KAVANA'S GUIDE TO HORMONES & SKIN IN PERIMENOPAUSE

Are you a woman between the ages of 35 and 55? Have you felt or noticed changes in your skin that seem like more than just a sudden, new skin condition?  Have you noticed changes in your sleep patterns, menstrual cycle, mood, energy levels, appetite and libido? Ever wondered why these changes seem to occur, what causes them and what you can do about it? Have you ever heard the term 'perimenopause'? 

PERIMENOPAUSE: IT'S ALL GREEK TO ME!

While most women are familiar with menopause- the stage in a woman’s life following 12 consecutive months of no menstruation, many women are as equally unfamiliar with perimenopause and the physiological and emotional changes that accompany it.

Understanding what perimenopause is and getting familiar with the symptoms that may occur as hormones fluctuate during this time, can help women recognize and navigate the changes occurring in their bodies. This understanding is empowering and valuable, since women's health in middle age is a predictor of their health in old age.(source) Knowing more about one's health in mid-life, can ultimately help women reach old age in good health.

WHAT DOES IT MEAN?

The word 'Perimenopause' is from the ancient Greek and means: 

'Peri' is ancient Greek for 'surrounding' or 'around'.

'Meno' is ancient Greek for 'monthly' and refers to a woman's monthly period or menses, which has the same root.

'Pause' is ancient Greek for 'to stop'.

Perimenopause as a passage of time, is a physiological stage that women go through, 'around' or more accurately, in the approach leading up to menopause. Typically, barring a hysterectomy and / an oophorectomy- the surgical removal of the uterus and/ or the ovaries, regular patterns of menstruation progress to irregular or atypical menstruation during perimenopause, until the menses cease altogether in menopause. (source)

Perimenopause can start as early as age 30, though it more typically begins when a woman reaches her early 40’s, though genetic, environmental and hormonal factors along with ovarian health, also play a part in age of onset. (source) It can last anywhere from a few months to 10+ years, with 51, being the average age of menopause. (source)

There is so much focus on menopause, that many women are often totally ignorant of perimenopause-'the change before the change' as it's also referred to, and yet, it's a totally natural part of ageing.

While women may not know about perimenopause and recognize what's going on in their bodies as typical of this transitional stage of life, the symptoms of perimenopause are numerous, varied, and can be painful and difficult to ignore.

Changes in the skin are significant during this period and into menopause, so identifying and tracking them and contrasting them to 'normal' patterns in one's skin prior to perimenopause, can be most helpful in mitigating them.

THE 7 DWARVES...OF PERIMENOPAUSE:

The hormonal fluctuations that accompany this transitory time are not limited to the menstrual cycle. Hormone fluctuations in perimenopause can also cause all kinds of fluctuations and accompanying symptoms in the brain (the neuro-endocrine system), the skin and even the heart. 

Perimenopausal symptoms like dry and itchy skin, menstrual irregularities such as heavy bleeding, vasomotor symptoms such as nigh sweats and daytime hot flashes, heart palpitations, changes of blood pressure and more, have been comically referred to as "The Seven Dwarves" by comedienne Suzanne Sommers.

She famously renames the fictional characters of the children's fairy tale, by naming the major symptoms of perimenopause. She jokingly calls them: 

• Itchy
• Bitchy
• Sleepy
• Sweaty
• Bloated
• Forgetful 
• All Dried Up 

However humorous these names may be, they represent serious symptoms that accompany this transition period's hormonal changes in women.

CH-CH-CH-CH-CHANGES:

While women in different cultures and races (source) have been shown to experience certain specific symptoms more frequently than others, if at all (source), the majority of symptoms that most commonly show up in women's bodies in addition to menstrual cycle fluctuations occur in no particular order and can affect a woman's: 

• skin a.k.a "ITCHY": all manner of changes in the skin, including: skin thinning; dryness; itchiness; excessive sweatiness; dull or less radiant appearance; sagging starts and fine lined can begin to appear. Thinning hair/ hair loss, may also begin. (source)
• mood a.k.a "BITCHY": irritability, anxiety, depression and mood swings can increase.
• sleep a.k.a "SLEEPY": trouble falling and staying asleep, insomnia, interrupted sleep become increasingly common before and after one's period.
• body temperature a.k.a "SWEATY": increased sweating (hot flashes, flushing and, night sweats can begin.
• appetite a.k.a "BLOATED": appetite variation, feeling bloated, and weight gain around the middle section is common. 
• the brain 'FORGETFUL" : brain fog, trouble with concentration, focus and memory can become increasingly common. Less common, are changes in vision (depth perception and spatial awareness), changes to smell and taste perception. (source)
• vaginal dryness & discomfort during sex "ALL DRIED UP" : increasing lack of vaginal lubrication and painful sex can be common.

