Dr Ginni on Menopausal Skin & The M Word

Transcription- Dr Ginni on Menopausal Skin & The M Word

Trish

Hello listeners, it’s Trish Hammond here from the Transforming bodies podcast. And today, I’m catching up with Dr Ginni Mansberg. Now she’s a general practitioner based in Sydney at Sans Souci and she has so many passions that should have to do with health. But today, we’re gonna actually talk about women’s health in particular. We’re gonna be talking about menopause because at the Nonsurgical Symposium, Dr Ginni Mansberg is actually speaking about menopausal skin, and her book called The M Word, so we’re gonna get a bit of an insight into that. So welcome.

Dr Ginni

Thanks for having me.

Trish 

I feel like that introduction went forever, but honestly, if I had to actually introduce you for all the things that you’ve done, it would be the whole podcast.

Dr Ginni

I know. I have, like I think it must be everyday or maybe I’m just too excited. Like, I’m an energizer bunny, so just get excited by everything and just keep taking on more projects. 

Trish 

Yeah. Well, tell me, first of all, you actually spoke today about menopausal skin. Tell me, what are other skin changes that happen to us women as we get older?

Dr Ginni

So obviously, ageing has its entire own trajectory, but to understand what happens as you go through menopause, you need to understand what oestrogen does in the skin and then what happens when you lose it, which of course, is what menopause is. It’s twelve months since your last period. Only the problem is you didn’t notice your last period at the time. So very few women actually know that they’ve gone through menopause. Which is a single day.
It’s a single day. It’s the day twelve months from your last period. In the lead up to it, you go through pre menopause or perimenopause or sometimes called menopause transition and everything after that single day is post menopause. Now in the lead up to menopause, in that menopause transition, the first thing that you lose is progesterone. So a lot of women think that they’re going crazy, they don’t sleep, they get a lot of anxiety, and then your oestrogen starts to tank as well in the second half of your premenopausal, of your premenopausal and then you’re gonna have, if you’re gonna have hot flashes, that’s when they’re gonna happen.
Your aches and pains are gonna happen. You’re gonna have terrible brain fog, and you’re gonna start to see problems with your skin. So the skin problems that we see really fall into two big buckets. The first thing is that you lose a lot of collagen. Now we know that oestrogen helps your skin make collagen, but it also turns off these horrible enzymes. I don’t even know what they’re doing there, but they actually help your body break down collagen.
I don’t want any of them, but oestrogen actually keeps them in check, lose your oestrogen. They’re left to run wild. They’re breaking down collagen everywhere. What are we talking about? Thirty percent collagen loss in the first five years after menopause.
And then lucky you, two percent additional loss of collagen per year after you’ve gone through menopause. And the result of that, well, we all know. It’s fine lines, it’s wrinkles, it’s thinner skin, it’s pores that look much bigger because the skin is less tight around those pores. So all those things happen. The second big bucket is the loss of the skin barrier in integrity.
So what we’re talking about with skin barrier is this tight tight knitting together of skin cells with a whole lot of glue, and it’s things like hyaluronic acid and ceramides, as well as a whole lot of proteins and fats that form, like, looks like a brick wall and it keeps good stuff in by that, I mean, hydration and moisture, and it keeps bad stuff out so we’re talking about bacteria and toxins. When the skin barrier breaks down, what we start to see is dryer skin, itchy skin. Some people feel what we call formication, which is the feeling of bugs crawling on your skin.
Love that. And then generally, we’re just getting poorer quality skin. We know that the pH of the skin goes up after menopause and that the bugs that sit on your skin normally are best friends keeping everything in check, they all change so they’re the two big buckets.
It’s your drier itchy skin as well as your definitely your loss of collagen.

Trish 

So funny I feel like you’ve been living with me for the last year or whatever. That’s exactly how those are, even those, like, prickly skin things where you’re itching like a crazy person.

Dr Ginni

And sensitivity, including test skincare. So you might have used the same sunscreen every day since you were twenty and all of a sudden you can’t use it because it’s driving you crazy. Your makeup, you might have to change all of your makeup so all of these things are all to do with menopausal skin so that’s what my passion is actually to fix that.

Trish 

Amazing. And tell me, so how do you fix it? Like, what? Well, sorry.
What can someone kind of do apart from see someone like you? Because it’s really hard to actually find someone who is a specialist in this that actually doesn’t want to prescribe, I don’t know, HRT or which could be the right thing to do anyway, but like I’m not one to one to have HRT, but I want to find you know, where did we go as a patient? 

