The Lifestyle Prescription – Episode 18: Perimenopause, Hormones & Skin Ageing Explained with Dr Mandy Leonhardt

Did you feel like that as well? And is that what drew you into, um, the area of, of women's hormonal health?

Yes, absolutely. Um, so. In medical school, we learn the very basics, um, of ovarian function,

right?

Mandy Leonhart: Um, mainly through the lens of reproduction. So ovaries are there, you know, to help us become mothers. Um, but there is very little discussion about, um, for example, perimenopause or menstrual cycle related issues.

Um, so unless you, uh, go into gynecology or endocrinology and you specialize in these areas, you tend to not, um, study any of this in, in depth through medical school. Um, and then I think most therapists or most people who end up specializing, they often start off from a place of personal experience. So where you may have come [00:03:00] across, uh, people you want to help and you find you'd know nothing about the subject.

So you dig in, you really go home and you think, oh my God,

i've seen this patient today and I failed her. I couldn't give an answer. Not that I would've thought as a doctor, you failed them, but they, they put you on the spot and they ask a question that you couldn't answer. And I was always, a doctor was always very honest, and I said, would say to a patient, I'm sorry, I can't give you an answer today, but I'll have a look.

I'll, I'll research this and see if we find a solution. Yeah. So, um, then you, you start researching it mm-hmm. And you start to read about it and then you, um, I, I developed a real passion for this. Um, also because I, I, I'm a woman myself. I, you know, experience. Menstrual cycle cycles, um, the female life cycle in general.

And I felt, I started to feel very passionate about helping women through, um, my own experience and as a medical, from a medical point of view.

Rena Annobil: So, you know, you've mentioned hormones and I wanna get into to your book your, your recent [00:04:00] book now, uh, because you do talk about how certain hormones in a woman's body, uh, are the key influences of skin and hair.

Um, so what are these hormones?

Mandy Leonhart: Yeah, that is a very complex question. It's a good question. Oh, okay. Very complex because the skin in its own right is an endocrine organ. So the skin pretty much makes all the hormones that are also made in our large glands. Thyroid, cortisol, the skin makes cortisol, for example.

Um, the skin, um, responds to hormones that are made in the rest of our body.

Rena Annobil: Okay.

Mandy Leonhart: Um, and. One of the, um, one important hormone is estradiol, which is made in our ovaries. Um, estradiol plays a, an important role in skin health. Um, and then we also have testosterone, which can be both helpful and detrimental for our skin.

So, for example, during puberty, testosterone rises and then we can, this can result if you are susceptible, um, and have that sort of skin that responds to the [00:05:00] testosterone can result in acne because, for example, testosterone increases oil production in the skin. Um, later on testosterone declines. So we see less oil production, which is actually.

Again, not helpful because we have drier skin and we would like a little more testosterone hope probably, and would benefit. Mm-hmm.

Rena Annobil: But

Mandy Leonhart: when we have too much testosterone, for example, in puberty, then we get breakouts. Um, so that is not helpful. So humans have a huge play, a huge role in skin health. Mm-hmm.

And it's a bit, follows a little bit. Um, the, the Goldilocks, um, the Goldilocks principle, we want a little bit, but not too much, um, of certain hormones. So we don't, we want a bit of testosterone to get that healthy oral production, but not too much of it so that, that it results in acne, acne or increased hair growth.

Um, we, we do benefit from estrogen as well. Um, we know that often during pregnancy, women who have a lot of eastern during that time have very glowing skin and [00:06:00] very good skin. You know,

Rena Annobil: my hair was amazing.

Mandy Leonhart: Pregnancy.

Rena Annobil: Your the best

Mandy Leonhart: it's ever been. Maintain the glowing pla phase. So that is, that is when you experience the benefits of these hormones and when the, the hormones come down after the baby's born.

Um, often you see changes in, in your hair texture or your hair falls out or, um, so, um, it, it's very complex, but hormones, definitely of hormones like testosterone, um, estrogen and cortisol or cor play utero and skin health. Okay. So when we are stressed, for example, the skin produces more cortisone, um, cortisol, which is, um, is initially helpful but can be detrimental as well.

It's

Rena Annobil: What about, um, perimenopause? What are the most, uh, common skin complaints that you see in perimenopause?

Mandy Leonhart: Mm-hmm. So during perimenopause, um. The, as I said, the ovaries start to be less effective, um, and much more random and estrogen [00:07:00] fluctuates a lot. Um, at the same time we often see cortisol increase, so perimenopause, um, I would spec specify this as the time that starts in your mid to late thirties until you have had at least a year of no period, right?

So over the age of 45. Mm-hmm. So the perimenopause goes un until, um, last, until at least, um, until your last period, which is when you start your post menopause a year. Um, and this can be anything up to 15 years. During that time, your ovaries are, are starting to decline. Initially, maybe they produce more estro, but then they, they decline the ES eastern production.

Um, and estrogen is an important hormone because it maintains moisture levels in the skin, so it holds onto water. We do know that, um, through our detriment during pregnancy when we have water retention because. You know, Eastern is very high during pregnancy and mm-hmm we get swollen legs, for example, because Eastern is extremely high in perimenopause.

We see eastern fluctuating a lot going up and [00:08:00] down, and that can affect the skin barrier. So one of the, uh, common things I see in perimenopause is women develop sensitivities. So they, they can't, they put, um, you know, makeup on or skincare and they don't tolerate it anymore. They break out or they get dry skin.

Flaky skin, itchy skin. Itchy skin is a really common, uh, symptom. And that can be the face, that can be the, the entire body. There's another extreme, uh, symptom called formation, which is a skin crawling sensation. It feels as if you've got ants crawling under your skin. You've got no rash or anything, but it is a really, um.

An awful symptom to have.

Rena Annobil: Why, why does that happen? How

Mandy Leonhart: does that happen? I don't quite know. Um, probably, again, related to changes in hormone levels. Um, and you know, it could be related to histamine release as well. Estrogen and histamine are very much related. Um, and there's an interplay between those two.

And histamine can result. Uhin release can result in [00:09:00] blotchy, um, itchy skin. Um, this is often, um, excel or this is often made worse when you drink alcohol, for example, this is just a good example. You drink alcohol and, and perimenopause. When you have a glass of wine, you suddenly have this blotchy rash along across your neck or your face, and you can't tolerate alcohol anymore, um, because you now get his histamine sensitivity.

Um, and. Um, alcohol is terrible for us in any way, but, um, it also, uh, is, um, a hormone disruptor. So, um, this is just an example where maybe a younger woman, when she has a glass of wine, nothing happens. You're on perimenopause, you sit there, you have a nice glass of wine and stuff, you break out in an itchy blotchy rash

Rena Annobil: right

Mandy Leonhart: when you have a drink.