SO WHO'S TO BLAME? THE BRAIN & HORMONES

While the ovaries' declining follicle (egg) store and declining estrogen are often blamed, women's brains are also involved and play an important part. Since these same hormones affect women's brains more drastically than men's, the role the brain plays in perimenopause and all cycles of a woman's life, may be used as a significant predictor of neuro-degenerative diseases like Alzheimer's and dementia, which disproportionately affect women (source).

Above: photo, showing the differences in the brain, according to MRI brain scans of women in various stages of life, as taken by leading neuroendocrinologist and nutritionist, Dr. Lisa Mosconi PhD. (online source)

So the major shifts causing perimenopausal symptoms, don't just occur in the reproductive organs, ie: the ovaries, but they occur across what's known as the neuro-endocrine or brain- hormone system, specifically the Hypothalmic-Pituitary-Gonadal (HPG) axis, one of four neuro-endocrine systems in the body, which is in constant contact with all of the hormones in a woman's body. (source) 

This axis is like a superhighway or feedback loop between the brain, where the hypothalamus (brain stem) and pituitary gland reside, and the ovaries, the female gonads or reproductive glands, where estrogen and other hormones like progesterone and testosterone are produced.

At a glance, here's what these parts of the brain do and how they interact with women's hormones:

• The Hypothalamus: part of the 'ancient' or 'lizard brain' (source) encompassing the hippocampus, the amygdala and the hypothalamus, this part of the brain the hypothalmic axis is named for, stimulates estrogen production in the ovaries, which are the gonads or reproductive glands of the human body in women. In men, these are the testes. 
• The hypothalamus regulates temperature ( hello hot flashes! ), sleep (hello insomnia!) energy (or lack thereof) and food intake (appetite) and more. (source)
• The Pituitary Gland: secretes both FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) which affect the follicle maturation (egg being developed) and what happens once it's released and fertilized or not fertilized.

Other parts of the brain that the hypothalamus communicates with and that affect hormonal fluctuations that contribute to perimenopause, include: (source)

• The Raphe nucleus: main source of mood regulating serotonin. 
• The Locus Coeruleus: in charge of the fight or flight response - signals the adrenal glands. The adrenal glands produce adrenalin, noradrenaline, aldosterone and/ cortisol in response to stress. The adrenals also make hormones that the body uses to make estrogen and testosterone and they help with balancing salt and water (and water retention), keeping blood pressure normal and more. (source)
• The Posterior Cingulate cortex: Autobiographical memory, task preparation (source). (re: Where are those keys and did I lock the door?! ;)
• The Limbic Cortex: Memory, (hello brain fog!) information processing, emotion, motivation. (source)
• 

Understanding how the hormones and brain interact is key to understanding what causes the "7 Dwarves", as well what causes women's skin and brains to change with age. While this is beyond the scope of this blog, there are many books on the topic and I will share them on my IG @kavanaskincare, so please find me there too.

Before we get to know how the primary fluctuating hormones and brain interact in perimenopause, an understanding of how they interact prior to it, during 'normal' cycling time, can be extremely helpful.

Understanding the patterns of one's body is useful for men and women of all ages, not just women in perimenopause. Observing and monitoring what is 'normal' for your body at every stage of life, from the start of your cycling years, through perimenopause and even if you are done cycling!  Observing and noticing can help you connect with and make sense of your body through comparison, and also help predict longevity and health issues going forward. (source) 

WHAT EVEN ARE HORMONES?

Every woman's cycle can differ dramatically based on myriad factors throughout her reproductive years. The principle function of hormones, is to bring about balance in the body and a woman's period/menstrual cycle is a perfect example of this.