 

Dr Ginni

Well, that’s a big question, Trish, to unpack. In terms of the HRT, let’s just park that because we’ll take that offline, you and I will have a chat. Because I don’t think it’s a really bad rap and not everyone can have it. Like, if you’ve got breast cancer, we can’t give it to you. That’s not a risk no. No. You can. That’s actually not a risk factor and that is not a contraindication to HRT at all. That’s one of the many many myths that I’m trying to bust. But in terms of what else you can do, there are a very large number of uber expensive menopausal specific skin care ranges that are out there, and I’m calling bs on them. Because the reality is, impaired skin care is a skin barrier function. We know what to do with that. We’ve known that for ages. We’ve got lots of studies about what to do with that. We’re talking about ingredients like niacinamide, ceramides, highly runic acid, and panthenol, which is provitamin B5. We know what to do with an impaired skin barrier. We know that you need to moisturise. We can do that. In terms of loss of collagen, every single person at the Nonsurgical Symposium, that is their bread and butter. They are collagen growers. So of course, the blockbuster ingredient is vitamin A. A real problem if you’re using prescription vitamin A or retinol, which is two steps away from that prescription vitamin A because it does cause sensitivity in so many people even without that impaired skin barrier function that comes with menopause. Put menopause into the mix and a lot of people can’t use it. But luckily, we’ve got you covered. We’ve got a form of vitamin A called Retinal, a hundred percent of which is converted into retinalic acid, but just in a slow release way so it doesn’t cause any irritation. We’ve got you covered on that one. We know L ascorbic acid is a great collagen builder. We know that we can build collagen with alpha hydroxy acids, plus a whole lot of other ingredients and a lot of procedures as well. What you need to take into account with a client in front of you or if this is you trying to make some decisions for your own skin, what you need to think about is how impaired is my skin barrier, and how would you know? Because it’s itchy. It’s itchy and it’s inflamed. You want to avoid alpha hydroxy acids like a plague and you want to avoid even L ascorbic acid which is the evidence based form of vitamin C. Both of those two ingredients, even though they’re amazing at building collagen can really irritate. That’s okay. That’s all cool. We’ve got you covered because we know how to repair your skin barrier.
Pierce one of the ways is hormone replacement therapy then. Now, Trish will take that offline and talk about it later.

Trish 

Mhmm. It’s so interesting what you said because I’ve actually just been through exactly the same thing where I’m using retinol. I started off twice a week, and I went to every second day, and then I went to every day because I thought, oh, this is working great and then all of a sudden, I developed this itchy allergy and I started to flare up and be inflamed and and I rang where I bought it from there so I’ll just stop taking it for that amount and then start again because it started to scratch so that up into exactly what you’re talking about, so I could totally relate to it. 

Dr Ginni

The problem with the vitamin a product and of course with retinol which is so far removed from retinol that we have really very little evidence that it actually works. So you’d want to have either retinol or prescription vitamin A. They’re the only two options where you’ve got evidence based vitamin A. The problem with either mixing it in your moisturiser or what we call retinol sandwiching, so you actually put some vitamin A under a moisturiser and then sort of mix it all up. You now have a very dilute form for which we have no evidence. Same thing with using it every second day or every third day. We just don’t have evidence that works and I’m all about the evidence. Right? I want you to use something every single day, which is why I love retinal. Because with retinal, you can use it every single day. You don’t need to dilute it. You don’t need to mix it in with your moisturiser just use it as is, and we can use that even if you’ve got rosacea, even if you’ve got the most sensitive skin, you’re totally fine and we can build your collagen, restore your skin barrier, all in one fell swoop. Gonna love that.

Trish

Fantastic. And tell me so as like how will someone because some people say they don’t go through menopause.

Dr Ginni

Sorry. What?

Trish

Yeah. No. I was gonna rush the same thing. So people say, oh, no. I just breeze through it.
Nothing happens. So we are all different. Hey.