Rena Annobil: Okay?

Mandy Leonhart: So this is, this is very common in perimenopause, but also, um, the type of acne that is a bit different from and puberty where women get nodular spots around their lower face. So not the T-One. Mm-hmm. The t zones are to be really dry, but you get nodular breakouts [00:10:00] around, um, your chin area, your lower neck.

Um, you get more hair growth on your lower, lower neck. So this is common perimenopause and I would say the third. So other than the sensitive and the dry skin, um, and the on the low, lower neck, the third are symptom I see is, uh, rosacea, for example. I dunno if you, um,

Rena Annobil: is that the, uh, the redness on the cheeks?

Mandy Leonhart: Yes. So that is the, that is sort of, um, it is not acne, but it's sometimes called or referred to as ad adult acne.

Rena Annobil: Mm-hmm.

Mandy Leonhart: So you get, um, enlarged blood vessels on, on, you know, on your nose or on your cheeks. And it's often made worse by UV light, uh, sunlight, alcohol, spicy food, caffeine. And again, it can be, um, it can be painful.

Sometimes you can get little, little, um, spots as well, but that this is different from teenage acne.

Rena Annobil: Okay.

Mandy Leonhart: It's not a form of acne.

Rena Annobil: What about hair shedding?

Mandy Leonhart: Yes. Again, this is very common [00:11:00] and um, there are many different types of hair thinning. Um, perimenopausal hair thinning is very often related to low iron in women who have heavy periods, prolonged heavy periods.

Um, and that is a common symptom in, in women 35 and over. Mm-hmm. You know, you often have a woman who has a baby in her thirties was breastfeeding and no one checked her eye level and she, after she had the baby and she was a little anemic during pregnancy and then goes on to into breastfeeding, uh, further depleting her iron storage and then carries on having heavy periods after, um, afterwards for years.

Um, so I would say iron deficiency is the most common reason for generalized hair shedding in women in their forties. Um, the other reason why women often see hair shedding generalized all over the scope, so there other. Forms of hair loss where you have patchy hair loss, which isn't entirely different.

So if you have patchy. Patches of hair, [00:12:00] hair loss, then you really need to see a dermatologist because this is probably aria, um, alopecia areata, which requires dermatologist input. So this is a, a n immune condition, but women in the who are stressed don't sleep well. Or, um, generally, you know, impairment of course, we have a lot of burden with small children, high financial burden like mortgage, um, elderly parents.

So we are all over the place. So stress can be a real trigger for hair thinning. And this is called, uh, intelligent uv. It is often usually reversible when you treat the underlying course, but again, it can be very detrimental. It's hair shedding all over, um, or it's hair shedding around the, the temples, um, around the temple area.

Mm-hmm. Um, so this is, this is very common because we do see an increase in cortisol as well. So stress hormones in women can go up to perimenopause, uh, because they have to now compensate for. Partly loss of ovarian function and we are stressed anyway. Uh, during that [00:13:00] time. A lot of women are stressed because we are spreading ourselves very thinly.

Um, we are trying to keep it all together. Job, family, you know, work, um, everything.

Rena Annobil: Yeah. Um, a lot of people, uh, similar age to me now, like my friends, we talk about brain fog. Mm-hmm. Like a lot of us forget a lot of things and, you know, I can never remember my kids' names are, and uh, you know, you get 'em wrong all the time, that kind of thing.

But brain fog, um, and that link to perimenopause, is that an aging thing? Just a normal aging thing? Or is that perimenopause? Like how much, and sometimes I feel like it's quite difficult for like, for me to, to know, okay, what is just getting older and what is a perimenopause? Mm-hmm.

Mandy Leonhart: Yeah. That's a good question.

So a lot of women who go through the, who are within the perimenopausal transitional phase think they have. Dementia. They just, they feel really, um, quite a severe decline sometimes in their cognitive function. [00:14:00] And it's quite scary. Um, you know, yeah. It's not just, um, not knowing where you put the, the house keys, but it's making lists.

Um, you know, as you said, not remembering people's names when you meet them. Um, word finding issues where you can't think of a word, but the good news is that obviously in the vast majority of women who have this symptom, it is not dementia and unfortunately can't yet pick up the women because women are at high risk of developing dementia.

But we can't yet pick out those who will go on to actually develop dementia in their later years. Um, so it is a really common symptom, and mainly it is word finding and, um, lack of focusing.

Rena Annobil: Mm-hmm.

Mandy Leonhart: Um, sort of problems with, with sort of short term memory, uh, potentially. Um, and it is a phase, and it is mostly related to lack of good quality sleep.

So we know that sleep deteriorates or can deteriorate a lot in [00:15:00] perimenopause. It's the quality of sleep, the sleep duration. And women, if you do not get sufficient sleep and good quality sleep, um, this leads to a sleep deficit, which can really affect your brain function in the day. And I think this is the most common reason.

And if you, um, improve your sleep, you will find that your brain actually works much better. Okay? You know, so it is not, um, a symptom that will carry on. The good news is, yes, it can continue for several years, but on the whole, I can reassure women to say, look, you are very, very, very likely not going into having dementia or developing dementia, but you, um, at this point, um, it will get better and just hang in there.

Uh, make sure that you optimize your sleep as much as you can. Relax the brain. So the, the brain is the organ. That suffers the most. During perimenopause, the brain holds the, the entire burden of your emotional, um, burden, your lack of sleep. It processes, um, [00:16:00] memory, emotions, cognitive function. And when we don't sleep, uh, it can't do its housekeeping.

So the, the brain is feeling and that that will also lead to weight gain. For example, you know, if you, if your brain's tired and you haven't had restorative sleep for weeks, you're gonna crave biscuits and sugar in the day to just purely function and to get through the day at work. So, um, looking after your brain is one of the most important things you can do in perimenopause and finding ways to unwind properly, relax, get good night's sleep, avoid anything, disrupt that disrupts your sleep like caffeine late in the day or alcohol.

Um, and really. Looking after your brain during that time. It doesn't mean that you can completely resolve all symptoms of brain fog, but you can make it better.

Rena Annobil: Okay.

Mandy Leonhart: And, and at some point, most women, when I speak to them in their late fifties, they were, oh gosh, yeah. Years ago I had terrible brain fog. I thought I was, there was something really wrong with me.

And actually now I'm so much better.

Rena Annobil: Well, that's really hopeful

Mandy Leonhart: for a lot of us to hear. [00:17:00] Absolutely. Yes. But when you are in the, in the thick of it, in the midst of it, you do not think it'll, well

Rena Annobil: people are thinking, oh, I've lost myself. Like, who even am I anymore? 'cause I

Mandy Leonhart: can't remember thing. Well, your emotional health as well.

Yeah,

Rena Annobil: exactly.