By acting as chemical messengers between the brain and the rest of the body's organs (including the skin), glands and tissues, hormones keep everything running smoothly, a state known as 'homeostasis'. (source)  

PERIOD PEACE: *HORMONES AT A GLANCE BEFORE PERIMENOPAUSE

*read more in detail about this in my blogs on: SkinCycling and Pregnancy

During a woman's monthly cycle, five main reproductive hormones come into play in a balanced way, effectively regulating reproduction and a woman's survival:

• Estrogen & Testosterone
• Follicle Stimulating Hormone (FSH),
• Progesterone 
• Luteinizing Hormone (LH).

FOLLICULAR PHASE: At the start of a woman's cycle, when she gets her period, all hormones are low. Estrogen, Testosterone and FSH (Follicle Stimulating Hormone) begin to rise, signalling the ovaries to stimulate a follicle and produce a mature follicle or egg.

The maturation process produces estrogen (mostly estradiol, one type of estrogen) to help grow the uterine lining to support an egg and potentially host a baby. While estrogen is doing all this work, progesterone waits in the sidelines for the egg's fertilization by sperm.

OVULATION: Once an egg is released into the fallopian tube during ovulation, on route to the uterus, if the egg comes into contact with sperm and is fertilized, a woman is pregnant, which begins a whole other cascade of hormone changes*.

LUTEAL PHASE: If it does not get fertilized, another hormone called Luteinizing Hormone (LH) is released by the brain and initiaties the Luteal phase. The balancing act continues as estrogen takes a declining bow and progesterone, so named as it is the 'pro-gestation' hormone which helps prepare and nurture the baby in utero, comes to the fore in the second half of a woman's cycle. Progesterone works to dismantle all the hard work estrogen has done during the follicular phase (first half of the cycle).

MENSTRUATION: The thick lining and blood that estrogen helped build up to line the uterus to host the follicle/ egg/ potential baby, is broken down by progesterone, so the blood and lining can be shed and leave the body during menstruation. The cycle repeats itself until a woman's finite supply of follicles which she is born with, begins to decline in perimenopause and fully stops when she reaches menopause. 

In perimenopause, this cycle of delicately balancing, rising and falling hormones begins to change, causing the symptoms previously outlined ("The 7 Dwarves").

WHICH HORMONES ARE RESPONSIBLE FOR WHICH SYMPTOMS of PERIMENOPAUSE?

ESTROGEN: THE BEYONCE of the HORMONE HIVE

Estrogen, the 'queen bee' of hormones, has a pronounced effect on the brain throughout our entire lives. (source) It's effect in turn, affects everything else in the rest of the body, including the skin, the body's largest organ, where the effects are easiest to see, which is why paying attention to changes in the skin, in addition to other changes/ symptoms mentioned previously, can be a good way to know if you have begun perimenopause.

ESTROGEN DECLINE & SKIN:

Estrogen helps prevent skin ageing by influencing skin thickness, skin wrinkling, and skin moisture levels. (source) Estrogen- specifically estradiol, the main form of estrogen, is the hormone that primarily promotes collagen and elastin production- the two proteins that are respectively responsible for the skin's strength/firmness, plumpness and elasticity. (source)

The skin has various estrogen receptors, that help induce the production of the body's own endogenous collagen. (source). From our early 20's onwards, women start to lose 1% of skin collagen a year, and this accelerates up to 30% after the age of 40. (source). In perimenopause, which typically starts in a woman's early 40's, estrogen production typically slows down, affecting the skin's thickness, plumpness, moisture and strength.

WHAT HAPPENS TO THE SKIN WHEN ESTROGEN DECLINES:

The intrinsic or chronological effects of ageing vary, but typically, estrogen's steady decline in production, is the dominant factor affecting skin, and most other symptoms of perimenopause controlled by the HPG axis. 

Estrogen decline in perimenopause contributes to: (source)

• Skin thinning:  Our outer epidermis takes longer than the usual thirty to forty days to replace skin cells, and the layer connecting the epidermis (top layer) and dermis (lower layer) begins to flatten, thinning the skin. (source) 

• Fibroblast retirement: As the builder cells of our skin slow down and think about 'retirement', less collagen, elastin and glycosaminoglycans are produced deep in the dermis. These proteins are responsible for the strength, plumpness, stretchiness and lubrication of the skin. (source) As we age, the ability of fibroblasts to transform into fat cells, diminishes.

