Issue link: https://www.ascpskindeepdigital.com/i/1523489
82 ASCP Skin Deep Summer 2024 enter perimenopause at different ages, often starting in the mid-40s, but it can begin as early as the mid-30s. During this time, there is a gradual shutdown of the ovaries, and important hormonal changes take place. The body is thrown off-balance due to the declining production of the dominant female hormones such as β-estradiol (a common estrogen) and progesterone. Although people experiencing menopause have only a small amount of male sex hormones, or androgens, the effects become more dominant during this time due to the depletion of estrogen and progesterone. This can lead to skin becoming excessively oily or dry during different times of the month. This can also lead to increased hair growth on the face and other areas of the body. HORMONE BASICS AND SKIN EFFECTS Estrogen—such as 17β-estradiol—is a key signaling hormone in the body, generated at ovarian and peripheral sites and transmitted via estrogen receptors to influence many important biological functions. Skin estrogen biosynthesis has been reported in keratinocytes, melanocytes, and fibroblasts. Estrogen induces the structural protein ezrin that enables the intercellular bridges that furnish epidermal integrity; induces the hydrophilic glycosaminoglycan hyaluronan, which underlies skin thickness and opacity; induces elastin, which gives the skin its resilience to deformation; and induces the expression of several types of collagens that are the basis of the mass of the dermis. Changes during perimenopause include loss of collagen, elastin, fibroblast function, and blood flow vascularity, as well as increased enzyme activities that cause cellular degradations leading to dryness, wrinkles, atrophy, impaired wound healing and barrier function, decreased antioxidant capacity (i.e., defense against reactive oxygen species and oxidative stress), and increased perception of aging.5 All of these changes can have tremendous impact on mental health, which can create a vicious cycle of internal and external problems.