A Few Changes You Might Not Realize Are Connected to Menopause (skin and muscles)

When we think of menopause, we tend to think of the caricature version of a woman sticking her head in the freezer or desperately fanning herself to survive a hot flash. While hot flashes are definitely a hallmark symptom of menopause, there are dozens of other symptoms that can give you cues on whether your body is headed toward “the change”. Two key areas of the body that we can look to for signs are our skin and our muscles. Read on to learn what to be on the lookout for, and the role that estrogen plays in the health of our skin and muscles.

Skin

Skin changes that occur with age include wrinkling, thinning, loss of elasticity, and increased fragility. These changes are affected by both external factors (like sun exposure) and internal factors. Internal factors include thinning of the top 2 layers of skin (the dermis and epidermis), reduced blood flow (vascularity), decreased collagen production, and decreased sweat gland activity (which leads to dry skin). These changes occur slowly over time as part of the natural aging process, but can accelerate as your body stops producing estrogen and can be a vital clue to the status of your menopause journey.

Here’s why: Estrogen is an antioxidant: Estrogen is a key mediator in the skin changes that occur with chronological aging.1 Estrogen is a potent antioxidant and promoter of other antioxidants. In animal studies, removal of estrogen leads to an increase in these harmful products: damaged mitochondrial DNA, oxidised glutathione and lipid peroxidation; replacing estrogen reverses this. In another mechanism, estrogen prevents telomeres from being shortened (telomeres are the protective ends of our DNA sequences - like those protective plastic ends of our shoelaces). Research suggests that longer telomeres mean longer healthier lifespans. Your skin is actively looking for estrogen: Facial skin aging with the decline in estrogen during menopause occurs because of loss of collagen, decreased hydration, fine wrinkling, poor wound healing and loss of skin elasticity. Skin cells called dermal fibroblasts and epidermal keratinocytes contain estrogen receptors and respond positively to topical estrogen. A 14 week study of an estrogen cream showed a statistically significant improvement from baseline in skin dryness, dullness, and atrophy (death of skin cells) when compared to a placebo.

Estrogen promotes healing: Low estrogen levels play an important role in poorer wound healing that occurs as women age past menopause. 1 The authors of “The role of estrogen deficiency in skin aging and wound healing,” state, “While chronological age is a clear risk factor for poor healing our recent studies suggest that estrogen deprivation is the major factor controlling delayed healing in elderly humans.” 1 Topical estrogen improves healing in elderly females and males.

Estrogen cannot reverse damage from external factors, but it does help with all of these internal factors.
In addition to decreasing hot flashes, night sweats and insomnia, studies show that estrogen improves skin health and appearance when given after menopause. Animal studies show that replacing estrogen after menopause causes the following beneficial effects on the skin:

• Increased collagen content

• Increased production of hyaluronic acid

• Improved epidermal and dermal thickness

• Increased elastin content

• Increased skin moisture

• Decreased wrinkles

• Improved appearance

• Improved wound healing
  

Further evidence of estrogen’s beneficial effects on skin include the improvement in psoriasis that women note during pregnancy (estrogen levels are quite high during pregnancy), the improvement in acne with oral contraceptive pills, and lower rates of melanoma and non-melanoma skin cancer in women.

Muscles

Are you feeling like your workouts aren’t giving the same results, or the exercises you used to do are becoming more difficult than they were a few years ago? Many women are surprised to learn that menopause can have a noticeable effect on their ability to build and maintain muscle tone. The preservation of muscle mass is important for optimizing overall health, but becomes even more important during menopausal years to support metabolism, preserve exercise capacity, and reduce falls.

The causes of sarcopenia - loss of muscle mass - include reduced hormone levels (testosterone, estrogen, and growth hormone), nutritional deficiencies, inflammation, and decreased physical activity. Loss of estrogen causes decreased muscle protein production, apoptosis (cell death) of skeletal muscle, and decreased muscle strength. We need more research in this area, but the studies we do have show a beneficial effect of estrogen on maintenance of muscle mass. Estrogen decreases inflammation in muscle tissue and reduces the breakdown of muscle protein. As with other tissues in the body, it’s important to replace estrogen (estradiol in particular) soon after menopause to ensure the muscle tissue gets all the benefits. Animal models show that estrogen replacement led to increased muscle protein content and strength.

Bibliography

1. Emmerson E, Hardman MJ. The role of estrogen deficiency in skin ageing and wound healing. Biogerontology 2012;13(1):3–20.
2. Draelos ZD. A Double-Blind Randomized Pilot Study Evaluating the Safety and Efficacy of Topical MEP in the Facial Appearance Improvement of Estrogen Deficient Females. J Drugs Dermatol 2018;17(11):1186–9.
3. Rzepecki AK, Murase JE, Juran R, Fabi SG, McLellan BN. Estrogen-deficient skin: The role of topical therapy. Int J Womens Dermatol 2019;5(2):85–90.
4. Keller K. Sarcopenia. Wien Med Wochenschr 2018;
5. Collins BC, Laakkonen EK, Lowe DA. Aging of the musculoskeletal system: How the loss of estrogen impacts muscle strength. Bone 2019;123:137–44.
6. Tagliaferri C, Salles J, Landrier J-F, et al. Increased body fat mass and tissue lipotoxicity associated with ovariectomy or high-fat diet differentially affects bone and skeletal muscle metabolism in rats. Eur J Nutr 2015;54(7):1139–49.
7. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause 2018;25(11):1362–87.
8. Hansen M. Female hormones: do they influence muscle and tendon protein metabolism? Proc Nutr Soc 2018;77(1):32–41.
9. Park Y-M, Keller AC, Runchey SS, et al. Acute estradiol treatment reduces skeletal muscle protein breakdown markers in early- but not late-postmenopausal women. Steroids 2019;146:43–9.
10. Bunratsami S, Udomuksorn W, Kumarnsit E, Vongvatcharanon S, Vongvatcharanon U. Estrogen replacement improves skeletal muscle performance by increasing parvalbumin levels in ovariectomized rats. Acta Histochem 2015;117(2):163–75.