TIPS FOR BETTER SKIN AFTER MENOPAUSE
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Episode 223:
Show Notes
In this week’s episode of the Real Health and Weight Loss podcast, host Dr Lucy Burns is joined by the fabulous Dr Ginni Mansberg as our special guest in the Menopause Series! They explore tips for better skin after menopause, sharing practical advice to help listeners thrive during this transformative time.
Dr Ginni Mansberg is a superstar in the menopause world, a bestselling author of The M Word: How to Thrive in Menopause and the founder of Evidence Skincare (ESK). Known as the “Sunrise GP” on Channel 7, she has made a significant impact in educating others about menopause and women’s health. In 2022, she was named Australia’s most trusted healthcare professional and also teaches at the University of Notre Dame while sharing her expertise through various podcasts.
As they dive into their discussion, they cover a range of important topics surrounding menopause and its impact on health, including:
Menopause and Its Impact on Health:
- Menopause significantly affects physical and mental well-being, including weight gain, sleep disturbances, skin health, and self-confidence.
- Loss of estrogen leads to joint pain, skin changes, increased inflammation, and disruption of the skin barrier.
- Women often experience sensitivity, dryness, collagen loss, and skin aging post-menopause, with collagen declining rapidly after menopause.
- Estrogen also plays a role in mental clarity, mood regulation, and overall vitality, making its loss impactful across multiple facets of life.
Skin and Aging During Menopause:
- The decline of estrogen during menopause causes rapid skin aging, including wrinkles, large pores, and sensitivity.
- Skin pH rises, damaging the acid mantle and disrupting the skin's microbiome.
- Effective skincare during menopause should focus on restoring the skin barrier with gentle ingredients (niacinamide, ceramides, polyhydroxy acids), avoiding harsher substances like retinol, vitamin C, and alpha hydroxy acids.
- Collagen-building strategies should begin early, especially in perimenopause, to prevent drastic skin aging later.
Society’s Views on Aging and Beauty:
- Women face societal pressure regarding their appearance, being judged harshly for both maintaining and not maintaining their looks.
- There is a stigma around women seeking cosmetic interventions like Botox, despite the desire to feel confident in their appearance.
- Women are also more harshly judged for weight gain, leading to economic and social disadvantages, whereas men do not face the same scrutiny.
Weight and Body Image:
- Many women struggle with weight gain during menopause due to metabolic changes, hormonal fluctuations, and stress, impacting their confidence and health.
- The societal judgment around weight gain is largely borne by women, leading to shame, decreased confidence, and worsened mental health.
- Women often delay or avoid seeking treatments like bariatric surgery due to stigma, even when it could benefit their health.
Women’s Role and Self-Care:
- Women often prioritise others' needs over their own, neglecting self-care in the process.
- The analogy of the "golden goose" emphasises that women need to invest in themselves to continue caring for others effectively.
- Encouraging women to value themselves is crucial to improving their overall health, whether through better nutrition, skincare, or mental health support.
The Importance of Discomfort for Growth:
- Discomfort can be beneficial for growth and resilience. Both women and children should embrace and model the ability to tolerate discomfort, as it can lead to personal growth.
- Society has become too comfort-focused, leading to a lack of resilience in coping with life challenges.
Mental Health and Menopause:
- Many women experience brain fog, anxiety, and emotional distress during menopause, which is often exacerbated by societal pressures and changes in family dynamics.
- Women frequently feel belittled or gaslighted during menopause, adding to their emotional burdens.
Perimenopause checklist: https://www.rlmedicine.com/checklist
Connect with Dr Ginni:
- Website: https://drginni.com.au/
- Skincare: https://www.eskcare.com/
- Menopause Workplace Training: https://dontsweatit.com.au/
Episode 223:
Transcript
Dr Mary Barson Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:23) Hello, lovelies. We are super excited to be bringing you this series in Menopause, where we're interviewing guests on their expert subjects regarding perimenopause, menopause, and beyond. As always, any information in this podcast is just considered general advice and we would urge you to seek medical attention if you have any concerns about your health. If you're interested in exploring the symptoms of menopause or perimenopause, we have a checklist that you can download at our website, www.rlmedicine.com/checklist or as always, you can click the link in the show notes. Thanks, lovelies, enjoy this series!
Dr Lucy Burns (00:58) Gorgeous friends. How are you this morning? I have an absolute treat I know I say this all the time and it's not that I'm not with dr Mary who you know, we do love but I always get so excited when special guests, and we have one of the superstars in the menopause world today and somebody who I have followed for a long time and looked up to, so I'm super honoured that she's on our podcast. Her name is Dr Ginny Mansberg. You may well know her. She's written a book. She's got a skincare brand, like she's a total legend and she's out there educating people in the workforce and a whole heap of other things. And so I feel very blessed to have her on our podcast. Ginny, welcome.
Dr Ginni Mansberg (01:36) Oh my goodness. I just feel so overwhelmed. That is an amazing introduction. Hello. How are you?
