You’ve been so good about taking care of your face — slathering on sunscreen, remembering your night cream and making time to get facials regularly. But your hands may be making you look older than you’d like.

“Hand anti-aging measures should start early in life, because the face and the hands are the most sun and environmentally exposed areas of the body,” said dermatologist Cheryl Burgess.

If you’re noticing sun spots and bulging veins, you could always try treating your hands with the same over-the-counter TLC as your face. But some people are taking more drastic measures and turning to a cosmetic procedure that can give their hands a more youthful appearance: hand lifts, aka hand rejuvenation.

“Just as we can revolumize the face, we can do the same thing with the hands,” said Joshua Zeichner, a dermatologist and associate professor of dermatology at Mount Sinai Hospital.

If you’re thinking a hand lift is a face lift for your hands, you’re not quite on the right track. We talked to experts to explain the process.

Your hand are frequently exposed to the elements — and they have a more delicate composition than you might have realized.

Dermatologist Janiene Luke, an associate professor at Loma Linda University, explained what’s going on with your body: “As our collagen production decreases with age, the skin can become thinner, making underlying veins and tendons more visible. We can also lose fat and subcutaneous tissue, while the small muscles that are in the hands can be prone to atrophy. Sun damage can become cumulative over time, causing sun spots to become more prominent. And some people have a tendency to have small benign growths on the hands, too.”

These treatments target the backs of the hands, not palms or fingers.

“Good candidates for these treatments may be people who have noticed that the skin on their hands has become very thin and that their bones and blood vessels are prominent, giving the hands a skeletal appearance,” said dermatologist Arianne Shadi Kourosh.

Dermatologist DiAnne Davis said patients are increasingly seeking out hand treatments.

“With the exception of the face, the hands are one of the most expressive parts of the body,” she said. “Given that everyone is working from home more often these days, their hands are a lot more visible on their computer and tablet screens, especially if they use them while talking.”

You may have a pretty good understanding of the nip-and-tuck procedure that’s part of a face lift, but a hand lift is an entirely different matter. It’s not a surgical procedure, and the skin is never cut. In fact, nothing is “lifted” at all. Instead, doctors will most likely recommend a course of treatment that includes filler injections.

The process starts with some numbing cream or lidocaine, Davis explained. Then come the injections.

“Small entry points are made on the back of the hands in between tendons and bones, and small amounts of either hyaluronic acid filler or biostimulating agents are slowly injected,” she said. “The product is then gently massaged so that it can be evenly distributed throughout the entire back of the hands.”

A hand lift can cost anywhere between $2,000 and $4,000, depending on what is done and the volume of filler that’s used, according to facial plastic surgeon Michael Somenek. He said people who receive hyaluronic acid filler, which is the most common, can expect to see results last for nine months to a year.

If you’re considering a hand lift, it’d be a good idea to do some research and probably to have a consultation with a doctor.

“It often takes several syringes to give you enough volume to make a meaningful improvement,” Zeichner said. “The cost per vial of the filler ranges depending on what you’re using and what part of the country you live in. On average, costs vary from $800 to $1,000 per syringe. Optimal results may take several syringes.”

Some patients may benefit from a combination of hand treatments, including use of a laser to target a specific area.

“I tend to do a couple of procedures for hand rejuvenation,” Luke said. “I’ll inject filler but also do something like Intense Pulsed Light, a treatment that targets the melanin in the sun spots and addresses the surface of the skin to improve its overall appearance.”

Zeichner said laser treatments work well for people who have dark spots or crepey skin, and that there are different lasers for different issues.

“We have lasers that can lighten dark spots and others that can resurface the skin,” he said. “My go-to laser for the back of the hands … works by punching microscopic holes in the skin, creating a controlled wound and taking advantage of the skin’s natural wound healing process. This stimulates collagen to thicken the foundation of the skin, and it also helps the skin shed darkly pigmented cells to lighten hyperpigmentation and even skin tone.”

“None of these treatments are a substitute for good skin care habits over time,” Kourosh said. “It’s important to moisturize the hands and apply sunscreen each morning to the backs of the hands in order to prevent and minimize the damage from the sun and harsh exposures.”