Mandy Leonhart: It affects how you feel, your, uh, sense of enjoyment. There's another symptom that is extremely common. Perimenopause. It's called anhedonia. So women say, they come through the door and say, I just want to make it clear I'm not depressed, but I lost my sense of enjoyment. I have to mask, I have to pretend I'm having fun.

So they are pretending, you know, at the school gate to be their jolly, upbeat, funny self when actually they're playing a role. They're starting to not feel it in inside, but actually playing a role, which is in its own right, quite exhausting. And they say, I, yes, I do not feel like myself because I struggle to have authentic, genuine fun.

Um,

Rena Annobil: so that, that's an actual thing then

Mandy Leonhart: It's called anhedonia. Yes. So the lack of loss of enjoyment. And it's different from depression. So they're not miserable, um, all day, every day, [00:18:00] but they might find themself in a situation where they are in a beautiful place with friends and everything is really great, but they can't really enjoy that moment.

They, they can't, they can't be in the moment and enjoy it. And they really, they are aware of this and they struggle. So they pretend they're having fun. You know, that's why they stop going out.

Rena Annobil: Yeah, no, I know. And, and I know people that have said this to me as well.

Mandy Leonhart: Yeah.

Rena Annobil: Like, it,

Mandy Leonhart: it's, they'd rather be at home with a book.

Rena Annobil: Yeah. Yeah. I mean, not that there's anything wrong with that. No. There's

Mandy Leonhart: nothing wrong with being at home with

Rena Annobil: a book. Yeah, exactly. However, um, why is that though, that it's, 'cause that's quite a specific thing. Yeah. And also quite an unexpected thing for a, a lot of women.

Mandy Leonhart: Yeah. And previously before we had the, the whole men menopause awareness, a lot of women during that time were started on antidepressants, but that's not really what they needed.

What they really need, um, is a break. Someone who takes shares the burden, [00:19:00] the day-to-day burden, you know, who shares the emotional burden, remembers the children's birthdays. Um, you know, I'm talking about, you know, life partners maybe. Yeah. You know, sharing a little bit more and, um, giving them a break from things and, and helping them to relax, to get through this, um, uh, rather than expecting them to just carry on like a hamster and the wheel to, to, to function as they did before because, um, they, they will not carry on functioning as they are.

There is, it's a vulnerable time in a woman's life. Mm-hmm. A lot of women are diagnosed with A DHD or, um, autism, autism spectrum disorders during that time because, um, they can't compensate anymore, um, with, with, you know, with what they do. So we don't quite know. Anhedonia is a tricky one. We, we don't know that as too little research especially into, uh, women's mental health during particular life stages.

But, um, I would say that women who had previously, um, what we now call reproductive depression or re [00:20:00] reproductive related, um, mood disorders, for example, if you ever had PMS or PMDD in, in your youth, or if you had postnatal depression, women who had previously had. Mental health related issues, um, related to hormonal changes in their life are more likely to experience mood problems during the perimenopause.

Rena Annobil: Right. Okay.

Mandy Leonhart: So I think you're more vulnerable during that phase mm-hmm. To develop symptoms including lack of enjoyment. But it can also be you, you can really be depressed as well. You are at a high risk of depression. But unaid so lack of enjoyment is, is, uh, very common. And I do think what helps is, is the quality of social interaction needs to improve rather than the quantity.

So I think a lot of women look at the emotional side of what their friends expect from them. Yeah. And you know, we all have friends that drain us, and when we are young and we are full of energy, we don't mind having them around.

Rena Annobil: Yeah.

Mandy Leonhart: But then I think there comes a point in our life when we have to see [00:21:00] where we have to set boundaries and protect our own emotional health from people who are not really good for us.

Um. And just set boundaries. And I always think, I will always ask women if they are able to say no, or if they're just people, please as if you are people please and you don't know how to say no, you get emotionally drained. So if you look after your emotional health and set secure boundaries and have, um, really qualitatively really lovely interactions with people, you will be able to gain joy again from social interaction.

Mm.

Rena Annobil: Yeah, that makes sense.

Mandy Leonhart: Sense, sense. And you have a sense of enjoyment again.

Rena Annobil: Mm.

Mandy Leonhart: But, um, just going out and mixing with people that really aren't interested in you or where you notice that at heart. Yeah. You feel actually not part of it. You, you may as well say, I'm not going, but I will meet that one friend that is the joy to be with and rather have shorter, um, social interactions with a better quality and emotional, you know, real, [00:22:00] real connection.

Yeah. Rather than superficial connection. Um, and I think women do go through. Phases, um, where they purge their, their friendship groups where they go through and they just say out, write, no, I'm not gonna meet you. I haven't got time, sir. I'm busy. And that's good for them. You know, you need to learn that you can't just be there for everyone all the time.

Rena Annobil: Yeah, that's really good. If

Mandy Leonhart: you don't look after your own health

Rena Annobil: hundred percent,

Mandy Leonhart: you can't look after other people.

Rena Annobil: A hundred percent. Um, can we just talk about HRT for a

Mandy Leonhart: moment? Yes, of course.

Rena Annobil: Yes. So, HRT, um, there are women that are worried about taking HRT. Yeah. They, they wanna take it or they've been recommended.

They're quite concerned about it. Um, would you ever recommend that somebody doesn't take it?

Mandy Leonhart: Yeah, there are definitive contraindications, um, for particularly women who have women, uh, women positive types of cancers. So it very much depends what type of cancer they have. So they may have [00:23:00] had ovarian cancer or state.

Two or three endometrial cancer. So they're said, or breast cancer. So if you had a certain hormone, um. Positive cancer. So we are talking estrogen positive in particular. You may not be able to take, um, HRT because HRT is a combination of estrogen and progesterone usually, or estrogen is the main component.

But we also need to give progesterone and, um, some types of cancer part of the treatments to suppress or block your ES eastern receptors. And you cannot then take HRT because it would interfere with your cancer treatment, or it would, um, increase the likelihood of a recurrence, for example. So this is some, this is one group of women where I would say definitely there are medical reasons, uh, who may, um, give you a contraindication for HRT.

But, um, saying that there is one form of which isn't actually h there's topical, uh. Solutions. So if you, for example, have a vaginal dryness or janitor urinary symptoms of [00:24:00] the menopause, most women or a lot of women who have had um, trine positive cancer, had um, these types of cancers who are on remission and they have janitor urinary symptoms, we can now actually give them topical estrogen because, um, these are pastries or creams or um

Rena Annobil: mm-hmm

Mandy Leonhart: uh, gels that you can apply to your external genitalia or internally and they can make a huge difference in quality of life.

But because they are not actually going into the bloodstream and replace your hormones, they shouldn't be called HRT as such. So HRT hormone replacement therapy, it would be a systemic estrogen. So giving you estrogen that actually enters the bloodstream and goes around your body, circulates in your body, either through transdermal, um, application or through tablets.