Dr Lucy Burns (01:41) I'm very well. Thank you. Very well. And as you know, you've been following along too, we have been doing a little series on menopause because what I realised was that our people who develop sort of metabolic syndrome following menopause have a whole heap of other menopause symptoms that Dr Mary and I don't talk that much about so we've been wanting to get other people on. to talk about it. And you, my friend, are basically like the queen of Australian menopause. So Huzzah! Huzzah to that as well. Indeed. Indeed. So one of the things I wanted to ask you is, how did you get into the menopause space? Because honestly, it's certainly becoming more prominent, but when you started it, it wasn't at all sexy.
Dr Ginni Mansberg (02:28) I've got to be honest, Lucy. It was not like I was just sitting there going, I wanted to talk about menopause. I so didn't. I got a proposal from a publishing company there and they came over and my manager had said to me, are you interested in writing another book? And I said, never, ever ever again, will I ever write another book. And she said, I just want you to listen to this proposal. So I listened to it and this who I now adore, this woman came and said, we want you to write a book about menopause. And I was like, F off, like seriously, how old do you think I am? Oh, wait, I'm 50. Okay, but I did realise that I didn't know anything about it. So for me to write a menopause book, I might as well have written a book about bricklaying and I had literally no idea, but at the same time, I host this podcast for doctors, which is an educational one. And literally every time we would do something tangentially related to menopause, I would realise that I had no freaking clue. And I did think that I do need to upskill in my knowledge. And initially, when I got brought the proposal of a menopause book, I was like, no, not really not that interested. And then I kind of just got hooked on the idea. The more I looked into it, I was like, there is a real story to be told here. Like women are really suffering and we doctors are not stepping up to the plate here. And it just became a passion project. And what was initially a no became a yes, and then became like my last work. So, you know, there you go. I, but it definitely wasn't because I was ahead of the curve and worked out that something needed to be done about this. No way.
Dr Lucy Burns (04:01) Yeah. It's sort of like serendipity. Sometimes you just sort of, it falls in your lap and you just go rightio. And I mean, I'm so grateful for people like you and the various other people that have, I guess championing the cause because you're turning it from something that is hush, hush. And it's like, Oh my God, menopause. So untrendy, so old lady. So, you know, continence pad into something that is actually right. Well, this is just a thing. It's just what we all do. It's what we all go through. So yeah. Let's talk about it.
Dr Ginni Mansberg (04:35) Yeah, especially because when you think about it, menopause average age in Australia is 51, which is coming down because we are a multicultural society and we know that women of colour tend to go into menopause a little bit earlier. So it is a number that is coming down in Australia, but it's the perimenopause, which is sort of the up to 10 years in the lead up to menopause proper that causes, you know, the hormonal rollercoaster that nobody wanted to buy the ticket to. And that experience is happening to women in their forties. These are young, hot babes. Like they are at the top of their game. You know, they're looking hot. They're doing amazing things with their career or not. As the case turns out, it is not about ladies in a cardigan, you know, clutching their pearls and grabbing the shawl. It's not like that at all.
Dr Lucy Burns (05:20) No, it's interesting, isn't it? Cause there are kind of these two distinct areas, I guess, the peri and the post that nobody has really talked about up until more recent times. And I mean, they're both significant for different reasons.
Dr Ginni Mansberg (05:39) Yeah, absolutely. So I think menopause, which is a single day that happens 12 months from the first day of your final menstrual period, which very few women work out that the period they're having right now, is going to be the last one. There's never going to be another one after this. I mean, you've got to be superhuman to work that out. So it's always something that you work out in retrospect. And when it's, when it's been 12 months to the day from then you're in menopause and everything after that day is post-menopause. And that kind of marks a bit of a transition because estrogen has so many unbelievable roles. It's got receptors in literally every cell in the body, but it plays amazing roles in your arteries, in your heart, in your guts, in your brain, in your skin, your vagina, like everything. And so losing your estrogen after menopause really does mark a bit of a turn, which is quite interesting. And then it's not like you go along having these perfect cycles, these perfect, you know, fertile cycles. And then one day you just go, stop. There is a slow wind down by your ovaries where they've just got no idea what is going on. They are trying to pump these little hormones out. They're doing their best. Sometimes they're good. Sometimes they're a little bit too good. They go overboard. Sometimes they have an epic fail, you know, failure to launch. There is just so much happening in the ovaries in the lead-up to menopause that you can literally feel like you have got no idea what is going on. And that during that period, a lot of women want blood tests to see what was happening to them hormonally. And I often say to them, a hormone test will tell you what is happening at that moment on that day. It doesn't tell you anything that's happening the day after or the day before. It's just an interesting point in time. And because it is the rollercoaster, there are a lot of women who do this hormone test and go, Oh, well, apparently I'm in menopause. Well, I had a period two weeks ago. No, you're not in menopause. You can't be. That's definitely not right or worse. A lot of women who get told, no, you know, we're near menopause because your hormone tests are normal. Well, that's particularly unhelpful.