Davis suggested using moisturizers with vitamin A derivatives to help stimulate collagen production. If you want to boost your hand care regimen even more, she said you might want to consider supplements of biotin, also called vitamin B₇, which can help with the appearance and strength of nails. “Certain lightening ingredients, such as kojic acid or niacinamide, also can help reduce the appearance of brown spots on the back of the hands,” she said.

Dermatologists previously paired up with people who use their hands for a living to give us their best product recommendations for dry hands, and here are their top picks:

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It’s not news to anyone that women have to prove their worth at almost every stage in their lives. While it’s already challenging enough for women to claim their rightful place in professional fields that are saturated with men, the struggle is also there within their own community, especially in the world of beauty influencers.

The value of beauty bloggers and influencers has historically been dictated by a woman’s age, with younger women attracting most of the lucrative work in the field. So what’s it like once those young women grow up and want to continue their life’s work at a more advanced age?

We talked with fabulous beauty bloggers and influencers over the age of 45 who are #proaging, slaying their professional game and influentially educating everyone on what it’s like to age gracefully and naturally. Here’s what they have to say about their journey in the beauty industry.

Gail Hanlon

Founder of Is This Mutton?, a U.K.-based fashion and beauty blog for women over 50

I definitely attract different brands, and in the main they are brands that are specifically tailored toward older women. The first challenge is getting brands to see the value in using older women in their marketing and advertising. There’s nothing more infuriating than seeing face creams for “mature skins” being advertised by girls in their 20s.

Secondly, most of the brands have a blind spot when it comes to older women and social media. They occasionally “like” a picture we may have posted showing ourselves wearing a new lipstick, but they rarely share it. This makes me think their social media teams are probably young people in their 20s who don’t want to taint the brand with pictures of older women. Yet the women behind brands like Charlotte Tilbury, Pat McGrath Labs and Lisa Eldridge are women in their 40s or older.

Thirdly, the brands’ social media teams seem to want only Instagram or TikTok. The number of women over 45 on those channels is nowhere near as big as it is for younger people. Many influencers with huge followings bought their followers when this was possible. If you analyze their numbers, half of their followers are either bots or men. Fashion brands have started to see the light: We see more diversity now on the catwalks. But beauty brands seriously lag behind.

The final challenge is the wording they use when they target products at women over 45. Anti-aging? Why are so we so against aging? We all get older, nothing stops that. We need to embrace aging and stop bullying older women into thinking they have to turn the clock back and look younger in order to be acceptable.

Blogger behind Beauty Blog Over 40

I was under 40 when I started my beauty blog, but as soon as I hit the big 40 I noticed that big brands (that actually specialize in anti-aging) like Olay, It Cosmetics or L’Oreal would rather work with younger influencers and completely stopped working with me. And most makeup brands have no interest working with women over 40 ― it’s almost like they think only young women use makeup. But I do love makeup and so do many of my followers! The same is true for PR agencies ― they cater to the 20-to-30-year-old influencers.

I don’t know if younger bloggers make more money than I do ― this is a big secret and nobody is actually talking openly about that.

Blogger behind Amanda Ramsay, a popular Australian beauty blog especially for women over 40

I didn’t intend to be an influencer. I’m an experienced professional makeup artist who simply saw a gap in the market ― no one here in Australia was talking to this huge collection of women. They were greatly forgotten, ignored or left to feel inadequate. I’ve got the skills and experience as a pro artist to share my knowledge, and the passion to make sure women get the right info, without the marketing BS, so they can remain seen, feel fabulous and rock on at every age.

So I guess it’s different over 45. Beauty PR is more focused on the younger generation of influencers, but I see that as a reflection of the whole industry. The beauty industry’s narrative has been youth as the only definition of beauty, and scaremongering the more “mature skinned” beauty into being fearful, like there is something wrong with aging.

I suspect as brands catch up to the notion, beauty PR and brands will seek out us older birds. The wave of change is coming, albeit a little slow, but the pro-age movement is gaining traction!