• Dryness:  The eccrine (sweat producing) and sebaceous (oil producing) glands respectively, begin to dry up. (source)
• Loss of fat & thinning blood vessels: As the blood vessel walls in our skin begin to thin, this leads to easy bruising, and as we age, less speedy wound healing. The gradual loss of fat below the skin compounds the collapse of the skin's shape and facial features can begin to appear sunken. (source)

ESTROGEN DOMINANCE & TOXINS: XENO ESTROGENS:

Extrinsic factors like toxins in the form of xeno-estrogens (synthetic estrogens) that enter the body, can cause an increasingly common hormonal imbalance for women in perimenopause, called 'estrogen dominance'. (source) 

Estrogen dominance is when an excess of estrogen, in proportion to the 'natural' estrogens and other hormones, occurs in the body. Xeno-estrogens ('xeno' is Greek for 'stranger') or foreign/synthetic estrogens, and come from a variety of toxic chemicals.

These toxins, such as pthalates, are ubiquitous. Pthalates are plasticizers that help plastic remain moldable and malleable, while still retaining a form to contain things in. Think plastic water bottles, where they can leach into the water and also pollute soil and water bodies, marine life and eventually humans all over again, because plastic is not biodegradable.

Pthalates are also most commonly found in perfumes (a.k.a synthetic 'parfum', 'fragrance') in everything from household cleansers, scented candles and car and air fresheners, to stinky $400 splurges, where they help extend perfume hold and dispersion on the skin.

In cosmetics and personal care products that are mostly packaged in plastic, pthalates act as plasticizers- to keep the plastic soft but hold it's shape. This can leach into products and eventually make it's way onto your skin and into your body. Avoiding pthalates is one of the main reasons Kavana chooses to use refillable and recyclable, frosted glass and aluminum packaging. The Kavana or intention, is to green as we grow, to eventually eliminate and replace all plastic packaging and plastic components.

BPA (bi-sphenol-A) in plastic toys, plastic tupperware, takeout containers, canned food, and ever ubiquitous water bottles is a major offender when it comes to xeno-estrogen/ hormonal imbalance in the body. Pesticide pollution, industrial pollution and ubiquitous microplastics in our food and water- which can be inhaled, ingested or applied on the body are also hugely problematic. (source) *See more on toxins, on Kavana's Toxic Tuesday posts on Instagram.com @kavanaskincare or in the blog post on "Toxic Babies & The Mean 15'.

THE DANGERS OF TOO MUCH ESTROGEN:

While an excess of estrogen in the body may sound like it could be good for the skin, as with anything, moderation and balance are key to success. Excess estrogen is related to many deleterious issues including hyperplasia of the uterine endometrium, estrogenic cancers like estrogen dependant breast cancer, cardiovascular disease, (source) abnormal menstruation (heavy/painful periods), PMS, headaches, decreased sex drive, bloating, mood swings, fatigue, anxiety & depression, breast tenderness, endometriosis, fibroids, and hormonal weight gain. (source) 

Since estrogen is the last reproductive hormone to change (decline) significantly in the body, after testosterone and progesterone respectively, it's important to harmonize and keep it in balance with the rest of the hormones in the body.

PROGESTERONE: DO YOU WANNA DANCE?

Progesterone is estrogen's main dance partner, and balances estrogen's effects in the second half of a woman's cycle. It is known as a hormone with sedating effects in the ballet of reproductive hormones, as it is associated with less energetic states of a woman's luteal phase, making women feel like 'nesting' in preparation for a potential baby.

It is produced mainly in the corpus luteum and the ovaries in preparation for a fertilzied egg, and is also made in small amounts in the adrenal glands.

Critical to hormone balance, the body makes progesterone by using cholesterol to make Pregnenalone, the precursor to DHEA (Dehydroepiandrostenone). DHEA in turn makes progesterone, estrogen, testosterone and cortisol, the stress hormone. Phew!

STRESSED MUCH?
Cortisol takes precedence over progesterone in response to stress, and can 'steal' pregnenalone from progesterone, contributing to excess stress and cortisol and low levels of progesterone. This 'pregnenalone steal' that occurs when we're stressed, may thus also contribute to imbalances like estrogen dominance (excess estrogen) and it's adverse effects. Managing stress is key to harmonizing our hormones!