Dr Lucy Burns (07:36) Yeah, absolutely. And I mean, I guess it's educating both sides, isn't it? The doctors and the public that blood tests are really not that useful.
Dr Ginni Mansberg (07:46) Yeah, they're not helpful at all. I tell you where they are really good is if a woman has a Mirena and she wants to know if she's in full-blown menopause, so a Mirena is an intrauterine device. So it's a contraceptive device that has progesterone inside it that is designed to both be a pro contraceptive but also to really lighten the flow of heavy periods of many women who have a Mirena. Do not have periods at all. So they don't miss their final menstrual period because it doesn't happen to them. So for that group of women, it can be interesting for a group of women who've had a hysterectomy while they were premenopausal, so they don't really know the date, but to a certain extent, even then it doesn't help you that much because we treat your symptoms and it doesn't really matter whether you've gone through menopause or not. What really matters is what are you experiencing. What is a day in the life of you looking like? Let's treat that.
Dr Lucy Burns (08:40) Yeah, absolutely. I love that. I love that. And I think that then, if we, you know, look at symptoms, not arbitrary blood markers. Then everyone wins.
Dr Ginni Mansberg (08:52) Hallelujah. I love that. Cause that, that is absolutely the truth. I think that there are a lot of menopause symptom checkers that you can do online, but at the end of the day, nothing beats having a good chat and the good chat can't happen in six minutes, 10 minutes or 20 minutes, because yeah. I do this for a living and I am telling you, Lucy, I don't meet two women with the same journey ever never. Everybody has a slightly different experience of this. It's not like high blood pressure where you can step through an algorithm really neatly. There are the numbers. They're either up or they're down. If you're really not sure, you can get a third party to test it, you know, going on for 24 hours. But we pretty much got the numbers. You trade the numbers. If you have blockages in your heart, we work out how much is blocked. We treat them according to an algorithm. If it's 60%, we do this. If it's 70%, we do that. Menopause is completely different. It is all about the experience of the person and how that is impacting them on their daily life. Because if you take hot flushes, for example, which is, I think the hallmark symptom, for example, that happens to 75% of women, less than brain fog, about the same amount as aches and pains, but anyway, we'll call it the hallmark symptom. One in three women describe them as unbearable. Two and three women go, yeah, I do have them. Oh, that's bad. No, I don't want treatment for that. So, we can't just, even if a woman has a symptom, it might not worry her. So it's so highly individual, which is why I think. It can be really hard to treat for doctors. We love a good algorithm, don't we? A good, a good flowchart.
Dr Lucy Burns (10:29) Ah, and totally. And also though, I think, and you mentioned this in your book, about the WHI study. So I think you and I probably went through uni about the same time and then, you know, as I was a junior doctor, that's when, you know, HRT was all in and then a bit like menopause, it was out. That's right. Stop. Stop. And it was like, we're all killing people. We need to stop this. And so suddenly, you know, everyone threw their HRT in the bin. And it was like, don't you give this to anybody unless they're just about dead.
Dr Ginni Mansberg (11:04) And to this day, while I think we're slowly unpicking the last vestiges of fear of hysteria around that study. The black box warnings that are placed on every leaflet in every form of hormone replacement therapy, they persist. Again now we're starting to look at unpicking some of those, but they've been around since 2002 when the women's health initiative study a massive prospective study of over 110, 000 women where they were randomised to either get a placebo or an oral form of synthetic hormone replacement therapy in a dose we don't really use anymore. When that study was done, the results of that was that we actually created these black box warnings on all hormone replacement therapy products that have persisted to this day and literally are terrifying. They're terrifying to pharmacists. They're terrifying to a lot of GPs and they're terrifying to patients, which is really, it's weird. It's just weird. Sorry. I'm sounding like Walsh.
Dr Lucy Burns (12:11) No, not at all. Not at all. And I think I love it because you, you know, we've all got a soapbox that we like to stand on and I have many. And I think it's always great when you see people who are passionate about something that they work in, that they believe in and the stupidity of regulations. And that's, you know, what you're railing against. Conversely, though, you know, you can go and buy or get prescribed or somehow purchase a compounded hormone that won't have any black box warning. What are your thoughts on that?
