Integrative, Anti-Aging Approaches for Skin Health in Perimenopause

Skin aging begins to accelerate in our 40s as we experience the perimenopausal hormonal changes leading to menopause. These changes, like fine lines, sagging, and sun damage, while very normal, can affect how we feel about ourselves and our confidence in the world.

Today’s article will help you understand skin health and aging. You learn how to stay young from the inside out with integrative approaches.

Keep reading to learn more about:

• Skin structure and function
• The skin microbiome and gut-skin axis
• Skin health and perimenopause – the importance of estrogen
• Integrative approaches to skin health

Skin Structure and the Importance of Collagen

The skin has three layers: the epidermis, dermis, and hypodermis.

The epidermis is only four or so cells thick and creates the skin barrier, your first line of defense against environmental toxins and pathogens. The epidermis is an integral part of the immune system and interacts with the skin’s microbiome, the bacteria and microbes that live on your skin. The epidermis also has keratin for water resistance and melanin to give the skin pigment.

The dermis is the middle layer and is thicker than the epidermis. It contains nerves, blood vessels, sweat glands, hair follicles, and protein. Collagen is the main protein in the skin, providing structure and firmness. Elastin is another essential protein, allowing for stretch and elasticity of the skin.

Finally, the hypodermis, or subcutaneous tissue, contains fat for warmth and cushioning. You’ll also find connective tissue, including more collagen.

Collagen levels begin declining around age 30, decreasing skin hydration, firmness, and elasticity. Collagen loss correlates with signs of skin aging, such as fine lines, wrinkles, and sagging.

The Gut-Skin Axis

Perhaps you’ve heard of the gut-brain axis, the bidirectional relationship between the gut microbiome (all the microbes in the gut) and brain health. The gut also communicates with the skin. In fact, the digestive tract and skin are similar in their barrier and immune functions.

Gut health and skin health inform each other. Imbalances in the gut microbiome affect the skin microbiome and are a root cause of skin conditions, including acne, dermatitis, psoriasis, dandruff, and more.  

The microbiome plays a crucial role in women’s health. Hormonal changes, including those in perimenopause, affect the composition of the gut microbiome. And microbiome changes, in turn, affect hormone balance and skin health.

Skin Changes in Perimenopause

Given all these connections, it’s no wonder women experience many skin symptoms and signs of accelerated aging in perimenopause and beyond.

Skin changes you might notice in perimenopause include:

• Fine lines
• Wrinkles
• Skin sagging
• Sunspots or age spots
• Dry skin
• Thinning Skin
• Hair loss
• Poor wound healing
• Vaginal dryness

Aging skin affects women’s perceived attractiveness, mental health, and quality of life. Many women seek cosmetic and medical treatments designed to restore the skin’s physical appearance.

The skin changes of perimenopause primarily have to do with declining estrogen levels. Like many cell types, skin cells contain estrogen receptors. Estrogen binding to receptors is critical for collagen and elastin production, vascularity, and skin cell function.

Estrogen-deficient skin correlates with dryness, wrinkles, reduced barrier function, and increased oxidative stress.

Integrative Approach to Skin Health

At TārāMD, we use integrative approaches to address the underlying causes of accelerated skin aging. While many topical products can be beneficial (like sunscreen and antioxidant serums), many of our interventions address gut health, estrogen levels, and other health habits that influence skin health.

Here are some ways to support skin health in perimenopause from the inside out:

• Use food as medicine for gut health. What you eat shapes the microbiome, influencing hormone balance and skin health. Include fermented foods for beneficial bacteria, lots of fiber, and specific prebiotic foods to nourish healthy microbes.

A gut-friendly diet means whole, unprocessed food, including healthy fats, quality protein, and colorful carbohydrates full of bioactive compounds. Here are some gut-friendly foods to add to your diet in perimenopause:

• Flax seeds
• Sesame seeds
• Pumpkin seeds
• Walnuts
• Yogurt
• Kefir
• Fermented vegetables
• Miso and tempeh
• Cold water fish (salmon, sardines)
• Slow cooked meat (brisket)
• Bone broths and mineral broths
• Coconut oil
• Pomegranates
• Berries
• Red grapes
• Apples
• Bananas
• Oats
• Buckwheat
• Asparagus
• Artichokes
• Sunchokes
• Dandelion greens
• Onions, garlic, leeks
• Green tea

If these foods are difficult to tolerate or you need more support with gut health, please work with your TārāMD provider.

