds significantly increases the risk of a heart attack (myocardial infarction) in the future. Better news is that a loss of just 10% of body weight by overweight women results in multiple health benefits – less diabetes, heart attacks, and hypertension.

Given that over 65% of women ages 45 to 55 are overweight in the United States, here lies an enormous opportunity for improvement in health.

Have a great week!

Wulf Utian MD PhD DSc

Author; CHANGE YOUR MENOPAUSE – Why one size does not fit all. http://www.amazon.com/Change-Your-Menopause-size-does/dp/0982845723/

The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

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