Okay, yes. But this, so yes, there are contraindications for women and they feel of me left out, um, when it comes to menopause treatment. 'cause there. Many offer solutions or therapies for them. Um, and often the own, the main focus is on the cancer [00:25:00] treatment and not on their night sweats or their lack of energy.

Yeah. Or their joint pain. And they're left in limbo. It's a really underserved group of women.

Rena Annobil: Um, the, I I've also read about, um, bioidentical hormones. Mm-hmm. So how different are those from the standard N-H-S-H-R-T?

Mandy Leonhart: So the NHS does offer, um, bioidentical and not, not, not in a sense that they, they're not called bioidentical hormones.

So we call in the NHS, they're called body identical. They're mass produced by pharmaceutical companies, and they are, um, they, they are accessible. Um, we don't, so the word bioidentical just refers to the structure of the molecule, of the hormone that we give to women. And basically, it used to be a marketing term by, um, pharmacies.

Mm-hmm. The private pharmacies. Um. Use to, to sell this, this product. Um, but we now have, um, the same hormones that our own body makes, um, in ready-made must produce very high quality product in the [00:26:00] NHS. And I personally only prescribe licensed products now because we have a variety of body identical HRT now in the NH as accessible to most women.

Um, so we don't need to, so bio bioidentical, um, hormones were previously made, um, in onsite in um, pharmaceutical, um, in, in pharmacies, um, and then shipped out to women. But we don't need that, uh, anymore. Um, so there is no advantage in going, uh, in, in applying it privately made by identical cream over using, uh, a gel that might be available in the NHS.

Okay. Alright. So it is more of a marketing term.

Rena Annobil: Sure.

Mandy Leonhart: In America it is. So they have a lot of compounding pharmacies in America where medicine is mixed. Um. On prescriptions for individual patients. Um, when we didn't have our body identical products available, that was the only way to get, uh, the same hormones, um, to treat your menopause symptoms as your own body was making.

And [00:27:00] it used to be, um, host urine derived hormones. Um, so equine estrogens that were the, the first line treatment many years ago, but we have moved on since then. So we don't require to use animal derived, um, hormones to treat menopause. Good to know anymore. We now use as a, as a standardized options in the NHS.

Um, the majority of, um, HIT prescriptions are now, um, products that are plant derived body identical. Um, and we have a lot of, a lot of choice now for women in the NHS as well. So we don't really need to use compounded products anymore that are quite expensive and often accessible to most women.

Rena Annobil: Okay, that's good to know.

Um, what does HRT do to our skin and our hair?

Mandy Leonhart: Very good question. And, um, we don't, so there is no really straightforward answer. When I wrote my book about skin and tear and how hormones affect, um, our skin and tear, I found a variety of [00:28:00] studies. A lot of them were very small studies that weren't very long.

They, they didn't really last a long time. And some found, um, an increase in skin thickness and, uh, skin barrier functions or benefits for skin barrier function, skin thickness, some studies found no difference at all. Overall, I would say estrogen in particular. Estrogen, if anything is beneficial for our skin and.

Um, so, but again, there might be a window of opportunity there. So if you have been left in a post-menopausal state, so let's say your last period was at the age of 50 and you only start estrogen, um, or hormone replacement therapy at the age of 60.

Rena Annobil: Mm-hmm.

Mandy Leonhart: Um, in those 10 years, you wouldn't have made any estrogen or very, very little.

So your body was deprived of Eastern. In those 10 years. During that time, you would've lost about 30% of your overall collagen. And when you start, so in the first five years, we lose 30% of our overall collagen. This is entirely normal, but it results in loss [00:29:00] of, um, skin, you know, you know. Our skin starts to, to sack.

Although,

Rena Annobil: so, so the No, because I, I, but, but it is what it is. 90

Mandy Leonhart: because it is, we lose the collagen.

Yeah.

Mandy Leonhart: So, and the first five years are crucial. Okay. And the, the important thing is if you start H 30, beyond that, you cannot bring the collagen back. Whatever anyone tells you, whatever skincare you purchase, you cannot really make or stimulate the skin to make collagen.

Again, it is, once it's gone, it's gone. You can only make collagen if the skin is injured. So when you cut yourself. And you have a wound, the skin will heal and make new collagen, but the collagen that is made during wound healing is of lesser quality than what you had before. That's why a scar is more rigid and more stiff, and it doesn't look like the original skin.

So when, um, we, when we make our collagen, this happens during [00:30:00] puberty, the majority of our collagen, um, there's an accelerated production collagen during puberty, and that goes on until we are 25. And then from there to 30 onwards, collagen slowly declined. But after we lose estrogen with the onset of menopause, so our last period, um, we lose quite collagen quite more rapidly.

So as I said, 30% in the first five years. So when you then start HRT beyond those years, you cannot reverse what happened in the previous years and it will not get your collagen back. Um, you can still look after your skin and keep your skin healthy, but the collagen will not be coming back. Overall, I would say though, that.

If you are starting HRT, uh, before the, within those five years, what you may see is maybe potentially, if you're lucky, you can slow down the, the decline of collagen, although we haven't got a lot of big studies confirming that. Um, I think overall though, estrogen is beneficial to maintain the hair in the growing face [00:31:00] to, um, maintain moisture in the skin.

Often women come back after they started HT and say, and say, oh, my skin is a lot less dry, less itchy. The itching is gone. I still have to moisturize, but it doesn't feel like my skin is so sensitive. So estrogen plays a huge role in skin barrier function, for example, um. Overall, I would say, um, you know, go for it.

Uh, if you have menopausal related symptoms, it will be likely beneficial for your skin and tear than the other way round. But, um, don't expect miracles if you started late and I certainly would not ever prescribe paty only for the purpose of your skin and hair. Um, it is not licensed for that purpose. It has got pretension.

Nice little benefits sure that you might notice along the way. Um, but you should always use HRT after making an informed decision based on the symptoms you experience or other symptoms, you know, skin and has maybe one symptom, but. You, you know, you, you probably have other symptoms as well. And it is much more [00:32:00] effective for the reduction of hot flushes and night sweats.

And again, those are not good for our skin. So when we have a lot of hot flushes, that's really bad for our skin. Skin as well.

Rena Annobil: Mm.

Mandy Leonhart: It can disrupt our skin barrier. You know, excessive sweating can, uh, can be detrimental to our skin. Um, not sleeping can be detrimental for our skin, so

Rena Annobil: Sure.

Mandy Leonhart: In it. So there, there is a knock on effect by treating other symptoms, improving your sleep, improving your energy, um, um, you know, that, that HRT can also have, um, a secondary benefit for your skin further down the line.