Dr Ginni Mansberg (12:50) So the menopause societies to which I belong, which are, I guess, the peak bodies that represent best practice for doctors who work in menopause, are quite strongly against bio-identical, compounded hormones for menopausal symptoms. I want to explain why, and it is partly about the lack of oversight from a peak body like the Therapeutic Goods Administration in Australia or the European Medicines Association or the FDA in the United States. There is no oversight as to what somebody is doing in the backroom of their pharmacy. And we all saw what just happened with the scandal of the homemade Ozempic that was apparently in such disgusting conditions and not at all related to what was meant to be prescribed, that it was shut down by the TGA in Australia. We don't know what's happening in, you know, the back kitchen of somebody's pharmacy. But apart from that, we don't have evidence that they're safe. So we've just now fallen over ourselves to say that HRT was unfairly called unsafe in the Women's Health Initiative, the reporting of that trial. But what we do know is that estrogen, which is going to do most of the heavy lifting when it comes to the symptoms of menopause is an amazing hormone. But if you give somebody estrogen and they have a uterus and you don't give them progesterone, you will inevitably get an overgrowth of the lining of the uterus, which can just cause vaginal bleeding, but it can also, unfortunately, in a certain percentage age of women become cancerous. And so our desire as practitioners is to prescribe a safe level of progesterone to balance out the estrogen in order to keep our patients safe. We don't have good data about what is required for bioidentical estrogen, but the way that bioidentical progesterone is delivered, whether it's across the skin, we know that there's very, very little penetration on the skin, so that that's probably going to be unsafe. And troches, which are these kind of lollies that you're meant to suck. Again, very low levels of progesterone, so very low levels of protection. And so there have certainly been cases of endometrial or cancer of the lining of the womb because of people taking bioidentical hormones. And for that reason, it is really frowned upon, but not shut down by peak medical bodies in Australia. So it's advised against strongly by the Australasian menopause society. And yet doctors are fairly free to do it. And they're not going to be taken out by medical boards around Australia. Don't have a relationship with your patient. But if you do something that's really frankly, poor medicine. Good luck. Go for it. That's fine.
Dr Lucy Burns (15:49) Yeah. I know. Yeah. Yeah. It's it. Yeah. It's incongruent, isn't it? Yeah, totally. Yeah. Yeah. So perimenopause is the rollercoaster where it's all up and down. Everything's all over the place. Postmenopause is when things are a bit more stable, but we've lost, you know, our best friend, estrogen. Current recommendations are that you know, and again, I think this is where doctors still get a bit nervous. How long should you stay on this? You know, no more than five years. Lots of people are being taken off their oestrogen. That's pretty out. We don't really say that anymore. But lots of people still hear it, or I guess lots of doctors are still saying that. So what are your thoughts then? Is there a limit on when, and how long we should be taking oestrogen if you're indeed taking it?
Dr Ginni Mansberg (16:34) So the origin of the five-year or six-year number came from that women's health initiative study, and that was the point at which we started to see an increase in breast cancer. So just to remind everybody, this is a form of synthetic oral estrogen and progesterone that we no longer use here in Australia or really anywhere in the world. At that five-year mark, we started to see an uptick in hormone and breast cancers in women who are average age of 63 who were taking hormone therapy and just to put it in context for every 10,000 women taking a placebo. What we saw was 30 cases of breast cancer versus 38 for the women on hormone replacement therapy. If you took a subgroup analysis of the women who started the HRT before the age of 60, in fact, the numbers were the same between the placebo and the HRT group. So we suspect that if you reflect real-world use nobody starts the 60s. Most women have got through the worst of their symptoms by then. They don't really need it anymore. For those women, it is very likely that, well, it's pretty safe, but there's still that sort of lingering hysteria, but that's where we got into the, look, you've got to cut it out at the five-year mark, but here's what we know, which I think is really interesting. It seems to be potentially protective of both your brain and your heart. And we are getting more and more data on this all the time, but definitely of your bones and preventive of osteoporosis fractures and probably colorectal cancer as well. What we know is that every menopause society in the world now says that you take HRT for as long as you need it to control your symptoms. The thing is, you don't have symptoms when you're on HRT. So how do you know when you can go off it? So what I tell my patients is you can freely go off at any time you want. Anytime, like go off it. I wouldn't go cold turkey. I'd cut it in half. If you've got a patch, cut it in half. If you're taking a gel, do one pump instead of two. And that's it. I'll do it every second day, see how you go. And if the symptoms all come back, you can restart it again. I would normally do that in winter in case you're going to have hot flushes. I think come February in Australia, everybody is a menopausal woman, even if you're a 28-year-old man and we're all having hot flushes, don't do it then. But really you have it as long as you need it. And if you want to try, because it is still expensive in this country, if you want to try getting off at any time, feel free, but studies show us that the average of hot flushes is 7.9 years unless they start while you're still in perimenopause, in which case they're 11 years. So feel free to try and go off it after one year. I suspect you'll be back on it very tootsweet, but you know, all power to you. And I think this is very important in the whole menopause journey. It is about the woman and what she wants. So if she wants to go off it, go for it. I am there by your side being your co-pilot on this. And if it doesn't if it all goes, you know, tits up, call me.
Dr Lucy Burns (19:35) Yeah. Yeah, absolutely. I think that's great. It's so interesting. I think one of the sneaky things about menopause is that some of the symptoms are sneaky. And you know, I got a few hot flushes at night and I thought, Oh, that's easy. I just went the blanket off and put it back on. Like no big deal. A symptom that I reckon I had for about nine months before I finally, the penny dropped. And every now and then I think, God, how can I, you know, you feel so stupid when you finally realise, but I was waking up at about 4 AM with just this intense anxiety, having never been an anxious person having had you know, situations where I should have been anxious, you know, workplace conflicts or friendship issues, the usual things where you would normally, you know, gnash your teeth over nothing. And I'm thinking, Oh my God, it must be my business. You know, I'm running my own business. That must be what's causing it. Oh, this is terrible. And then it wasn't, it was just physiological.
