Menopause isn't as bad as it's cracked up to be, however, it does create some interesting new dilemmas you need to figure out how to handle. How would I know? Well, it has been more than a year and a half since I underwent surgical menopause (a complete hysterectomy) to help correct a medical condition. I thought it was a breeze awakening into menopause, it was about a week later that I discovered the hidden joys of the experience. I realize how lucky I am, that this should be the worst problem to face right now. But I have to admit that as a doctor, even I was surprised to find out how quickly nuisance skin changes arose. I would like to share this experience with you and how to work out solutions.

HORMONE REPLACEMENT THERAPY (HRT)

I am not an OB-GYN, so I don't feel it appropriate to lecture on the pros and cons of HRT. However, I think many women now recognize the importance that estrogens play in protecting our bones from osteoporosis as well as protecting us from heart disease. Estrogens have been implicated in increased rates of breast cancer, at least in those women who have a higher familial risk of this disease. However, for a woman who no longer has her uterus or ovaries, the use of HRT with low dose estrogen without supplemental progesterone can be very helpful in decreasing the severity of many of the issues I will discuss below. I personally use the Climara Estrogen Patch, which I change weekly. This is not only convenient, but also keeps me from having to metabolize oral estrogens through my liver. In my personal medical case, this is important for me. Anyone with a history of blood clots/clotting disorders may find this a way in which to at least contemplate the use of HRT more safely.

There are also a variety of soy based products on the market that use plant derived estrogens (phytoestrogens) to help make menopausal symptoms more tolerable. Increasing soy in your diet or taking one of these supplements may be helpful if you do not want to take estrogen or cannot for some reason. Discuss this option with your doctor. However, remember, if you are already on estrogen, you do not want to take additional large doses of phytoestrogens.

There are several different wrinkle creams on the market that contain topical estrogen or progesterone (natural/synthetic or plant derived) derivatives. While there is no doubt that topical prescription estrogens can help improve vaginal concerns associated with menopause, so far I have been unable to find anything in the medical literature to back up the wrinkle cream claims. I will certainly update this if I find good medical documentation.

DRY SKIN

The loss of estrogen does cause a decrease in the amount of sebum that is produced, leading to drier skin. Post-menopausal women are blessed with this event while the average male does not experience a decrease in the levels of sebum until approximately age 80! Despite HRT, I have found this to be true, although for now, winter seems to be more troublesome for me. I personally find that the use of the Priori Advanced AHA Hand & Body Revitalizing Lotion really cuts through the dry areas on my shins (my personal trouble zone) better than a plain bland emollient. For really dry skin areas, I am actually using the DermaNew Total Body Experience Kit before showering. If I have shaved my legs, sometimes I will wait to apply the Priori Advanced AHA Hand & Body Revitalizing Lotion until later in the day because I know it may sting, substituting something like Vanicream Lite Skin Care Lotion or Nutraderm Therapeutic Lotion - Original Sensitive Skin Formula instead. And sometimes my skin isn't so sensitive, so I put up with the stinging for a few minutes. That's an individual thing and certainly is something you can play with to see what works best for you.

ANDROGENETIC ALOPECIA

A nice way of referring to the loss of scalp hair, this is due to the influence of the male hormone testosterone. It results in a receding hairline at the temples (aka widow's peak) for most women as we age. In more extreme instances, women may thin in a diffuse generalized pattern across the entire scalp. Whether this is genetically predetermined due to an increased sensitivity to "normal" testosterone levels no longer balanced out by your estrogen; or due to an increase in this hormone, the result is the same. FNS Follicle Nutrient Serum is currently the sole product actively marketed for women to help slow or stop this hair loss. Remember that it is best to start it early as is best for prevention of loss as opposed to widespread hair regrowth. In addition to hair loss of the scalp, all body hair can be affected as well as the hair diameter decreases after menopause. This may result in a thinning of eyebrows, pubic hair and even underarm or leg hair. I also recommend you take a good general well-balanced multivitamin like around the time of menopause to help supplement your baseline nutrition. This seems to help bolster your hair and nail growth as well as contribute to your overall health.

FINE LINES

This was something I was not anticipating after years of using my skin rejuvenation products. Actually, I was appalled. However, I had become lax in my maintenance regimen for several months prior to the surgery. Within a few weeks, I was noticing early signs of crow's feet and forehead lines. I immediately restarted my products and have been happy with the results. However, I find that the lines are likely to return if I become lazy in my treatment. Remember, you lose approximately 1% of collagen per year after the age of 40 as well as in response to the loss of estrogens, despite HRT (hormone replacement therapy). Start your products now and do not let up once you are happy with the results. It is far easier to prevent lines than eradicate them! Now that N-Lite is available, I anticipate a surge in preventative use as well as fixative therapy.

UNWANTED FACIAL HAIR (UFH)

Now I understand why fairy tales always depict the grandmother with that stray hair sprouting off the chin. Yes, I too have had to deal with plucking in areas I NEVER thought I would. Vaniqa has become a great way to help stop the growth of these unwanted strays. Keep this product in mind for UFH no matter what the cause.