Um, you probably, I dunno if you've heard about the, the creams that some people now proposed to put on the hormone creams, to put on the face

Rena Annobil: hormone creams. I've not heard of hormone creams.

Mandy Leonhart: Um,

Rena Annobil: are there, is this a thing Yes. That, that a doctors prescribe or is it something that people are just getting on their own?

Mandy Leonhart: Yeah, so there is a lot of bus. Um, about eastern creams for the face for anti-aging. Okay. At the moment. Um, it comes from [00:33:00] America or there are a lot of American doctors that, um, are, are promoting this. And again, I looked for that. So I looked at that, um, looked at studies and um, so some women will put, um.

Estrogen cream that they're supposed to put on the genitor urinary area, under the eye area, for example. And yes, we do have limited evidence that potentially putting estrogen or estriol cream on directly onto the skin can help with skin barrier function and, and retain moisture and increase hydration, the skin and maybe help with fine line and wrinkles.

But we have to be mindful of the fact that this is the hormone. This is

Rena Annobil: so it gets absorbed

Mandy Leonhart: it, yes. Very good. This is exactly the, yes. You, you've got it Spot on. Rena, the absorption, the question of absorption is not clear yet. We know that the, um, mucus membranes are different from the skin. And you know, in our Jennifer, are different from the skin surface in our face.

We don't know how much of the estrogen will be [00:34:00] absorbed into our body when we put it on the face. Um, and how far are we going to be put it on the entire face. Should you put it on the neck as well? Yeah. So the dose makes the poison. So at the moment, I think I'm hearing a lot of patients asking me should I put my estrogen cream that I use for other purposes, you know, for, for my, my vaginal health on my face?

And I would say the answer is probably don't do that, because also we haven't got enough studies about side effects. Some women are prone to hyperpigmentation. Um, you know, this is sort of the, the darkening. Um, so we, I don't like the word age spots, but, or you know, there are different. Types of hyperpigmentation.

So there's areas of darkening that are getting worse with sunlight exposure, but some women are, had melasma when they're more pregnant, so they had darkening around the mouth. And estrogen can potentially increase melan melanin production in the skin. So they stipulate melan melanocyte, which are the little cells that make our skin pigment.

And one science of aging as we get older is hyperpigmentation. So [00:35:00] it's uh, you know, changes in skin texture and changes in skin, um, and skin, um, sort of, um, the shade

Rena Annobil: of

Mandy Leonhart: the skin, the shade and, and patchy. When it's patchy it becomes more obvious. You know, it's not the, the skin, the skin doesn't look sort of uniformly.

Um, yeah, the same, the same shade. Um, and there is a risk that when you put, um, eastern creams on pigmented skin that it can enhance this type of pigmentation. That's really not what you want.

Rena Annobil: No.

Mandy Leonhart: You know, so,

Rena Annobil: no,

Mandy Leonhart: I think I would be careful at this point until we have a product that's actually. Being trialed and tested more thoroughly.

I would say clear of this, but I would say if you are on systemic HRT or you have started it for other reasons, other menopause, perimenopausal or menopause related reasons, and you may, I wouldn't be surprised if you find that you, um, have, have more glowing skin or you have better, better skin function down the line.

So it is overall beneficial, I would say, but we wouldn't specifically [00:36:00] prescribe it for skin related symptoms.

Rena Annobil: Can we slow down hormonal aging,

Mandy Leonhart: um,

Rena Annobil: through our lifestyle choices?

Mandy Leonhart: It depends what. Hormone cland you are referring to?

Rena Annobil: Well, like you're saying how the estrogen kind of declining Yeah. Means collagen is also Yeah.

Declining and that is the thing that causes, uh, us to look a little bit older. Right?

Mandy Leonhart: Yeah.

Rena Annobil: So can that be slowed down?

Mandy Leonhart: No, unfortunately not, because it would also mean we could extend our reproductive lifespan. So it could, would mean that we would also then be having, it would give us the opportunity to have our babies longer.

I mean, there are experimental studies where women freeze part of their ovary and have it reimplanted later on to continue, um, having, you know, having, um, a, a, a second um, gland that we'll keep producing estrogen for them, but we are not there yet. So [00:37:00] menopause is inevitable. We all will experience. So women who were born with ovaries will inevitably become menopausal at some point in their life.

Um, there is some genetic, um, input. So it's genes play a role. So if your mom, for example, had an early menopause, early menopause is when your ovaries stop working below the age in the age of 1445, then you are at risk of having an early menopause as well. So this is something that is a medical condition and we need to give these women HIT, but we can't yet extend, um, our ovarian function through lifestyle, saying that we know that women who, um, smoke, women who drink a lot of alcohol, women who have a lot of stress will are more likely to experience an earlier menopause.

So there are certain lifestyle factors that can accelerate the aging of ovaries. However, if you are doing all the right things. [00:38:00] Already. You can't, there comes a point when you will become menopause. You can't, um, magic, you can't sort of extend your, your ovarian health or lifespan as it were. At some point, your ovaries will stop working and produce and stop producing significant amounts of ES Eastern.

Um,

Rena Annobil: yeah. I mean it, you know, it is a natural thing, right? It's a natural thing. And, and it's, it's coming to all of us women. Absolutely. Right. It hasn't happened already. Yes. And, and you know, even like, um, with the beauty industry, for example, right? There's people like drinking collagen drinks and things like that.

They like that, like their life depends on it. And there's other things, and we will get into that. But also, do you think that there needs to be some level of acceptance as well?

Mandy Leonhart: Absolutely.

Rena Annobil: The it, the whole thing. Uh, I just find it quite stressful listening to some people Yes. Myself, I'm not doing half the things they're doing and I'm like, I'm stressed.

Just thinking about what you are doing to yourself to slow down aging or whatever, like, is there just a part of us that that needs to be, and I know this is very like non fashionable now [00:39:00] to say this. Is there a part of it that that's just, is there a part of this that should be like, well, okay, this is, this is happening.

We can still look good, we can still have a nice life, but except you will look different.

Mandy Leonhart: Absolutely. And let's not forget menopause. So when menopause your last period. Is also a celebration. You know, it comes with benefits. So you can stop using contraception. You don't have to worry about getting pregnant anymore if that's not what you, you know, if, if a lot of women who have completed their family planning are still having to worry for 10 years about not getting pregnant in their forties, you know, so you can stop worrying about that.

You no longer have periods that can be crippling, painful and make you bleed and stop you from going to work. Um, you, they stop, uh, many women stop having, uh, crippling migraines that are related to their menstrual cycle. Mm-hmm. So the, the cessation of the menstrual cycle does not need to be, um, a negative thing.