Dr Ginni Mansberg (20:33) Yeah. Yeah. I had the first time it happened to me, the panic attack, which I'm pretty sure was three or four in the morning. I sat bolt upright in bed and I also like, I've never suffered from anxiety or depression and I didn't have it when I was awake. It would only ever happen to wake me up from sleep and I would wake up, sit bolt upright and I knew I'm about to die. At this moment, I'm about to die. And then the shock that comes five seconds later when I haven't died, I don't know, even know what to make of it until I realised, Oh, that's a panic attack. That's what I've just had. And then you're almost scared to go back to sleep because you don't want it to happen again. It's happened to me, I think three or four times. Oh God, like the worst thing ever. I do feel so sorry for people who do have panic attacks all the time.
Dr Lucy Burns (21:20) Yeah, I know. Well, anyway, luckily mine was cured with a bit of HRT and you know, love that. Yeah, I know. It was great. So. I think that, you know, it seems fairly apparent that if you have menopausal symptoms, then you should consider MHT or HRT, whichever camp we like to stand in. One of the things I've seen though, in, and again, I do a lot of Facebook stalking of groups to see what are the average Joe Blow or Flo Blow saying, whether that's in an Ozempic Facebook group, whether it's a low carb Facebook group, whether it's a menopause group. And there are some women out there, I think, who feel like once they get on an MHT, everything in their life should now be better. What are your thoughts on that?
Dr Ginni Mansberg (22:12) I always think menopause comes at the worst time of a woman's life. Often your parents have transformed from the people that you are your go to's when you need to make a decision, when you need to make a decision. Some support to being the people who you need to support now, and you've got to make time for in your life to take them to doctor's appointments or, you know, sort out what the hell is going on with the, why, you know, the bills not being paid or whatever it is. And that's an extra time burden on you. And often you've got teenage kids and maybe your partner is going through his own midlife crisis and you're trying to be a support to him and some of your girlfriends are going through marriage crises and that's all really tough. So I think it often comes at the wrong time. And there's only so much any medication can do. There are situations that are difficult. I think that we also have an intolerance as a society of things just not being perfective distress and we've seen incredible rates of dependence on antidepressant medications when not necessarily everybody who's prescribed an antidepressant medication necessarily needs that. A lot of dependence on pain medications when not everybody who has. Pain necessarily needs a medication. We're very protective of our children and we don't like them to experience any pain. We have zero tolerance of their distress at their distress distresses us. And as a result, we have these unrealistic expectations of all sorts of things to be the cure all our role is not to have a perfect life, but the slings and arrows that come with life. And when conquering them is so empowering is to make everything bearable. That's what you want, bearable. And if you have no slings and arrows, you have no key learnings in life either. But there's a lot of empowerment that comes from getting through a really stressful situation. So I could not be in more agreement with you, Lucy. I think that we sometimes put too much pressure on seeing a psychologist or getting a different job or, you know, moving house to cure everything. I think our job is now just to say, what can I do to make life doable so that I've got enough resilience to get through the slings and arrows.
Dr Lucy Burns (24:48) Yeah. Totally. I love that. I think you're right. I mean, we have a little phrase, it's not ours, but we use it a lot, which is, you know, getting comfortable with being uncomfortable. It's actually good for us to have some discomfort.
Dr Ginni Mansberg (25:00) So good. And good for our kids. And I think our kids need to see us being a bit uncomfortable as well. And then getting through it, because it's an amazing feeling when you get through it.
Dr Lucy Burns (25:12) I know, we have just turned into this society where we value comfort over almost everything. And I think back to, you know, back in the 50s when people went to the movies, they sat on the, you know, the old church pew or something, it was some wooden thing. Then we moved into cinemas and we got, actually got seats and that was nice. And now nobody can watch a movie now unless they're lying down and being drip fed popcorn. It's just.
Dr Ginni Mansberg (25:36) With a phone in their hand. Yeah. Yeah. They can scroll through social media at the same time.
Dr Lucy Burns (25:51) Exactly. Exactly. So yes, sometimes that, yes, yes. Getting comfortable, increasing that distress tolerance is actually the thing that will help you.
Dr Ginni Mansberg (25:49) Yeah. I agree.
Dr Lucy Burns (25:50) Wonderful. Now, one of the other things I wanted to pick your brain while you're here is that you are also know a lot about skin. And I thought, okay, well, there's probably some crossover with menopause and skin and all of the things. So I'd love to know your thoughts on that.
