Menopause and its effect on ageing

menopause, ageing, Dr Liz McCulloch, Henpicked

What factors influence how we age and what can we do about it?

menopause, ageing, Dr Liz McCulloch, HenpickedAs part of our Lunch & Learn series of webinars, we were joined by Dr Liz McCulloch of Hormone Health.

Dr McCulloch helped us understand what can influence the ageing process and gave expert insights into what we can do. How we feel about how we age can have a big impact on us.

Henpicked: What effect does menopause have on ageing, and what influences the ageing of our face?

Dr Liz McCulloch: There are intrinsic and extrinsic factors to ageing.

Intrinsic means anything that comes from inside, for example hormones are intrinsic to ageing. In the menopause you see a decline of a woman’s main hormones – oestrogen, progesterone and testosterone. This decline doesn’t just start when you have your final period, but in the years leading up to it, your perimenopause.

Oestrogen can have a positive effect on your cardiovascular health and it also has an effect on your skin and bones. Progesterone is calming and soothing and can help with your sleep. Sleeping is another intrinsic factor, as sleep deprivation makes us age faster. A first sign of the perimenopause can be that women struggle to sleep well. We can look at how all those hormones work together.

Your genes are another intrinsic factor and will play a role on how someone ages. There’s a lot of research underway on sirtuins. These are enzymes and they have been linked to longevity. We know that caloric restriction and for example exercise, anything that puts the body into stress, may activate those sirtuins, which in return activate DNA repair on a genetic level. For those that want to find out more about these factors, I’d really recommend reading Lifespan by David Sinclair.

Extrinsic factors affect your ageing from the outside. Probably the most preventable photo damage from the sun, so you need to protect your skin by wearing SPF 50 sunscreen. I do think a vitamin D supplement can be a good idea, as it can be very difficult for us to build enough wearing SPF.

Smoking breaks down collagen and lead to fine lines around the mouth. A high-sugar diet creates AGE (Advanced Glycation Endproduct) which causes premature skin ageing by making elastin, the ‘elastic’ skin fibres, more rigid.

Environmental factors also play their part, so using antioxidants or vitamin C serums can reduce oxidative stress on skin.

We’ve covered menopause and skin twice on our Lunch & Learns which you can rewatch here.

Henpicked: We often associate ageing with wrinkles but what about our bones?

Dr Liz McCulloch: Oestrogens are known to prevent bone fractures later in life. If you are prescribed regulated bioidentical HRT, one benefit of this is that this will also protect your bones and increase bone density.

In ageing, our skull, which builds the foundation for the soft tissues changes. Our eye sockets widen, the brow bone recedes and the chin droops. This affects the superficial layers of skin, a deepening in the marionette line, we may see a sloping neck contour and pseudo jowls. Our mentalis muscle (the one above the chin) may become hyperactive causing the mento-labial crease (the one between our lower lip and the chin) to deepen.

Henpicked: And how about our muscles?

Dr Liz McCulloch: Facial muscles don’t change too much, but some can become stronger like the Mentalis Muscle and the DAO (Depressor Anguli Oris Muscle – the one that pulls down the corners of our mouth when we’re sad). As we age our fat compartments around the cheeks move downwards. This affects the ‘triangle of youth’. When we’re young our fat compartments are higher up on the cheek bones and our face becomes squarer as we age.

So with ageing we see changes to our skin layer, bone layer and fat layer.

Henpicked: Is there anything to be said for facial exercises?

Dr Liz McCulloch: Yes, you can train yourself to relax your muscles, anything that will stop you constantly frowning. You can also try Cognitive Behavioural Therapy (CBT), or meditation, as these can boost your feel-good hormones.

Henpicked: A lot of women ask us about hair thinning, is there anything we can do about this?