For many women, it is a liberating thing. They, it opens a new [00:40:00] chapter in their life. Um, they now go. Come from hormonal turbulence into hormonal stability. Mm. They enter a new phase of hormonal stability where every day when they wake, they wake with the same hormone level, whereas the previous 10 years, they may.

Uh, be exposed to the, you know, to the ovarian fluctuations on a daily basis, and your brain is tired of it. So a lot of women who are now entering the calmer waters of hormonal stability, uh, embrace this and love it, you know?

Rena Annobil: Mm-hmm. Mm-hmm.

Mandy Leonhart: That doesn't mean that we shouldn't be looking after ourselves.

And, and also it's aging is normal, you know, and, and there is a lot you can, else, you can do to, uh, look after your skin and maintain your skin. So one of the, so you don't even need to worry about it if you don't use daily sun cream or daily, um, you know, uh, sun protection. Don't even worry about menopause.

So this photo aging, so UV aging photo, um, so sun or light, uh, [00:41:00] related aging, uh, is, is much more contributing probably to, to, to wrinkles and, um, collagen breakdown together combined with alcohol than, than your, your hormones. Um, right.

Rena Annobil: So that's even before

Mandy Leonhart: you hit, so don't even before you hit menopause, don't, if you don't use sun cream every day,

Rena Annobil: you know.

Okay. I mean, is this even before you hit menopause?

Mandy Leonhart: Yeah, absolutely. Okay. It's an accumulative de detrimental effect.

Rena Annobil: Wow.

Mandy Leonhart: Okay. So you should really, um, I feel very strongly that, so if you are worried about wrinkles and want to maintain your, your skin health and your skin texture, then use factor. 50 on your face all year round.

I'm not talking about slathering the whole body in factor 50, but just the, uh, light exposed areas of your, of your body. So mainly the face.

Rena Annobil: Mm-hmm.

Mandy Leonhart: Um, yeah, just, but make it a habit. You find a, a good sunscreen that you like the texture of, you like to use it, it can be tinted, use it every day. You can re, it can replace your, your moisturizer [00:42:00] and that will be one of the biggest investment in to slowing down visible signs of aging.

Mm-hmm. Then there is obviously the external signs and there's the internal signs of aging as well, and that you can support with other lifestyle. Um, okay. You know, things, but, um, yeah, sunscreen is, is and not drinking alcohol. Collagen is broke. What's the point? Drinking collagen when you are also having two bottles of wine every week, you know, alcohol breaks down collagen, so don't drink alcohol if you.

If you want to maintain your collagen, you can't make collagen again, easily, as I said. Um,

Rena Annobil: so the whole drinking collagen because people are now drinking collagen, like their life depends on it or taking supplements.

Mandy Leonhart: I'm a very, I'm very skeptical about that. I think it's poor value for money. I don't, so let's, for anyone out there who bought the collagen and has it in the cupboard, use it up.

Don't waste it. Just, just use it. See what happens. Um, I would think that, I'm very skeptical about its benefits. Most studies have been done or paid for [00:43:00] by the company who produce the products. So there's a lot of bias in this industry. Um, there is potential hazards like contamination with heavy metals and like, um, arsenic lead and mercury, because you have to remember, it's made from, from animal skin or fish skin or chicken feed or cow heights or pork.

Um, so you, the animal stores all sorts of things throughout it's lifetime in this. Skin that gets them boiled down and ends up as your collagen powder. Um, so we know that there is certain concerns over safety with collagen powders, but it's also very poor value for money. You know, just eat good quality protein in your day-to-day diet If you will have a poor diet and you don't manage to get your 90 gram of protein each day, so you're 30 gram of each meal and you drink liquid protein, of course it may have a benefit for your skin.

But why not start with your diet? Why not eat pulses and lentils and you know, and eggs and good quality and tofu and good quality protein [00:44:00] on a daily basis because your body will take the peptides and amino acids and we'll utilize it as it as it wishes. And there's absolute this idea that we drink collagen particles that are being assembled in your body to collagen.

That's not how it works.

Rena Annobil: This is so important for a lot of women to

Mandy Leonhart: hear. And I think it's a waste of money too,

Rena Annobil: because you, it's not cheap. This stuff,

Mandy Leonhart: it isn't cheap. And, um, no, it's, it's, it's an extra stress women put themselves on.

Rena Annobil: And so, so I, I wanna just continue on this, uh, skincare trends now that, that are around us.

Uh, another trend, infrared masks. Now, uh, a lot of people now use them at home. You know, uh, people, some people swear by them 10 minutes a day, 20 minutes a day, they'll sit there and they'll say, it tightens my skin. Now, me personally, I personally couldn't think of a worse way to spend my time, but that's just me.

Is there any evidence that these are good for us? Are they good for our skin? Do they really work to tighten the skin?

Mandy Leonhart: Yeah. Tricky. [00:45:00] I've got one too.

Rena Annobil: Look at your skin though. You have

Mandy Leonhart: amazing skin. I use it once a year maybe.

Rena Annobil: Okay. Um.

Mandy Leonhart: So, you know, again, if you are one of these women who are listening who bought it and spent a lot of money, they now feel guilty, don't feel guilty.

But you know what, if you don't use it every day, it ain't gonna do anything. Nothing. And even if you do use it every day, I'm not entirely convinced, uh, that it will do much, you know? Right. Um, I think with medical grade treatments, um, where, so anything that has an effect also has a side effect in my view.

So that's why, for example, tretinoin is on prescription only because it can cause problems and side effects. It is one of the most effective, uh, wrinkle treatments that we have so far, other than a facelift. Um, but it causes side effects. That's why it's on prescriptions. So when we have versions or water [00:46:00] done therapeutic versions, uh, that for home use, they have to be so safe.

To not do harm, but equally will they still have a benefit. And probably the benefits are so limited, um, that I would not rely on it, but I, I don't blame anyone who goes for it and tries it. And if anything, I mean you don't enjoy using it. But I do think that if a woman takes 10 minutes out of her day to lie down with a thing on her face and just it forces her to lie still and just brief, you know what her cortisol levels will go down.

That is probably what really works.

Rena Annobil: Yeah.

Mandy Leonhart: She has a 10 minutes just to herself with a door closed with a thing on her face. Um,

Rena Annobil: nobody wants to talk to you with that on your face anyway. Exactly. So you'll be well left

Mandy Leonhart: alone. So you know what, go for it. Um, but don't expect miracles. It probably doesn't do much.

Um, um, you have to always be careful with the blue light. Some of them have a blue light option for acne, but that can also increase hyperpigmentation. So some of them you have to be a bit careful. Um, but yeah, I would say [00:47:00] I probably would not buy it again, if I'm really honest. I've got it at home. I never use it.

It's just in the cupboard gathering dust. If you think about it. Just, just maybe save the money.

Rena Annobil: What about retinol? 'cause retinol is also something that a lot of people are talking about retinol. A lot of people use it.

