The woman’s life is marked by a series of very well determined physiological periods (puberty, pregnancy, climacteric, old age) that are associated with profound physical and psychic changes. Menopause is defined as the permanent cessation of menstruation. It is convenient to differentiate this term from the climacteric or perimenopause, which refers to a much broader period, which extends from the moment when ovulation begins to experience alterations or irregularities until it disappears completely.
MENOPAUSE AND AGE
Menopause is a biological and physiological process, of marked relevance in the life of women. It is located approximately between 45 and 55 years in 65-70% of women.
Life expectancy has increased considerably in recent decades. The current average life expectancy of Spanish women is 81 years, so it is estimated that many women can live up to a third of their lives in a postmenopausal state. Hence the importance of ensuring that the alterations that develop during this period, all of them physiological, begin as late as possible, are the least intense and symptomatic and, consequently, allow a good quality of life for women.
The majority of care for women who reach the climacteric are aimed at bone and cardiovascular disorders. However, the skin also undergoes significant changes at this stage of life. Subsequent estrogenic deficiency causes a series of organic changes that include a decrease in skin collagen and skin aging.
DERMATOLOGICAL PROBLEMS ASSOCIATED WITH MENOPAUSE
The skin is regulated by hormones (estrogens), and these have a decisive influence on the thickness of the skin, its hydration, its pigmentation and the regulation of the amount of sebum. They also promote the renewal of the cells of the dermis and stimulate the synthesis of the collagen and elastin fibers of the epidermis for a better elasticity of the skin. In menopause, the decrease in estrogen production causes an acceleration of aging. We know that there are two fundamental types of skin aging: extrinsic and intrinsic:
Some radiations, such as infrared rays and especially ultraviolet rays, play a primary and primary role (photoaging), although the important role of habitual daily behavior habits, such as diet type or tobacco consumption, should not be forgotten , alcohol or drugs.
We can distinguish several subtypes:
- Chronologically, parallel to the passage of time, as a result unstoppable;
- Genetic, which influences the skin phototype as a decisive factor and can lead to premature aging;
- Catabolic, clearly related to chronic intercurrent and debilitating diseases, such as various infections and cancers;
- Gravitational, in relation to the force of gravity, and
- Endocrine or hormonal, which is analyzed here, by dysfunction or suppression of some systems or organs that produce hormones (ovaries in women, testicles in men, thyroid in both genders).
In relation to hormonal skin aging in women, first of all it should be noted that the advances made in recent years in the knowledge about menopause and climacteric have allowed reducing the number, frequency and intensity of their symptoms but, in In any case, some skin changes continue to be found and the presence of estrogenic skin receptors is essential for these symptoms to be expressed.
There is a decrease in the thickness of the epidermis in direct relation to a lower cellular turnover, and dermal atrophy, as a consequence of the decrease in the amount of collagen (the thickness of the skin is directly related to the quantity and quality of collagen it contains) .
Likewise, there is a decrease in elastic fibers, which secondarily conditions another transcendent fact in the aesthetic development of the menopausal woman’s skin, such as the increase in wrinkles and skin folds in general. Nail dystrophies also appear, in the form of striations, grooves and brittle nails, and facial hyperpigmentation, in a highly variable degree, depending on the phototype and exposure to ultraviolet radiation.
Menopause and skin collagen
The decrease in dermal collagen is the most important factor in the pathogenesis of skin atrophy and the most significant data of hormonal skin aging. It seems to be an age-related phenomenon, but also estrogen-dependent, that is, clearly related to postmenopausal hypoestrogenism.