Dr Ginni

Well, look, the reality is if you’re a woman and you live long enough, you’re gonna go through menopause because menopause is when your ovaries run out of luck and they just stop producing eggs. Right? So that happens to one hundred percent of women unless tragically you pass away before your ovaries were ready to, you know, shuffle off this model coil. But not everybody has such a horrible, you know, constellation of symptoms. The thing Trish where I think we’ve come from is we used to think that menopausal hot flashes. And we used to think that if you didn’t have hot flashes, you didn’t have a menopausal, that’s just one symptom. Seventy five percent of women get hot flashes. One third of them describe them as unbearable, but a lot of women get a couple of hot nights and then it’s not that bad. Why would you go and take medication for that? But now we know that there are so many other things. For example, eighty percent of women experience brain fog insomnia. It is the peak time in a woman’s life when she gets anxiety or depression. One in three women and we have really rightly focused on that postnatal period as we should. As a really important time for governments to intervene and really give a lot of support to women. But the reality is the postnatal period is nowhere near the risk for women as that forty five to fifty five age group peers, which is the highest risk of suicide of any time in a woman’s life. So we need to be thinking about the mental health effects and nobody talks about the intimate areas.
I’m just gonna name the vagina. Yeah. Drive vaginas are really, really, really awful. And while there’s this stereotype when you’re 20 that, like, surely, you have stopped that whole sex business when you hit 50, you know? When you’re 50, you really don’t wanna give it up.
Not necessarily, and unlike hot flashes, which last on average 7 years unless you start getting them during your menopause transition 11 years but you can weight them out. If you really don’t wanna take something, you can weigh them out. With vaginal symptoms, year on year, they get worse and worse and worse. And not only that, if we do start to fix it, the ceiling that we can get you to is lower and lower and lower. In other words, I’ll always be able to improve things for you but not that much and so I would urge the sisterhood to stop pretending the vagina doesn’t exist. It does and a lot of women want a very healthy vagina going into their 70s. We can in the same way as protecting your vagina, we’re also going to protect you from recurrent urinary tract infections. They are awful as you get older and they can put you into hospital so we really want to be talking about this more so that women have more options and can make informed choices.

Trish

Oh, absolutely. So I’m so excited. Yeah. I’m so excited because I haven’t got a look at my husband. The guy’s well, I feel like I’m going crazy, and he’s going through this journey with me as well and now I know why.

Dr Ginni

And you know what is really interesting is perimenopausal like that anxiety. It’s got different flavours to it. Number one, there’s the rage. Everybody pisses you off. So your kids piss you off. You’re convinced that they hate you. You convince your partner hates you. You’ll convince your work colleagues that you, and in fact, one in ten women will actually leave the workplace altogether. They quit their jobs, and that’s because they have this massive confidence cliff.
So many women just feel who would want to employ me, who would want to date me, who would want to be friends with me, friendships break up. Emily’s employed at this time because we don’t talk about it and yet a lot of people will go to their doctor, get put on an antidepressant, and antidepressants don’t really work at this time. It’s not the best treatment for perimenopausal depression. In fact, we know that hormone replacement therapy is far more successful, but we need to tailor it for you and your particular need, but we can get rid of that rage. We have so much that we can offer to women if they know, to step up and ask. And I think a lot of these women will turn up as their institution. Thinking that the answer to their relationship problems is to have a boob job or to have a labioplasty or to have a little bit of filler, you know, in the most mild cases. And to be able to say, hey, what’s going on for you? I know this is really common in Perry. Is that what’s happening with you? Opening up that door for that conversation, you won’t believe what happens. The trust, the love, that opening up the way that you genuinely help women in a way that you can’t if all you ever do is you want that injection? Sure. I’ll do that. See you later. 

Trish

Yeah. And you know what you mentioned, everyone going on this is true because I could see a lot of my girlfriends. I’ve been like, oh, yeah. I’ve had to start taking antidepressants. So it’s probably actually the wrong solution for them or, you know, I mean, who knows?

Dr Ginni

Look, we know that it’s often the wrong solution and if anybody has not listened to professor Jayashri Kulkarni from the heart centre at Monash University, she has led the charge with a lot of this research around the world. But in the United Kingdom, the official guideline is to start with HRT, not to start with our antidepressants. They have side effects, including loss of libido, which amongst my patients is like a hundred percent anyway. And then on top of that, it’s weight gain. Well, we know that in my experience as a clinician, I speak to women and they’ll go, yeah. Yeah. I’ve got hot flashes. Yeah, m vagina or whatever, but I have put on so much weight and that’s what they want to talk to me about and that further exacerbates that confidence cliff and the impairment of your sexuality because you don’t want to take your clothes off in front of anybody. Why would we give anybody a medication that is second, third, or fourth best when it’s got those kinds of side effects? We wanna get you the right medications that will actually work for you. I’m not saying that they’re never required. But it wouldn’t be the first thing that we go through. 