Dr Ginni Mansberg (26:06) Oh, I'm so glad you asked. So to understand what happens with peri and menopause and skin, you need to understand the role of estrogen in the skin. So estrogen is actually anti inflammatory across the body, and it probably contributes to the lack of estrogen to the joint pains and the back pain and that sort of thing, but it's anti inflammatory in the skin as well. And it also helps you build your skin barrier function. So the skin barrier is designed to keep bad shit out, mainly sort of toxins and bacteria and viruses and fungi and get, keep the good stuff in, which is mainly your water inside your skin. So as you lose estrogen, assuming that you don't go on HRT, you get unmasked inflammation and you also get a disruption of your skin barrier. And we have Dutch research that actually shows that 70% of women will experience some sort of sensitivity around the time of transition into menopause. And a lot of women will experience dryness for the first time in their life. On top of that, estrogen is also essential for actually stimulating your fibroblasts, these amazing cells that are all over your body, in your muscle, in your bone, in all of your cartilages and ligaments, making connective tissue via collagen, the scaffolding that actually holds your skin together. There are estrogen receptors on fibroblasts and fibroblasts will make more collagen when estrogen is around. Not only that, but your body has a natural recycling system for collagen. And there are these enzymes called matrix metalloproteinases and there are a number of them, but MMP1, matrix metalloproteinase 1, is switched off by estrogen. So when you lose your estrogen, it's allowed to just go and gobble up all the collagen that you have in there. So you've got this double whammy hitting your collagen to the effect that women will lose 30% of the collagen in their skin within five years of menopause and lose an additional 2% over time per year after that. And the impact is a very rapid onset of fine lines and wrinkles, but even big pores, you know, if you lose the collagen around each, what we call pylosabaceous unit, the unit where the hair and the oil glands, they come out of all of your skin, you're covered with pylosabaceous units everywhere. You lose collagen around those and they get more floppy and your pores can look a lot bigger. So you've got the double challenge if you really want to stimulate your collagen. And I would say that you probably want to hit menopause with a lot of collagen on board. So already from peri having a lot of your collagen. But once you get into late perimenopause and early menopause, you've lost a lot of your estrogen. You're also going to be very sensitive. And on top of that, the skin, which has a naturally slightly acidic pH sort of sits between 4. 5 and 5. 3. So not car battery acid, not orange, but sort of definitely not soap and definitely not neutral, which is seven. It's much more acidic than that. It drifts upwards to about six. Now that's really significant because that protective acid mantle is created by the microbiome on your skin. And we think that there are changes around the way you metabolise sebum and oil that actually change the microbiome of your skin and see you get more alkaline skin. And again, that disrupts more of your skin barrier contributes more to the inflammation in your skin. So what it putting all of that together, we want a collagen building regimen that is not going to stuff up your pH of your skin. It's not going to cause sensitivity. That's actually going to repair your skin barrier at the same time, which means some of the heavy hitters that we love like you know, Tretinoin, which is the prescription form of vitamin A. Awesome stuff. Horrible when you're going through menopause and you have a, you know, a really nasty sort of sensitive skin. Off the table, alpha hydroxy acids here, glycolic acid and lactic acid, they're amazing for building collagen. Certainly don't want those when you've got sensitive skin. So we need to tailor your skincare regime to both rebuild your skin barrier, reduce the pH of your skin, reduce inflammation in your skin. So you want a nice antioxidant hit, and then we also want your collagen builders. So I've got my system for doing that. If I look at a woman in front of me, I look at whether she's got a damaged skin barrier, I make sure we're getting rid of her skin. We make sure we're getting rid of any irritants in her skincare. So any prescription vitamin A, any retinol, which is both ineffective and irritating. So we just want to get rid of all of her retinol skin products, get rid of her vitamin C, get rid of our alpha hydroxy acids, make sure she's using sunscreen. And then we start to introduce your skin barrier builders. So niacinamide, panthenol, which is vitamin B5 and ceramides. And we also want to start rebuilding collagen, using the gentlest collagen builder. So instead of alpha hydroxy acid, I'd use a poly hydroxy acid instead of a retinol or prescription vitamin a, I would use a retinol or retinaldehyde, which is both really gentle and tolerated by absolutely everybody and as effective as the prescription stuff. So that's my approach to menopause skin. Does it make sense?
Dr Lucy Burns (31:10) Yes. And it's quite a lot. It is a lot. Yeah. But it's good to know because I think that lots of women do, they go from feeling youthful to feeling like they look old in a matter of two years or something.
Dr Ginni Mansberg (31:29) Because they are losing collagen. But if it comes at a time where they've put on weight. So it's really stuffed up their confidence. And women are losing confidence. Anyway, they've got a bit of brain fog, so they feel like an idiot. And sometimes inside the family without meaning to puppy and kids are gaslighting her a little bit and making fun of her because she's so vague and forgetful and whatever, she's maybe got a bit of anxiety. Her mom's gone, you know, troppo and is now falling over all the time. Things are not going so well at work, you know, she's not sleeping. So her tolerance levels are now this high. And then on top of that, she feels like she's looking like an old crone. That is just a quite a nasty combination of things there. You know we want to rebuild her, but I wouldn't belittle her wanting to look better in her skin in particularly in the era of zoom. But anyway, you know, we've all got cameras on our phones all the time. You just don't want to be hiding, you know, and saying, Oh no, don't take a photo of me. I look horrible.