Dr Liz McCulloch: Hair thinning is another common complaint in the menopause, and is often associated with the drop in oestrogen levels, though it can have other causes. We can offer a blood test to see if you have enough zinc or iron in your blood. Thinning hair can really affect a woman’s confidence and lead to depression. Oestrogen can help if this is the reason, or you can also try a topical minoxidil shampooIf your hair loss is concerning you, you should speak to a doctor.

Henpicked: We’ve talked before about Botox and dermal fillers. So if there are things that are bothering you and there’s something you can do about it, why not?

Dr Liz McCulloch: Absolutely! From an aesthetic point of view, you can use dermal fillers in the deeper layers of the face to create a subtle lift and you can use Botox to soften movement whilst keeping facial expressions which can slow down a deepening of lines. Nobody needs to have treatment but if something is really bothering you, it’s an option.

Using dermal fillers can counteract the downward movement in the cheek, it will lift the nasolabial fold and the jaw line. You can cleverly place tiny volumes of hyaluronic acid, which is a dermal filler similar to the natural collagen. I am a big fan of a natural look and I strongly believe that less is more. You don’t want cheeks like a chipmunk.

With Botox, you can help to soften expressions. Often the DAO (Depressor anguli oris) muscles become stronger over time, making a woman look sad even if she is not. A downturned mouth and this sad look are easily helped with a small dose of Botox. This might not be for everybody. My patients don’t want to look 20 years younger but they want to look natural and good for their age.

In the upper face and for the forehead I also prefer what I call baby Botox – smaller doses – as personally I don’t like the frozen look. It still helps to slow down the deepening of lines. I always recommend a natural look, so you don’t have that rigid face.

Henpicked: What can help with bone density if you can’t take HRT?

A healthy diet with plenty of calcium and vitamin D is essential and some women may need a supplement. Oestrogen helps with bone density but if you are not allowed to take it then make sure you also have plenty of exercise. Try impact exercise like running. Weight training is also important for menopausal women and if you’re fit enough – jumping from a metre height down onto a mat will make your bones stronger, but please be careful. There are other medications available, if you are concerned or have been diagnosed with Osteopenia or Osteoporosis, you need to talk to your doctor.

Henpicked: What can we do about ageing? What are your top tips?

Dr Liz McCulloch: I always recommend:

1. UV protection is my number one tip, it’s worth investing in a really good SPF 50. If you want to go one step further I would recommend medical-grade skincare with ingredients such as retinol. They are highly effective in protecting your collagen and treating fine wrinkles and pigmentation. I love my hyaluronic acid serums and you could also consider getting one or two antioxidant serums containing Vitamin C or Resveratrol.

2. Make sure you have a healthy low-sugar diet. 

3. Don’t smoke.

4. Sleep. Micronised progesterone is calming and soothing and helps with sleep. Sleep deprivation has been shown to increase DNA damage and inflammation and to decrease DNA repair. 

5Take plenty of exerciseMany women in the menopause feel exhausted and fatigued. Off-license testosterone in a female dosage can help to boost libido and energy levels, which can help create such a positive upward spiral for wellbeing. Of course this needs to be done under the supervision of an experienced doctor. 

6. Think about Botox and dermal fillers. Not for everyone but if there is something that’s bothering you, it’s worth considering.

Watch the video here:


Dr Liz McCulloch’s career started in Austria, where she graduated from Vienna University in 2001 and acquired her medical degree through academic research into Ovarian and Breast Cancer. Dr. Liz McCulloch trained in Obstetrics and Gynaecology in one of the most reputable Clinics (Ignaz-Semmelweis) in Vienna before deciding to move to the UK and gain her GMC qualifications as a General Practitioner. Dr. Liz McCulloch has worked as a GP in Brighton since 2008.

Dr. Liz McCulloch is a member of the British Menopause Society and a member of the British College of Aesthetic Medicine. She is currently the Deputy Chair of the East Sussex Medical Committee.

There’s more information on Hormone Health’s website:


Check out the rest of Henpicked’s Lunch & Learn video series!