Blogger behind Fab Over 40

Things have changed greatly since I started blogging in 2008. When I started, I researched who was blogging for beauty and skin care for the over-40 market and there was absolutely no one I could find. I don’t think PR and marketing firms knew how to handle it. For the most part, I was ignored, and a few years later I started getting noticed, but I would get countless pitches daily on things like “get the look of Kim Kardashian” or celebrities in their 20s. I would oftentimes respond either asking if they had anything that would be of interest to my age market, but most wouldn’t acknowledge my requests.

I was mostly offered free product to test ― all without compensation. Once in awhile I would be compensated, but nothing like younger bloggers get now. It would be a big deal if I got $100 for testing and promoting a product. I think the challenges are just having your voice heard in a manner you are comfortable with. I don’t want to hype a product that someone is pushing me to get the word out there if it’s absolutely nothing I would use or anyone in my age group would use. Sure, the latest seasonal makeup release is fun and pretty, but is it something women over 40 would even wear? If it is, I’m all for sharing about it.

Mary Zavaglia

Makeup artist, stylist and journalist

When I first moved into this space of work I felt out of place, as the younger bloggers all looked the same — very “Kardashian” — almost plastic-looking. I felt intimidated and dreaded anyone asking me my age! But slowly I decided that I didn’t have to fit that mold. I embraced being bolder, not older, and found my own tribe of bloggers/influencers and I looked forward to going to my launches. I was so flattered when the younger bloggers started to approach me and ask me for my beauty and hair tips! It was then I realized that we all have a space to work in.

For PR brands, youth sells. Yet, it’s interesting that PR agencies are slow to acknowledge that it’s the older demographic that have the money to spend and they relate to someone like myself touting a product or showing them how to apply the latest light reflecting or blurring product. Being an over-45 blogger/influencer has so many wonderful advantages. For one, I have a much larger audience to cater to, so I have far more opportunities.

Daphne Kapetas

Chemist, blogger and the founder of Lajoie Skin

Skin care advice from a woman over 45 who has aged well, in my experience, is something that a younger age group does respect ― especially when that person has obviously not resorted to fillers or injectables. When I was a young chemist working for one of the largest cosmetic companies in the world at the time, I remember how disappointed I was when the face of Lancôme, Isabella Rossellini, was dropped not long after she had just turned 40.

My diverse experience and qualifications are a huge advantage, but this can only be earned with time. But PR agencies and advertisers traditionally do use younger people, even when it comes to trying to target to an older audience. If we look at the sheer number of younger versus older bloggers, they do not represent our society, but then the same can be said for other marginalized groups.

Dawn Gallagher

Former ’80s supermodel and micro-influencer

Being a beauty blogger/influencer over the age of 45 is different! It’s different in the sense that many brands are finally starting to recognize that this age group has the disposable cash and can afford to spend it on items and products they like. I am attracting all kinds of brands that are finally recognizing that beauty comes in all ages and that beauty is truly how you feel inside, and we can always enhance our natural beauty with makeup, skin care and hair care.

My brand is growing and my work has increased dramatically as a vlogger/blogger. When it comes to money, I’m not really sure how much younger bloggers make, but I am paid very well for my services. However, I still struggle to convince brands that it is a great investment to recognize this demographic and the potential it can produce for them with ROI (return on investment). The advantages I have are that I am one of the very few beauty blogger/vloggers in the space and my Youtube channel has received over 4 million views and counting. It helps that I have been a beauty and wellness expert for decades.

For people of a certain age, these are the wonder years — the years when you look in the mirror and wonder, “What happened to my face?” If the children’s story “The Saggy Baggy Elephant” is starting to hit a little too close to home, you might want to see how our panel of experts can help you understand what’s happening and what you can do about it.

Yes, you can blame the matrix, no matter which color pill you took. “The structural foundation of your skin is provided by something called the dermal extracellular matrix,” dermatologist Brandon Kirsch told HuffPost. “This matrix is composed of molecules such as collagen, elastin and glycosaminoglycans, also known as hyaluronic acid, which is an active ingredient in skin fillers. Aging and environmental factors such as sun exposure, stress, pollution and smoking lead to the breakdown of these substances, leading to wrinkles, crepiness and sagging skin,” he added.