Dr Lucy Burns (32:26) Yeah. And I think it's interesting, isn't it? Cause there is this society thing where it's like, you can't do anything right if you're a woman. If you care about your skin or you're interested in your skin or you're getting Botox, well then you're some sort of, you know, superficial hag. And if you don't do anything, well then you've let yourself go. It's like you're damned if you do, you're damned if you don't.
Dr Ginni Mansberg (32:47) I actually couldn't agree more. And I feel like. It's like somehow, if a woman admits that she's had Botox, the stigma and shame around that is so awful. And yet I agree with you, I don't know why we've got a particular hatred of women who take care of themselves. Like it's actually okay to want to look your best cause it makes you feel better about yourself. And I think it's been really interesting to look at. We've broken down stigmas around ageism and racism and transphobia and gender phobia and all the rest of it. We're so much more inclusive. We are getting less inclusive when it comes to people who are overweight and obese. We know that studies have shown that, and that entire fattism is born by women. So if you break it down by gender, we don't judge men badly for being fat. All of that judgment goes into women. We know that they have less economic advancement. They're less likely to get a promotion at work. They're less likely to get a job. They are paid women who are overweight are paid less than women who are not overweight with all the stigma and shame around weight. That is just to me, unconscionable. We're even harder on women who want to put a bit of mascara on and look halfway decent. It's really, only to women.
Dr Lucy Burns (34:11) Yeah. Yeah. Yeah. I know. And it's this concept that there is an appropriate age in which you should do things. So, you know, that people go, Oh, she's dressing too young for her age or, Oh gosh, she's let herself get grey so young. And there's these kind of rules that are not spoken about and if you dare transgress them, well then, you know, you're some terrible person.
Dr Ginni Mansberg (34:43) Yeah. Yeah. And judgment's going to come flying at you left, right, and center, like it is anyone else's business. What you decide to do with your own face. Yeah. No F off really. I'm not interested.
Dr Lucy Burns (34:54) Yeah. And I also just think that we need to realise that women are in society, as you said, they're discriminated against for multiple things on the way they look. So then they go and try and improve the way they look. And then everyone says, Oh, well, they're just, you know, they've got no backbone. They're just trying to fit in with society. And it's like, yeah, well, why wouldn't you like, nobody wants to be on the outer.
Dr Ginni Mansberg (35:20) Yeah. I mean, I see people who've been battling their weight for 15, 20 years and they might lose 10 kilos, but basically doing it full time. Like they're really trying everything. And then they come back and they're 10 kilos heavier. And it's like, now we have the secondary effects of poor metabolic health. And now they're on the verge of diabetes. Now they're hypertensive and now they're on, on team medications. And if I mention, to just go and have a chat to a bariatric surgeon. They look at me like I I've just suggested that they go and jump off the nearest building. Like, no, I don't think I need to be that extreme. I'm like, at what point are you going to think that you're worth it? At what point are you going to see that your value as a human, that your potential in life to be healthy and to be happy and to not be depressed and about your own way. At what point do you consider that, that you're worthy of that? And people are awful to themselves when it comes to weight in particular, but also skin stuff as well.
Dr Lucy Burns (36:27) Yeah. What it is I think is the conditioning of women who put themselves at the bottom of the pile, look after everybody else. So, you know, I was talking to somebody recently about their food and they basically will not buy themselves good quality food because they'll give it to everybody else and then there's not enough money in the budget for them. And it's like, well, why are you worth less than anybody else in your family? In fact, you know, I love this analogy of the golden goose. And I think the often the mum, the mother of the family is the golden goose. She's the one with all the things. She cares for everybody else. She's doing everything for everybody else. And so. And if I had a true life, golden goose, I mean, wouldn't you put it in a palace and feed it well, and give it a silk pillow and sing to it and do all the things to continue to allow it to kind of give out these golden eggs. You wouldn't give it the dregs at the bottom of the feed bag that are full of mold.
Dr Ginni Mansberg (37:31) Yeah, totally, totally. Ah, well, you and I both see women every day who are at the bottom of the pile and hopefully someone listening to us is going, yeah, maybe I'm worth it. Maybe, you know, I always say, what would you say to your best friend or what would you say to your sister? Is she worth it?
Dr Lucy Burns (37:49) Absolutely. Absolutely. So, skincare, just to sort of bring my brain back to that, what I'm hearing from you then is that there's stuff that you can put on your skin that will do all these things that you were suggesting.
