• Extrinsic aging is also known as “Environmental Aging”, a term I introduced back in 1993. Extrinsic or
  Environmental Aging is the aging that results from the combination of external injury and compromised internal
  cellular functions. This is the type of aging that we can control. Factors such as sun exposure, smoking, stress,
  poor diet and intake of drugs or alcohol contribute to the aging process. Extrinsic aging effects can be reduced
  with preventative and corrective care. Signs of extrinsic aging are loss of collagen and elastin,
  hyperpigmentation, redness, dryness, thinner skin and loss of water in the cells.
• Hormonal aging occurs as levels of estrogen decline. Low estrogen levels result in weakening of the collagen
  and elastin fibers. Skin becomes thinner and more fragile, with an increase in facial hair, and breakouts, with
  reduced water content in the cells.

In addition to the three types of aging described above, there are over three hundred theories on the causes of
aging. At least a dozen explain why cells decline. No matter what the cause, free radical damage to inflammation,
the net effect of all of them is water loss. Water is lost from within the cells. Water is lost from the material that
keeps the collagen and elastin factories going. Water is lost from every layer of the skin.

Although there are no established rules for managing menopausal skin, proper skin care and long-term
preventive techniques can help lessen its visible influence. Without treatment, skin after menopause will continue
to degenerate. Estimates have indicated that skin loses up to 30% of its collagen in the first five years after
menopause. Moreover, as skin thins by approximately a percentage point a year, the decelerated cell renewal rate
leaves increasing numbers of dead skin cells on the surface².

I believe that the answer to caring for menopausal skin lies in the use of the anti-aging ingredient of the 21st
century, WATER. A skin care program for menopausal skin should consist of:

• Antioxidants to disarm free radicals, which ultimately damage the cell membrane and cause it to lose water
• Anti-inflammatory agents to reduce inflammation, which releases free radicals that damage cellular structures
  and cause water loss
• Natural Moisture Factors to absorb water from the environment and act as a reservoir for water in the skin
• Hydrophobic Agents such as ceramides, which prevent water loss from all cells and maintain the skin’s barrier
  function—these can also be essential in repairing and maintaining cell membranes
• Fatty Acid and Glucosamine supplements to encourage the body to make it’s own water-holding molecules
• Lecithin and its building blocks, Phosphatidylcholine and Choline to maintain cell walls

Having these in and internal and external skin care program will help maintain the water balance in your entire
body; I call it The Water Principle.

The Water Principle is not about drinking eight or more glasses of water a day, it’s bout getting and maintaining
water in the cells, so that the body can function in its full capacity.

Next to oxygen, water is the more important substance you need, and almost everything we know about aging
tells us that the decline in function over the years is a story on water loss. Imagine a baby, at birth, it’s body
weight is about 75 percent water. In our adult years it drops to just 60 percent. Combine the loss of water with the
reduction in hormone levels experienced in menopause, and the visual and physical effects of aging can be
quite dramatic.

What is menopause and why is it so unsettling? In a society that embraces youth, it signals the aging process and
takes it’s toll emotionally as well as physically. A part of every woman’s reproductive life cycle, menopause is the
cessation of menstruation during which a woman’s ovaries produce less of the female hormone estrogen.
Menopause cannot be diagnosed medically, until a woman has been period-free for one year without being
pregnant, breastfeeding, medication or certain diseases—factors that can also cause menstruation to cease.
After menopause, women are no longer able to bear children and become more vulnerable to certain diseases.

Menopause is unpredictable. The drop in hormone levels differs from woman to woman, as do overall menopausal
symptoms. While the onset of menopause usually occurs between the ages of 45 and 55, some women in their
early 30’s experience menopausal sleeplessness, weight gain, irritability, temporary memory loss, hot flashes,
increased facial hair, acne, and dry skin.

