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I had my hysterectomy and ovaries removed last year and I’m not taking HRT – as I’m 50 years old. I’ve noticed that fine lines have begun to appear on my face and the texture of my skin has changed. Is this something that is related to my HRT? 


Hormonal aging begins with the decline in estrogen levels around the time of menopause. Estrogen is important in promoting collagen. The loss of collagen causes decrease elasticity in the skin, joints, vascular system and vagina. There is a notable thinning of the skin and fine lines and sagging may appear. These changes also have in impact on bone and joint flexibility. Hormones are important for reproduction, but as they decline there can be profound effects on aging beyond hot flashes.

I started noticing this change in collagen and skin with my patients from one annual exam to the next. Anne is a good example. I hadn’t seen her for a year at the time of her last well exam when she just started noting that she was skipping some periods. At her yearly visit, I noted that she looked different because her skin did not have as much of a glow and she had more fine lines around her eyes and mouth. Not surprisingly she told me that she no longer had her periods at age 51. We cannot prevent menopause so it is a natural aging process that all women go through. My dear friend and partner, Dr. Rebecca Booth, calls it “ovarian retirement” in her book, The Venus Week. She beautifully addresses hormonal aging and the amazing menstural cycle as well as the lack of menstruation at menopause or with ovarian removal.

Just because women can no longer reproduce with the decline in their ovarian hormones, it doesn’t seem fair that they should lose such an important anti-aging substance with menopause. Compare that to men who have a very gradual decline in their testosterone that helps to promote collagen. This helps men with muscle mass, bone strength and possibly less wrinkles in their faces! This can put women on a different aging path than their same-aged male counterparts.
This doesn’t mean that all women should go on hormonal therapy since there are risks involved, but it an important option that women have as they go through menopause and should discuss with their medical provider.

What can be done?

1. Avoid cigarettes, sun, poor nutrition, stress, and dehydration.
2. Hormone therapy may help slow down the hormonal changes that cause bone loss, skin wrinkles, joint pain, and vaginal pain. Be cautious because there are important risk factors along with benefits and it is important to determine with your doctor your individual risk factors.
3. Certain foods that are phytoestrogens can help promote collagen including, nuts, hummus, soy protien, and lentils.
4. Supplements such as omega 3 fatty acids (fish oils and flax seed oils) may help lubricate joints.
5. Vitamin D is very important for healthy skin and bones. Make sure that you get 1000 IU per day and consider having a Vit D level checked.
6. Calcium 1500mg per day after menopause is suggested and I encourage dietary sources.
7. Vitamin C 400mg per day helps with collagen support.
8. Biotin 1000 mcq per day helps with nail and hair strength.
9. Exercise should probably be at number one as it helps to maintain bones and muscles and new growth of collagen. And it improves circulation.
10. Topical Estrogen helps vaginal elasticity and moisture.
11. Over the counter phyto-estrogen supplements can also help with symptoms of menopause.


My mother recently died from ovarian cancer. Should I be worried about the risk for myself?


I would like to start by saying that I am so sorry for the loss of your mom.

Unfortunately, an ovarian cancer diagnosis can be a death sentence to many women because it is often detected at an advanced stage which means the cancer has spread beyond the ovary and is more difficult to treat.

Although there is ongoing research looking at ways to identify ovarian cancer at an early stage, we still don?t have a reliable screening test. It is important to know your family history along with other risks factors to determine if you are at an increased risk.

Women who have a first-degree relative (mother, sister or daughter) with a history of ovarian cancer are at three times the risk of developing the cancer themselves. As you can imagine, the risk is higher if there are more than one first-degree relatives with a history of ovarian cancer. It is important to share your history with your physician to determine if you should consider genetic testing or having your ovaries removed as a precaution.

The BRCA1 and BRCA2 genetic mutations are responsible for approximately 10-15% of ovarian cancers.

If a woman tests positive for BRCA 1 or BRCA 2 she has a 60% to 80% risk of developing breast cancer and a 25% to 40% risk of developing ovarian cancer. This is the genetic mutation that Angelina Jolie tested positive for and underwent risk-reducing surgery.

Other risk factors include: women who are older than 50, women who have had a personal history of breast cancer, women who have never had children or have not been on the birth control pill, and women of certain ethnic (North American, Northern European, and Ashkenazi Jewish) backgrounds.

Research has shown that women who have been on the birth control for at least three years have a significantly decreased risk of developing ovarian cancer. Women who have had a hysterectomy or a tubal ligation are also at a lesser risk.

Women who have a strong family history of ovarian cancer may choose to have a prophylactic or risk-reducing salpingo-oophorectomy. This is the removal of tubes and ovaries which will greatly reduce the risk of developing ovarian cancer.

High risk women should consider having their ovaries removed. With the help of their gynecologic surgeon they will need to compare the risks and side effects of the surgery to the risk of developing this potentially devastating gynecologic cancer. I always recommend laparoscopic surgery which is an outpatient procedure with the least amount of pain and recovery time. Lori L. Warren, MD