• Increase collagen. Collagen is crucial for skin structure, and replacing it helps improve skin health. The above list contains bone broth, fish, and slow-cooked tough meat, all of which are excellent sources of collagen protein. You can also add a collagen supplement, also called collagen protein or collagen peptides.

Research suggests supplemental collagen improves wrinkles, skin elasticity, hydration, and skin barrier function. Add collagen protein to smoothies, warm beverages like a turmeric latte, or mix into yogurt, broths, or soups.

Quality collagen protein is available through our patient personalized supplement link.

• Reduce toxin exposures. Toxins from pesticides, air pollution, and, surprisingly, skin care products create free radicals that damage the body and skin. Reduce your toxin burden with these tips:
  • Choose organic food
  • Filter indoor air and drinking water
  • Choose clean cosmetics and skincare products (See EWG’s Skin Deep Database for options)
  • Use non-toxic household cleaners and household items

While you can’t control all toxin exposures, you can make a significant impact with simple interventions and swaps.

• Consider bioidentical hormone replacement therapy. Many skin changes in perimenopause and beyond come down to the loss of estrogen. Replacing estrogen is safe in many cases and offers systemic benefits. This single intervention can reduce menopausal symptoms like hot flashes and protect your bones, heart, and brain from chronic disease. Less often discussed benefits of bioidentical hormone replacement include the benefits to skin and hair.

To learn more about hormone replacement, please read Menopause, the Women’s Health Initiative, and Hormone Replacement Therapy.

Hormone replacement is a prescription and requires a conversation with your healthcare provider, hormone testing, and regular monitoring. It’s an option we believe is underutilized and should be available to more women when it’s a good fit. Dr. Fenske has extra training in hormone replacement and is certified through the North American Menopause Society.

• Redefine beauty. We live in a youth-centric society, but we can push against the cultural norms by redefining beauty and reclaiming our bodies as we age. Being healthy on the inside helps you feel your best in your body and reflects in your skin and how you show up in the world. Beauty is genuinely an inside-out endeavor.

Aging is a privilege; it’s beautiful, and we don’t have to suffer in silence in perimenopause like our mothers did. Luckily, there are many tools, including some discussed here, to support women through perimenopause and beyond. If you are looking for an integrative approach to improve your skin health and slow the signs of aging, reach out for an appointment today.

References

1. de Szalay, S., & Wertz, P. W. (2023). Protective Barriers Provided by the Epidermis.International journal of molecular sciences, 24(4), 3145. De Pessemier, B., Grine, L., Debaere, M., Maes, A., Paetzold, B., & Callewaert, C. (2021). Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions. Microorganisms, 9(2), 353.
2. Salem, I., Ramser, A., Isham, N., & Ghannoum, M. A. (2018). The Gut Microbiome as a Major Regulator of the Gut-Skin Axis.Frontiers in microbiology, 9, 1459.
3. Siddiqui, R., Makhlouf, Z., Alharbi, A. M., Alfahemi, H., & Khan, N. A. (2022). The Gut Microbiome and Female Health.Biology, 11(11), 1683.
4. Zouboulis, C. C., Blume-Peytavi, U., Kosmadaki, M., Roó, E., Vexiau-Robert, D., Kerob, D., & Goldstein, S. R. (2022). Skin, hair and beyond: the impact of menopause.Climacteric : the journal of the International Menopause Society, 25(5), 434–442.
5. Lephart, E. D., & Naftolin, F. (2021). Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin.Dermatology and therapy, 11(1), 53–69.
6. Kim, J., Lee, S. G., Lee, J., Choi, S., Suk, J., Lee, J. H., Yang, J. H., Yang, J. S., & Kim, J. (2022). Oral Supplementation of Low-Molecular-Weight Collagen Peptides Reduces Skin Wrinkles and Improves Biophysical Properties of Skin: A Randomized, Double-Blinded, Placebo-Controlled Study.Journal of medicinal food, 25(12), 1146–1154.