She also answers your burning questions about skincare, vitamins, and bone loss.
Worried about how perimenopause and menopause will affect your appearance? You’re not alone. Recently, we’ve been getting in touch with our resident women’s health expert, Dr. Brightman, to ask about all things menopause (if you’re still catching up, Dr. B has previously explained the perimenopause phase and the world of menopause treatment options). And when we asked the Wake-Up Call readers for their burning questions, there were a lot about appearance. And Katie’s curious, too! In their latest conversation, Katie asked reader questions about some of the more awkward effects of menopause: How can women navigate the way their skin, hair, weight, and bones change as they age?
Katie Couric: We got a lot of questions about weight. What happens when you go through menopause? Why do I have a spare tire around my waist where I never did before?
Dr. B: It’s a privilege to age! We have to embrace what we have, but our bodies do change. Estrogen plays a role with maintenance of muscle collagen and weight distribution. As women go through perimenopause and menopause, there is a redistribution of body fat and women tend to accumulate more body fat in their midsection. Exercise, posture, and alignment are important because many women don’t sit or stand up straight. When you slouch, you can have a much more protuberant abdomen. Posture and alignment make us appear to be taller and leaner.
But weight does redistribute itself. That has to do with estrogen changing. So estrogen can help with that redistribution. But the other thing is exercise and doing things to facilitate metabolism.
Should we be eating fewer carbs? Should we be increasing our cardio? Is there anything we can do?
Watch your carbohydrate intake, but don’t cut them out. Everything in moderation. Being too thin and not eating healthfully is not safe. It’s not the best way to go through life and it’s really not fun.
The other thing you can really do to optimize metabolism is appropriate exercising. It’s not all cardio exercising — maintain muscle mass and work out with light weights. Not only does it help with bone density, but we know that muscle burns more calories than fat. So it’s important to have good muscle tone.
What kind of exercise helps with that?
I am concerned for many women: We talk about weight bearing exercise, and they think it means kettlebells and heavy weights. But with age, we’re prone to injury, so it has to be age-appropriate exercise. You can actually become really toned using light weights — two and three pound weights. That’s what I do. Also, having a routine like yoga and Pilates that uses your own weight as resistance can make a huge difference. Yoga and Pilates also help maintain flexibility. When you’re more flexible, you’re less prone to injury. Also, it’s important to stretch.
We also got a lot of questions about skin and hair and the effect declining hormones have on those things. What is the relationship there?
Hormones play a significant role in skin and with hair. For example, women who are pregnant notice their hair is very full and it grows. Postpartum, when hormone levels shift, they can have hair loss. So there is a slowing down of hair growth for many women after menopause. And there’s a huge hereditary component. One of the questions I frequently ask my patients is, “What does your mother’s hair look like? Or your grandmother’s?”
The upsetting fact about skin is that within the first five years of a final period, women can lose up to 30 percent of their collagen.
What can you do to make sure that your skin stays healthy and to make up for say the lack of collagen or moisture in your skin?
A lot of women use collagen topically or use collagen powder, but collagen is synthesized by the body. So ingesting or applying collagen is not going to change anything. Everything becomes sort of dry after menopause. It’s important for women to moisturize and many women haven’t incorporated that into their day-to-day routine. I tell my patients, “As soon as you get out of the shower, slather yourself with a variety of inexpensive creams.” Buy them at the pharmacy or the grocery store. Creams are better than lotions for the most part. Stay hydrated by drinking plenty of fluids. Cook with healthy oils.
A reader asked, “My eyebrows and eyelashes are thinning. Is that a postmenopausal thing?”
Many women have thinning brows and lashes. There are all sorts of beauty products available to treat these things.
Somebody else also asked about how they can make their skin firmer on their legs or their stomach.
If you’re building muscle, it’s going to raise your skin and keep it from being baggy and saggy. Dermatologists have various procedures that they can perform to stimulate collagen production. But that’s not my area of expertise.
Let’s talk about bones: What’s the difference between osteopenia and osteoporosis?
So whenever we discuss bone density, we talk about a “mean” — think back to math class — in a bell shaped curve. The mean is zero and women want a score that’s above the mean. Rarely do I see a bone density that’s normal in my practice. Osteopenia occurs if somebody has a bone density that’s greater than one standard deviation below the mean. If one has a bone density that’s less than minus two and a half standard deviations below the mean, then that would be categorized as osteoporosis. The overwhelming majority of my patients who are newly menopausal and postmenopausal have osteopenia. There’s a huge hereditary component to it. The best thing one can do for bone density is to capitalize on bone deposition, which occurs when we’re younger. I lecture my young patients, “You need calcium in your diet.” They need to capitalize on bone-building capabilities while they’re young. Women increase their bone mass until they get into their 30s. Then, they cruise along with the gradual decline that occurs in their 40s and the most dramatic drop off occurs in the first few years after menopause.
I don’t take any calcium supplements. Is it better to get calcium through a supplement or should you be getting it through food?
We should ideally have 1200 milligrams of calcium per day, which would be the equivalent of three or four big glasses of milk. Full fat milk and skim milk have the same amount of calcium. The other thing people should know is that plant-based milks are fortified. They contain as much calcium, if not more. Calcium also may be found in other foods like broccoli, kale, salmon, and almonds, but those should not be your exclusive sources.
I’m not big on supplements. There’s data to suggest that if you look at most calcium supplements, they will recommend 1200 milligrams. There’s a concern that if you take too much at once, there may be adverse cardiovascular events or kidney stones.
If my patients have a diet low in calcium, I will tell them to take a supplement — maybe half of what is recommended to see how they tolerate it.
I’ve been reading a lot about vitamin D levels, which are really important. Of course, you get some from sunlight, but I think I’m deficient in vitamin D and that’s not a good thing. Should you get your vitamin D tested when you go to the doctor? What are good sources of vitamin D and how much should you have a day?
Vitamin D should be measured when going for routine checkups, because many of us are deficient. Vitamin D helps with calcium absorption. Eggs contain vitamin D and other food groups will improve vitamin D. Many multivitamins have vitamin D; if someone is deficient, that’s easily supplemented.
So you should make sure that you’re getting vitamin D either through a supplement or from food?
Exactly. Many women do have normal vitamin D levels, but vitamin D is so easy to supplement. Make sure if you’re going to your clinician and having blood drawn that you test your vitamin D level.
