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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.

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.

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
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.

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.

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

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.

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

CHANGE YOUR MENOPAUSE – Why one size does not fit all.


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