PROGESTERONE & YOUR SKIN:

While estrogen helps stimulate the production of the body's own collagen, elastin and hyaluronic acid, which help the skin stay plump, firm and moisturized, progesterone can cause the skin to swell and compress the look of pores.

Progesterone also stimulates the production of sebum, the skin's own oil produced by the sebaceous (oil) glands. Too much progesterone can lead to oil build up and potentially acne via p.acnes bacteria, which usually occurs in the Luteal phase/ second half of the cycle, approaching menstruation. In perimenopause, low levels of progesterone due to hormonal imbalances like estrogen dominance and it's causes, may thus mean less oily, drier skin, while too much progesterone can contribute to the causes of 'adult acne'. 

 

TESTOSTERONE: 

Often ignored when talking about women's hormones, testosterone imbalance in women is common, and happens a lot earlier than we might suspect. Though often thought of as the 'male' hormone, it is the most abundant and biologically active hormone in womens' bodies! (source)

While men can have 10-20 times more testosterone, this hormone plays a vital role in women's bodies too, and when it begins to decline by about 50% between ages 20-40 in women, it shows. Changes in the skin, lowered energy, sex drive, confidence, muscle mass and bone strength, are evident when testosterone is out of balance.

TESTOSTERONE & THE SKIN:

Testosterone, which typically rises with estrogen at the start of the cycle and again presents during the second half of the menstrual cycle in the luteal phase, works similarly to progesterone by activating the sebaceous glands to produce oil and can lead to 'period breakouts'.

Low testosterone which is most common in perimenopause, can contribute to thinning skin, thinning hair, reduced muscle tone (sagging skin), fatigue (low energy), brain fog, sleep troubles, overall decrease in strength, weight gain around the belly, fertility issues, decrease in bone density, less interest in sex/ intimacy, depression, anxiety, loss of pep, overall motivation and confidence. (source) What's not to love?!

High levels of testosterone can affect the skin, causing increased acne in the chin- mouth area, where 'hormonal acne' usually occurs. (*I will blog about adult acne next!)

Deepening voice, increased muscle mass and hirsuitness (excess body hair) are all signs of this imbalance as well. More serious issues like insulin resistance, PCOS (poly cystic ovarian syndrome), missed periods, can also be traced to testosterone imbalances. (source)

CORTISOL: THE STRESS HORMONE

Situated above the kidneys (renal = kidney),  the adrenal glands are mainly responsible for making Pregnenalone, which is biosynthesized to make DHEA, the precursor to cortisol, estrogen, testosterone, and progesterone. (source)

Cortisol is produced  not only by the adrenals, but also generated in adipose (fat) tissue, where it interacts with estrogen. To oversimplify that relationship: elevated estrogen contributes to elevated cortisol (source) and elevated cortisol, can contribute to low progesterone. 

The body's stress hormone, so-called because it plays an important role in mobilizing the body's response to psychobiological load (ie: stressors), helps to: (source)

• regulate blood sugar & insulin
• metabolize carbohydrates
• regulate the immune system
• assists with memory formation & cognitive function
• promotes or limits inflammation in the body

CORTISOL & THE SKIN: 

When cortisol is imbalanced, we can experience a flushed face, see fine hairs covering the face, may get an 'overnight pimple', experience menstrual irregularities which can cause fluctuations in our hormones and skin, similarly to the other hormones previously mentioned in this post. (source) 

When we're stressed, cortisol is released into the blood stream to provide the body with glucose or energy, via the liver. (source1 &  source2).

THE CHRONIC: STRESS & SKIN

Chronic stress means elevated cortisol and elevated blood sugar levels which can increase our risk of type 2 diabetes (source), weight gain, 'brain fog', insomnia / sleep issues and more severely, heart disease. (source)  

The demands of mid-life and a fast-paced, 'go-go-go!' lifestyle, where relationships, parenting, ageing parents, social, academic and professional demands, major life events, and chronic stressors such as (but not limited to) finances, climate insecurity, history of sexual abuse and more, can all contribute to a state of chronic stress.

Slowing down and finding lifestyle practices that give us time to take care of our physical, mental and spiritual health are key. A holistic approach to self-care includes caring for our skin yes, but also practicing good sleep hygiene to help regulate our sleep, eating a healthy diet and taking care to recognize when stress levels are too high and finding balance. 