Medical studies have shown hormonal changes taking place during and post-menopause change skin composition.
The subdermis, or layer of fat that cushions the skin, deflates while the production of collagen and elastin
(structural protein tissue) lessens. The dermis (the skin’s supporting and nourishing layer) thins out and the skin
loses much of its “extensibility,” or ability to bounce back. This is due primarily to the decreased level of estrogen
that prevents the growth, leading to the weakening of blood vessels causing broken capillaries. The lack of
nutrients and oxygen contribute to this thinning and slower cell turnover rate.

The physical ramifications of menopause are apparent. Wrinkles become more prominent, while the skin assumes
a dull, discolored, rough, dry appearance. Additionally, women who never had acne in their life may discover
unexpected breakouts because of a lack of estrogen in their bodies. They may find to have more facial hair and
due to the thinning of skin with age, brown spots, more sensitive skin and fine, dilated blood vessels.

An option for some women is Hormone Replacement Therapy (HRT), sometimes called postmenopausal hormone
therapy. With HRT, estrogen is supplemented with another female hormone, progesterone. HRT is available in a
variety of forms, such as estrogen tablets, patches, cream, implants or a combination of these. It is only
suggested for healthy women with specific problems directly related to menopause. HRT has been shown to
benefit in preventing many of the physical changes experienced during and after menopause. Side effects,
however, to this therapy include monthly bleeding, breast tenderness, nausea, abdominal bloating and headaches.
Recent studies warn women against the risks of HRT, it is important to thoroughly evaluate all benefits and risks
with a physician.

Alternative methods to Hormone Replacement Therapy are also being used to relieve menopausal symptoms.
Botanical and herbal products that mirror the effects of estrogen may provide some relief in alleviating
menopausal symptoms, however again, it is important to discuss these option with your physician.

With an increase of patients coming to me in the menopausal years, I’ve researched ingredients and formulas that
are specifically designed address menopausal skin concerns. I’ve outlined key ingredients to look for:

Topically:

• Apricot Oil, Evening Primrose Oil and Borage Seed Oil protect the skin’s natural barrier, increasing
  moisture retention
• Papaya enzymes gently exfoliate to reveal brighter, softer skin
• Soy and Wild Yam Extracts, natural plant based estrogens
• Clove Flower and Iris Extracts tone and firm skin
• Glycosaminoglycans inhibit collagen breakdown
• Shiitake Mushroom Extract conditions and firms skin
• Shiitake Mushroom Extract conditions and firms skin
• Shea Butter super hydrates to restore skin’s vibrancy
• Chaparral Extract inhibits facial hair growth, clinically proven to reduce facial hair growth by 22% in 12 weeks

Symptoms of menopause such as insomnia, irritability and joint pain may be addressed internally with natural
solutions such as:

• Melatonin to induce calm and encourage restful sleep
• Glucosamine to boost collagen production and ease joint pain
• Biotin to strengthen hair, skin and nails
• Essential Fatty Acids to hydrate from the inside out
• B-complex Vitamins for overall health benefits

In addition to topically applied treatments and internal supplements, I recommend a program that also includes
self-care or what I call, Inclusive Health™. Yes, you can reduce wrinkles, fight free radicals and inflammation and
keep skin soft and pliable. But all of this rejuvenation is not enough if you’re not taking time to relax, de-stress,
reduce isolation, and have passion in your life.

As you know, skin is the largest organ of our body. It not only signals touch and temperature, it detects nuances
in our environment and communicates that to the brain. Harvard University researchers have dubbed this
connection the neuro-immuno-cutaneous-endocrine network, or N.I.C.E. Translated, everything that affects the
skin, affects the body, and vice versa. The skin is connected to our brain, our nervous system, our hormones and
our immune system. In broader terms, it’s a mind-skin link that reflects health as well as disease.

¹ Lobo R., Medscape Women’s health, Clinical Management, Menopause Management for the millennium.
² Affinito P, et al. Maturitas. 1999; 33: 239-47 and Brincat M, et al. Br J Obstet Gynaecol. 1985; 92: 256-9.