Mandy Leonhart: Yeah. So this is a bit more efficient, I would say. So we, we've got, um, it comes under the term of retinoid, retinoids in general.

So our skin, um, so vitamin A is really important for skin health, and these are vitamin A IV derivatives. So they are, they are related chemically to vitamin A and our skin, uh, can make, uh, um, tretinoin or rettino acid. But retinol is a very weak retinoid. So it, it takes two chemical steps to be converted to retinoic acid within the skin, through enzymes.

Um, at the same time it is. It causes fewer side effects. So, um, the, the, the [00:48:00] companies that put creams out there on the shelf with retinol in it will put so little in that they will not cause side effects, but it is probably not strong enough to be very beneficial if you have very light, uh. Uh, very few wrinkles.

Rena Annobil: Mm-hmm.

Mandy Leonhart: And really just need a good moisturizer. And it happens to have some retinol in it. It will not do any harm, but it'll probably not get rid of your wrinkles altogether. But in the long term, it will have some benefits. Um, we see more benefits the stronger that. The retinal or the, the retinoid becomes.

Um, and it is a real minefield out there because, um, retinols can be effective, but it is all depends on the con concentration of the product.

Rena Annobil: Mm-hmm.

Mandy Leonhart: Um, how strong it is, how it's formulated, um, whether you use it con consistently or not. But I would say if you want more effective results than the prescription strength, reinos are more effective, but then they come with side effects and you have to start with a low concentration, maybe under the supervision of a [00:49:00] doctor.

Uh, you know, you start with no point or two, 5%, maybe once a week. You build it up in this, in, in your skin. You build up a tolerance and you go up to a higher level. And yes, uh, retinoids are one of the very few molecules that have been shown, and they've been around for many, many years in the sixties that were developed to, uh, maintain collagen increase.

A little bit of collagen production, the skin, uh, improve, um, skin turnover. Skin texture,

Rena Annobil: right?

Mandy Leonhart: Um, so they are still the gold standard when it comes to the treatment of, or prevention of, of skin aging.

Rena Annobil: Okay. Um, let's talk about skincare.

Mandy Leonhart: Yes.

Rena Annobil: So what are the skincare products that you think actually work and, uh, that you yourself would invest in?

Mandy Leonhart: So, number one, absolutely stand sunscreen. Um, every single day. And, you know, even on an overcast day, just get into the habit. Using, using a, a sunscreen every single day that, um, you may have to buy different products, tinted, un tinted, um, something that doesn't make you look white and [00:50:00] pasty, you know, I've gone through probably, I dunno, 30 different sunscreens in my lifetime.

And until I find something that, um, is tinted, that fits my own personal mm-hmm. Uh, skin shade. Um, so you can, if you've got fairly oil skin, you don't need a moisturizer, you just wash your face with water in the morning and, and put your sunscreen on as a moisturizer. There are some really lovely moisturizing sunscreen out there, sunscreens out there as well.

Um, generally, um, I would say, oh, too, too much cleaning can cause more harm than benefits. So this idea that you have to, uh, double cleanse in the morning, double cleanse in the evening, you don't need to do this. You really only need to wash your face in the morning with water. That's all you need. And then in the evening, you want to use, um, maybe an, an oil based cleanser, a a cleansing balm or um, a non foaming cleanser that takes off all the dirt and the makeup.

If you haven't worn makeup and you've only worn sunscreen, you probably only need to clean your face [00:51:00] once. You don't need to double scrub and rub and clean, uh, several times over. But obviously, if you have been wearing makeup and foundation, I get it. You probably need to use a cleansing balm, a flannel, and then wipe until you all traces have, have been removed.

I, I do think that advice that women have been given since the 1970s to never go to bed with makeup on still stands today. And not that your skin needs to breathe, but just remove all the grime and dirt. Uh, from the day before you go to bed, not only does it keep your pillows, um, clean, but it also, um, helps with your skin barrier function.

Mm-hmm. Um, so basic cleansing routine in the evening. Um, if you, um, want to increase, uh, skin turnover, then I would, I'm a big fan of, um, alpha hydro hydroxy acids, like glycolic acid, for example. Um, you can use them on alternating nights. You can just, um, use a, a cotton pad with glycolic acid solution and pad it on the skin.

This is a chemical exfoliator, which will [00:52:00] increase skin turnover and can give you, um, a, a with, you know, better texture, skin texture, um, more uniform, um, skin tone and potentially help a little bit with, with hyperpigmentation as well. And then just put a, a really nice moisturizer on top. As we get older, um, in the perimenopausal and menopausal years, our skin tends to be drier and less oily.

So the teenage oily skin is no longer a problem usually in those years. So you want to use a really rich moisturizer before you go to bed. You know, something that you like. The texture of that is really rich in seals in the skin. Um, I use, um, a fairly heavy moisturizer before I go to bed. And then as a last step, I always step a little bit of Vaseline around under my eye area.

So Vaseline is, um, a single ingredient product that has a lot of evidence behind it for trapping moisture in the skin overnight. It is not elegant to use in the day. No one would go around looking shiny with Vaseline in the day, [00:53:00] but at night, um, you have more what we call trans epidermal water loss during, during the night.

So you want to keep that moisture in the skin. And Vaseline is an excellent moisturizer, so it really keeps this. The moisture trap within the skin. So instead of waking with dry, uh, wrinkly skin in the morning, you may find that, um, you'd wake with very nice mo glowing skin in the morning, and it requires only a very thin layer.

So under your eye area or wherever you have the first signs of aging or where your skin tends to be drier, you don't need to put it on your forehead. If your forehead isn't dry, you know, put it where you have the skin concern.

Rena Annobil: But, but if, if people have dry skin on their face,

Mandy Leonhart: you can put it on your, they

Rena Annobil: can put it

Mandy Leonhart: over the whole face, put face very thin layer.

I'm not, I'm not talking thick layer, you know, we are talking a, a very small layer just to seal in the moisture and you can put it on top of your actual moisturized moisturized and when it's absorbed. Um, so this is, uh, a really affordable, accessible skincare, um, product that a lot of people, because it's a [00:54:00] Jeep, don't believe it works.

They think the more money you spend, the more effectiveness you get. But if you look at the, one of the very, there's a very expensive skin cream. That, um, sounds a bit like the sea, but not the sea. So it's related to water. If you look at I'm not naming the brand.

Rena Annobil: Yeah. I'm trying to think now. Yeah. Okay.

Mandy Leonhart: If you look at the main ingredient, it is liquid paraffin Vaseline amongst other things that they promote.