Dr Ginni Mansberg (38:04) Yeah, it's really interesting, Lucy, because a lot of people sort of really believe, because it intuitively sounds right, that it's more important what you put inside your body than what you put on your skin. And I think that intuitively sounds right. We just don't have the evidence that that is correct. And I guess it would be really hard to do a randomised placebo controlled trial in which you allocate somebody to have X diet and then follow them up for 20 years and they never vary their diet and just check their skin out. It's really tough. But the evidence for topicals is really, really, really solid. Certain ingredients are too large to pass through the skin barrier and into the skin. That's okay. Your basic stuff, your vitamin A, your vitamin B, your vitamin C, that stuff all passes through and it does amazing stuff to your skin. And yeah, the evidence is really strong, really good. Most of the products out there cut a few corners and don't quite do it the evidence based way, but you know, if you stick to the evidence, it's actually excellent.
Dr Lucy Burns (39:04) Yes. I know. So, which I guess brings me then to my next question, which is of course, both the companies that aren't regulated like you and I are by APRA and, you know, aren't necessarily producing products that are approved, but yet are allowed to make ridiculous claims on ridiculous things and sell an enormous amount of product.
Dr Ginni Mansberg (39:32) Well, I've been really struck by the menowashing, particularly, so there's been an enormous number of supplements that have come to market. And while studies have shown, and most of the studies have been on hot flushes because it's fairly easy to study. There's a number of hot flushes and you just put them recorded as a diary the placebo effect is up to 75% in some studies. So, and let's not kill it off a good placebo effect. I just, in my experience, you got six months on a placebo and then you're out. So ride that train while you can. It's just, these things are often really expensive, but there's the skincare for menopausal women is just, I'm sorry, what? There is no evidence for any of it. And it's pretty unconscionable. I think to grab a product, put an M on it. Chuck a pink bow on it and claim that this thing is better for menopausal skin or menopausal brain health or menopausal sleep than anything else. Are you trying to tell me Mr. Company Man that if a man puts this minnow washed skincare on his skin that his face will fall off? Or if we accidentally stick it on a perimenopausal woman what would happen to her? Or does it matter which phase of the perimenopause? It is complete, as my grandmother would have said, Bobomises, that's a Yiddish word for garbage. But you know, it's really, it is absolute garbage what is out there. And I would urge. People just not to be taken in. We know what we're trying to do. We're trying to rebuild collagen. We're trying to repair your skin barrier. We know how to do that. It's just a matter of your buffet of available options for skin. We've got a slightly narrower buffet because we can't use any of the irritating ingredients. That's okay. That's cool. But we don't need to stick an M on it and pay double.
Dr Lucy Burns (41:27) No. No. I know for anything, for powders that are going to somehow give you energy that yeah, so many, so many herbal.
Dr Ginni Mansberg (41:40) No evidence for any of it. None of it. Listen, there are, I mean, you want to take a magnesium to help you sleep. Better at night. We do have evidence for that, but do you need to have the M menopausal, you know, sleep point magnesium? No, you can probably just go to Coles and buy the UBU cheapest, cheapest home brand one, and it'd be just as good. So yes, smart women listen to this podcast, be smart about it.
Dr Lucy Burns (42:01) Indeed, indeed. Ginni, if people want to connect with you, have a look at your skincare, how do they, where do they find you?
Dr Ginni Mansberg (42:10) So the skincare, probably the easiest thing is to Google Dr Ginni skincare. So I'm, you know, G I N N I or it's Evidence Skincare. So it does what it says on the tin. It's got evidence for it. So Evidence Skincare. So it's, e s k care. com. I have the Mword. Best book ever. Of course, if I do say so myself, you can Google that as well. It's every, in every bookshop. And if you are interested in talking about menopause at work and getting your company, your workplace to actually deal with this topic, instead of sleeping in under the carpet, you can look at don'tsweatitcom.au, which is my menopause in the workplace company, which is doing great stuff at the moment, really making big differences to women around Australia.
Dr Lucy Burns (42:49) Oh, I think that's wonderful and lovely. So if you're driving, we will obviously put all of these links in the show notes as we always do. I've got Ginni’s book and I oscillate between the Kindle and Audible, which I love because it's just a very efficient way to read. And she's very funny, like, if you love a good laugh, and I know lots of you do, and you tell me how hilarious everything is, you will love this book. It's easy to read. It's got a few cracking good stories in it and it will suddenly you'll have like pennies dropping and it'll be amazing. So yeah, go check that out. And the M word and plus it's an easy title to remember. I mean, that's the other great thing. What a good name.
Dr Ginni Mansberg (43:45) So good. I know my husband named it. So good. So we're sitting around trying to work it out. And he just said, why don't you call it the M word? I was like, yes, brilliant.
Dr Lucy Burns (43:53) Yeah. Yeah. Written by the M girl. So yeah. Awesome. All right. Well, thank you again. Thanks so much for your time. Thanks for sharing your wisdom with our listeners and our gorgeous friends. I will be back next week, of course, probably with Dr Mary, I think, and, we will talk to you all then. Bye for now.
Dr Lucy Burns (44:13) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