If beauty is living in harmony with what we are, harmonizing our hormones is a practice of tuning into our bodies and adjusting as needed, to help us live a beautiful life.

A PRACTICAL APPROACH: SUGGESTIONS & SOLUTIONS

MONITORING CYCLE & SKIN AS 6th & 7th VITAL SIGNS:

In her excellent podcast and books, Dr. Aviva Romm proposes the idea that women monitor their cycle and consider the menstrual cycle as a woman's 6th vital sign.

Since perimenopause brings on unprecedented fluctuations in hormones that affect a woman's cycle, and her physiological, mental and emotional states in significant ways, a practice of cycle monitoring, is an incredibly empowering way to help women make sense of what is happening under our skin.

I propose that alongside cycle monitoring, that monitoring our skin, caring for it and recognizing what is 'normal' for our skin before perimenopause, may help us clue into the subtle or dramatic changes we can experience in perimenopause and later on in menopause.

YOUR SKIN STORY: KEEPING A JOURNAL OF CHANGES

While outside factors like sunlight- UVA and UVB rays, pollution and smoking, play a significant role in skin's ageing, along with genetics, diet and exercise, natural inner changes in our bodies and on our skin, act like sentinels of what lies (or tells the truth!) beneath it.

The skin is an indicator of the monthly fluctuations of hormonal balance or imbalances and changes in our brain. It gives us a glimpse of our overall health that can help us stay healthy. The skin and the menstrual cycle, are nature's wise built in balance measures- a way for us to notice, recalibrate and potentially course correct what is going on with our hormones, on a monthly basis.

Keeping a journal about the look of skin, how we feel physically, mentally and emotionally in our cycle on each given day of the month, our energy, appetite, sleep and anything else that we feel fluctuating, can be a helpful way to notice patterns and make changes, if necessary.

In this way, the skin and menstrual cycle as Dr. Romm suggests, are like useful tools- our 6th and 7th, vital signs and they have as much importance as the other 5 vital signs:  pulse, blood pressure, temperature, respiratory rate and pain. The skin and cycle can clue us in to underlying hormonal imbalances throughout our entire body, if only we know what to observe and look for.

KNOWING YOU BODY, IS HELPFUL AT EVERY AGE:

It's important to note that although this practice of observing is helpful to women in perimenopause, it can also be helpful to teenage girls starting on their cycle journey and women past the age of cycling. All girls and women can benefit from tracking and monitoring their individual body's patterns, and get acquainted with their body's individual skin, cycle and cycle history.

BRAVE NEW WORLD:

In a world that likes to pretend death and decline don't exist, our skin forces us to confront our own mortality.  While there's much to be said against the cultural constraints and pressures that drive women to inject all matter of things into their faces in pursuit of looking forever 25, there's an equal amount to be said for the importance and wisdom of letting skin age naturally and caring for it safely.

Photo by Richard Avedon 'In Memory of the Late Mr. & Mrs. Comfort'

Some women can experience many or all of the perimenopause symptoms and skin changes mentioned in this post and some can experience few and/ close to none. Here are some suggestions for how to care for your skin with Kavana. I hope my hormone safe skincare and therapeutic fragrances help support you.

OTHER SUGGESTIONS TO EXPLORE:

There is no one size, fits all experience, and consequently, no one-size, fits all treatment. This is precisely why being attuned to hormone changes in one's own body- it's changes in skin and cycle patterns, is most helpful and important. While hormone changes and skin and cycle monitoring are useful, some other ways to manage these changes include: 

• Finding a health practitioner to help you navigate these changes and adjust accordingly can be helpful and supportive.
• Being in community with other women who may experience the same symptoms as you, can be informative and supportive. 
• Volunteering to mentor or support younger or older women in a group can also be impactful.
• Making time for preventative self-care (not just after something 'bad' happens), is essential. 

SKIN IN THE GAME: KAVANA

Kavana skincare and therapeutic fragrances are specifically created with women's hormones and hormonal changes in mind. Helping women stay healthy by creating non-toxic products for face, body and peace of mind is the intention and purpose of Kavana. Sharing knowledge around these changes so women can make informed decisions is essential. If this knowledge and products are helpful to you, please consider sharing this post, the information in it or my products with someone you love!! Your support helps me and other women everywhere. Thank you!