But what does actually, the job, I think, um, apart from some other extracts that might add in this cream is the, is the, it's the liquid paraffin is actually Vaseline, you know, that gives you the texture, the thickness, the, the, the moisture, um, benefits. So you don't have to buy that cream. You can go straight to the Vaseline and whatever ingredients you fancy, if you've got, um, again, if you've got, uh, skin texture problems or bit of hyperpigmentation or inflammation, niacinamide is a really good ingredient to look for.

Uh, hyaluronic acid is pretty much in every [00:55:00] skin cream now. It's nothing special anymore. If you want to use a serum, you know, use something that contains niacinamide and maybe moisturize with ceramides. So we lose ceramide. Ceramides are an expensive skincare ingredient, so they're often not very, um, highly concentrated, but ceramides are really a, a really good ingredient to look for in, in, in skin creams.

So

Rena Annobil: what do they do?

Mandy Leonhart: They, uh, main, they, uh, retain moisture and fats. Uh, so these fatty lipids in the skin decline with age. Um, and they, they put the, those, um, lovely lipids, lipids back into the skin and, um, restore, um, skin, skin moisture levels. Um, and they're really, uh, good ingredients. Um, niacinamide serums, which is often like in a drop of bottle or in a more liquid version, or in a cream in a, in a, in a, in a, um, moisturizer, um, can be helpful for, for improving skin texture.

Uh, chemical exfoliators, like glycolic acid or a mixture of manic acid and lactic acid several times a week can help with [00:56:00] skin turnover. And, um, over time, the key with skincare is consistency. So you can't expect to put a, a cream on one day and wake up with a new skin the next day. This is not going to happen.

As I said, skin turnover takes around. Two months now at our age, you know, sort of 56 days for, for the skin turner, for all the skins to, um, exfoliate and shed, um, for the, for the skin cells. Um, so we need to be patient. If you've settled on a new skincare regime and you don't see results within a week, just carry on.

Just be patient. Just be consistent with your skincare regime. It will pay off at some point. Um, so be consistent when you do this, and don't immediately go from one product to the next because it doesn't, didn't give you the desired results. You know, unless you, you have a, a reaction to a skin product and obviously don't use it, but do not give up straight away.

And obviously the, the big, um, the biggest and the most effective product is reino, Reino and or, um, you know, [00:57:00] retinoic acid. Which is, um, or currently in the UK only on prescription, but it is one of the most effective skincare treatments for, uh, the treatment of lines and wrinkles and elasticity. Not elasticity, but, um, skin texture.

Um, and skin turnover. It's, it's also a chemical exfoliant as well, and, and stimulates, um, um. Collagen production in the skin.

Rena Annobil: Okay. Alright. So time as well. 'cause I have to say that I was, um, I, I want to put this night cream on my face. That was a hundred pounds.

Mandy Leonhart: Okay.

Rena Annobil: Uh, my friend got me, uh, as a gift, like a tester version of it, and I was, I was, uh, so excited I put it on at night and I thought I was gonna wake up in the morning with like a whole new face or something.

And, uh, I didn't clearly, but, um, yeah, maybe should have given that more time. It's just that it was so expensive as well.

Mandy Leonhart: Yeah. Yes. You know, but, you know, um, some, I, I don't mind it when women spend money on skin, but I'm also saying don't fall for the [00:58:00] marketing A lot of, so the skincare industry is really the wild west now.

And, uh, every brand has this. Its own USP and, and claim that they've got an ingredient that is specific to them. But at the end of the day, the majority of moisturizers are based on very simple, similar formulas. I'm not a cosmetic scientist or cosmetic formulator, but, um, from what I understand is a lot of these ingredients are very, very similar and no one's got the holy grail.

And what I would say is, look, if you have found a very cheap, affordable moisturizer

Rena Annobil: mm-hmm

Mandy Leonhart: that works for you, you don't need to spend a hundred pounds on a, on a skin cream, carry on with that moisturizer because very likely the ingredients are incredibly sim similar to the expensive one. But if you found a moisturizer that does cost a hundred pounds, but it, you really love the smell and the texture and the weight glides on your skin, and it's a joy to use.

And you can afford it, then just use what, what pleases [00:59:00] you, you know? But I do have a problem with predatory marketing where women think they need to spend a lot of money to get the effect that is probably, that is not correct. You know, you don't need to spend so much money on a, uh, skincare product to see results.

They're pretty much very similar. And there are some very affordable, effective companies out there that, that focus on effective ingredients at a, at a high strength.

Rena Annobil: Yeah.

Mandy Leonhart: Um, but I've used them, and some of them I just really didn't like the texture. I didn't, they were tacky, they were pilling. I didn't like them.

Yes, they had high strengths, concentration, they were really affordable, but I didn't like the way it felt on my skin. So I went back to my, my slightly more expensive, um, product. Um, and made my peace with it. But then equally, I also use Vaseline, which costs literally next to nothing. You know, it lasts a long time.

So make your peace with whatever works for you. And it's not a problem trying different products before you settle on what. What do you really like using?

Rena Annobil: Mm. Okay. [01:00:00] Um, so you have been so helpful today, I have to say. This is, uh, it's honestly, it's such a confusing time for women. Yes. There's so much pressure on us, and so I think that, uh, this is gonna be really helpful for a lot of people.

So, Mandy, lastly, as this is the lifestyle prescription, do you have your own lifestyle prescription that you would like to share with listeners and viewers?

Mandy Leonhart: Yes. So I, my biggest regret is probably that I have new sunscreen early in life every day. So my three top tips would be use sunscreen every day on your face or on the Sun Express areas.

Minimize alcohol as much as you can. It's not your friend, particularly not in the perimenopause. It has no nutritional value. Breaks down collagen, increases the cancer of 35 different cancer risks. You know, um, just, just don't. Drink it. Um, don't feel bad about not drinking it. Um, so no sunscreen, no alcohol.

And the last thing I would say, try and find, optimize your sleep. Um, really [01:01:00] work on your sleep. A good night's sleep is almost like a facelift, so we all know how we look if we had a really good night's sleep, you know. Um, so if you can, um, make sure you really get your seven or eight hours of restorative sleep.

It is not easy, but focus on that. So sunscreen, not drinking alcohol and, and really getting sleep.

Rena Annobil: Great. Very doable.

Mandy Leonhart: Those are my three. Yeah, not, not easy, but it's

Rena Annobil: not easy, but doable. Doable. Not easy, but doable. And you can work in, you can, yes. And work towards uh, getting those things under control. Um, Mandy, thank you so much for coming on the Lifestyle prescription.

It has been absolute joy to speak to you.

Mandy Leonhart: You're very welcome, Rina.

Rena Annobil: Um, and thank you for tuning in to the Lifestyle Prescription on a Pharmacy planet. I hope that this has been useful and helpful for you. And please do share it with people that you know would be interested in this as well, like, subscribe and all of that as well.

And I will catch you [01:02:00] on the next one. Bye-bye.