INCREASED RATE OF GRAY HAIR FORMATION

At my age, I refuse to go gray! Unfortunately, when you have dark brunette hair, each and every gray hair stands out like a beacon of light. So now I find I have to get color approximately every 6 weeks. I realize this is on the long side for color treatments, but time plays an important role here. Also, if you have dry, fragile hair or hair that is prone to breakage, extending the time between treatments is helpful. Make sure you also try to cut back on dryer time at home. I no longer use the hair dryer unless I need my hair styled for a meeting or just need to look good. Instead, I rely upon my Aquis Hair Towel to dry my VERY thick hair, brush it out and go. This helps extend the length of time my color looks good, too. The luxury of an Internet business is the ability to look casual. For those of you out there in the corporate world, etc., at least using the Aquis Hair Towel can give you less heat exposure for your hair, something that is still very important.

INCREASED WEIGHT

My friends warned me that once I went through menopause that I'd pick up a lot of weight. Actually, this didn't start to happen for about a year, but once it began, it was rapid, and seemed uncontrollable. While the weight was spread around, my stomach which had never been a problem was suddenly showing a little bulge that just wouldn't go away despite walking 4 miles a day. I was honestly at a loss until I discovered cross training. I have since learned the harsh facts. Studies have proven that the average adult loses about a half-pound of muscle a year after age 35, and gains one-and-a-half pounds of fat. For women going through menopause, hormonal changes combined with the aging process worsen the situation. With the drop in estrogen, the fat cells begin to produce (and reproduce!) a natural supplemental source of estrogen. Naturally, these over active cells are located in the abdominal area. This is why our mothers and grandmothers often tend to have poochy tummies. In addition, women naturally store fat in their abdominal areas. To make things even worse, our metabolic requirements drop significantly. The daily caloric needs drops by between 400-500 calories a day.

So how can you fight this? You need to work on muscle building in addition to aerobic exercising. By building your muscles (notice I didn't say go bulk up), the muscles help raise your metabolism. I don't know about you, but I'm a food lover. So I have decided that I am just going to have to somehow take the time to go work out. I'd rather sweat than have to watch every last morsel I eat! Follow me this spring while I try to maintain this new activity. Should be interesting! I need all the moral support I can get.

UNWANTED SKIN GROWTHS

Some people blame their mothers for their thighs, I blame mine for the lovely age growths known as seborrheic keratoses, which I have inherited. Yes, that's right, menopause has caused these beauties to pop out far faster than I ever anticipated them. Seborrheic keratoses (aka barnacles of life) are thickened, often dark brown stuck on appearing growths. I am personally acquainted with seborrheic keratoses, having inherited this trait from my mother. Fortunately, my growths are not nearly as dramatic as hers. However, this has left me on the alert to see what I can do to try to minimize these lesions. At this time, SKs are blamed on either abundance or an increased sensitivity to epidermal growth factor, a hormone that contributes directly to skin growth. Whether or not viral particles will be found to blame for perhaps stimulating this, is unknown, but we do know that genetics plays a very big role in this condition.

For now, in addition to liquid nitrogen, the maintenance use of exfoliants such as glycolic acid moisturizers (like the Priori Advanced AHA Hand & Body Revitalizing Lotion and the use of a procedure either like a series of microdermabrasion, or using the DermaNew Total Body Experience Kit, or a series of glycolic acid chemical peels may help prevent new ones or get rid of really tiny growths. On the face, the preventative use of exfoliants such as Renova periodically may help as well. I do not recommend trying to use it to try to get rid of an SK already present. Once a significant growth is present, liquid nitrogen remains one of the best options for getting rid of large numbers of SKs quickly and efficiently. You may want to try Mederma on any red spots that are left from the procedure to try to resolve them quicker.

Skin tags are another type of growth that you may experience. These soft, flesh toned lesions grown on a stalk and hang off of the skin. The most common areas for these to develop include the neckline, underarms, under the breasts, eyelids and sometimes the groin. For now, the only way to get rid of them is to have them snipped off by your doctor. This is quick, minimally uncomfortable and certainly effective. The down side is that most insurance companies (if not all) consider this a cosmetic procedure and no longer cover it. Expect to pay around $100.00 and up, depending upon the number present. Also, while the original skin tag that is removed is unlikely to regrow, if you are prone to them, you will likely have future lesions that require maintenance treatment to keep the skin smooth.

HOT FLASHES/FLUSHING

Nothing like a rosy glow to start out the day! Actually, I'm not really bothered by this new problem, I just skip my blusher unless I happen to be wearing foundation that day. It's the hot flashes that really get me. Despite HRT, these still catch me off guard; however, I have not yet felt it necessary to try blood pressure medicines like Clonidine to stop them. Remember, green counteracts red, so if you are looking for a way to mask the flush, look for a nice green powder (like T. LeClerc Loose Facial Powder - Tilleul) or cover-up stick.

The use of cooling masques such as Peter Thomas Roth Cucumber Gel Masque or Neova Illuminating Mask help put a chill onto your cheeks, which can rapidly constrict the blood vessels and reduce your redness. Keep this trick in mind if you are getting anxious (and red!) about a big meeting, date, etc. You can even keep your Peter Thomas Roth Cucumber Gel Masque in the fridge for an added chill.

Now you know the real scoop from a veteran of the anti-aging battle about what to expect from your skin during menopause. The good news is that for most women, it's not nearly as bad as the media would have you believe. Further more, women's medical concerns are finally gaining attention in the scientific community. Look for continued improvements in our knowledge base and therapy options in the near future.

Thank you for taking the time to read my newsletter. I hope you have found it informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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