Trish

Yeah. Amazing. Look, I can’t wait to actually read your book. Tell us a little bit about your book. Where I guess the inspiration was probably the people coming to see you.

Dr Ginni

Yeah. So women. Sorry. Well, all people with the uterus, as we now say, because we are being more inclusive. Yeah. I would say that, look, I’m not gonna lie. A publisher came to me saying, we need someone to write a book about menopause and I was like, sorry, what?
Who do you think I am? And I was like, oh, yeah. Actually, I’m fifty. Okay. Fair enough.
Average age of menopause in Australia is fifty one.

Trish

Is that. Yeah.

Dr Ginni

Fifty one. Yeah. I’m fifty five, and I’m not there yet. So I’m just in that other sort of area. But one in ten Australians are either Asian Australians or other people of colour who go into menopause earlier. And so I suspect that the next time we do a study on this, we’re gonna find out that the average age of menopause in Australia is actually much younger. But for people like me who go in a little bit later, I was just blindsided by the question, but it started my passion journey. Actually writing that book was actually the thing that made me go, oh my goodness there is so much to this. And at the same time, I’m a podcaster myself as well, and I have an educational podcast for doctors and every time we would do a podcast on menopause, I’ve seen your thinking, I don’t know anything about this. This is really embarrassing. And you tend to, as a doctor, have a cohort of patients that kind of reflect you. So most of my patients are women between the ages of forty and sixty. It’s just the way it works. Yeah. I need to know about this stuff. But in order to get educated, I had to go and join the Australasia Menopause Society, join the International Menopause Society, attend to every single webinar because the amount of training that I got as a as a medical student, zero, as a training GP, like close to nothing. I’ve had to teach myself by networking with the best and they are. I would say that if you I try to look for a doctor who’s right for you. I would find a doctor who is a member of the Australasia Menopause Society mainly because they tend to do evidence based treatments and there’s a lot of non evidence based treatments like bio identical hormones out there, and I’d be very concerned about that. But at the same time, go and get your options, find out what’s best for you and what I did notice because I was invited to speak at the Inaugural Menopause in Aesthetics conference in London, there is such a thing and I’m going back in November, so I went in February, I was the only Australian who was invited to go to this conference and what I have noticed is in the UK, the menopause field and the aesthetic field are merging into a single field. Wow. So that for aestheticians who are out there, you need to know about menopause. For menopause doctors, we need to respect, pay respect, to women who care about their looks and men who care about their looks because it’s really old school to say that is beneath me. We need to be where our patients are at and educate ourselves so that we can help them make good decisions for themselves.
We are the co pilot and we need to enable our patients to be the pilots and make really good decisions for themselves. That’s our role. 

Trish

Fantastic. So what else do we have in your book?

Dr Ginni

So it’s called The M Word – how to thrive in menopause. It’s been out since. I think, 2019. So it’s not an but it’s just it just does really well. It really hit the mark. A lot of doctors sell it, particularly women’s health hubs tend to sell it a lot and a lot of Gynaecologists sell it, so you can either get it probably through your doctor if you go to women’s health specialists. Well, you can order it online or it’s still in every bookshop. I know that because I get the royalty checks. I know it’s still selling a lot of those.

Trish

Well, that’s great. Look, thank you so much for joining us today. It’s been so insightful, especially for me. I’m really doing this now at my age and, like, you know, thirty years ago. Although, I might have been better prepared.

Dr Ginni

Yeah. I know. I know. Right? Awesome.

Trish

Well, thank you so much for joining us. 

Dr Ginni

Thanks for having me. 

Trish

And listen, look, if you do wanna find out more, just check out Dr Ginni Mansberg.
And she’s just done so much like she’s a co-founder and presenter of Don’t Sweat It, author of the M Word, this other book she’s written as well. She’s cofounder of a ESK Evidence Skincare and so much more so. I am so proud to be interviewing you today. I’ve got to say. 

 

Dr Ginni

Thanks so much for having me really appreciate it.

Trish
Thank you so much. And if you wanna find out more, just DM me and I’ll send you through her details. Thanks a lot.

 

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