The face you have today is not the same one you had yesterday. “Our face is kind of a moving target, with changes over time in the bones of our skull, as well as the fat and muscles underneath the skin,” dermatologist Arianne Shadi Kourosh, assistant professor at Harvard Medical School, told HuffPost. “Loss of these underlying support structures that are holding up the skin, and shifting of the fat from our cheeks downward toward the jowls and jawline, can add to the sagging appearance of the face.”

Gravity is great for keeping us, well, grounded, but it’s not our friend when it comes to sagging skin. “The facial bones that provide a framework start to resorb and lose density and structure, so it’s like the hanger holding up the garment loses its strength,” dermatologist Corey L. Hartman told HuffPost. “Youthful fat pads also start to shrink and disappear, leading to the decrease of another layer of deep, structural support.”

There are simple changes you can make to prevent even more sagging, the experts say. Here are some suggestions:

“A sugary diet can cause a process called glycation of collagen, in which sugars bind to it and accelerate the sagging and aging of the skin,” Kourosh said. “Drink enough water and maintain a healthy, low-glycemic index diet,” Hartman suggested. And knock off the sauce, too. “Alcohol is a diuretic, which means it will deplete your body’s natural store of water,” Kirsch said.

“This further weakens the skin, and it creates textural irregularities and pigment changes, as well,” Hartman said. “Avoiding exposure to first- and secondhand tobacco smoke is of critical importance, since that smoke contains a high concentration of free radicals, which are highly oxidative and damaging to all human tissue,” Kirsch said.

“Chronic exposure to ultraviolet light causes reduction in collagen and elastin, as free radicals contribute to an increase in matrix metalloproteinases that further degrade collagen, which gives our skin firmness,” Hartman said. “Commit to using daily sunscreen with SPF 30 to 50.”

Weight Loss

“Massive weight changes, especially weight loss, can affect the skin’s sagginess,” dermatologist Janiene Luke told HuffPost. “There may be redundant or excess skin when a large amount of weight is lost suddenly.”

There’s no such thing as a facelift in a jar, but there are some products that might help. “Certain ingredients in topical creams can be helpful in small and gradual ways,” Kourosh said. “But they’re limited in the depth and extent of their effects.”

“While topical products do not give the same results as a cosmetic procedure would, there are some that are effective and can help improve the appearance of aging, sagging skin,” Luke said. “Many of my patients are either afraid of or not interested in undergoing surgical procedures or facelifts, so they’re more inclined to try products or non-invasive procedures.”

“Although few results are documented with high-quality and objective evidence, based on my decades of clinical experience, it’s clear that limited benefits for sagging skin can be achieved with topical products,” Kirsch said. “These topicals work primarily to stimulate the formation of collagen, elastin and other structural components of the skin matrix. In addition, good moisturizers, when used in a regimented manner, can provide modest improvements by hydrating the skin.”

When you’re shopping, Kouroush said she tells her patients to “take a scientific approach, read labels and look for the right ingredients that have evidence behind them.” Here are some ingredients the experts said to watch for:

Antioxidants, Plant Extracts And Peptides

“Antioxidants scavenge free radicals that cause a breakdown of collagen, and they act as a cofactor in the production of new collagen,” Hartman said. “Antioxidants like Vitamins C and E, as well as plant extracts and peptides, have been used with some success to address the various pathways involved in sagging skin,” Kirsch said. “They target the extracellular matrix to address the loss of supportive structure and elasticity, and the antioxidants protect against contributing environmental factors.”

“Antioxidants such as Vitamin C and niacinamide have been shown in the literature to increase collagen production,” Luke said. “Peptides are amino acids that can penetrate the skin and signal our cells to produce more collagen and elastin.”

“Some eye creams contain caffeine because it’s a vasoconstrictor, which means that it shrinks blood vessels,” Kourosh said. “This helps because it reduces blood flow, which decreases inflammation and redness and ‘depuffs’ swollen areas of skin. Some slimming or cellulite creams also can contain caffeine or xanthene stimulants, which are found in cocoa beans, tea and yerba mate. It’s also possible that regular massaging of the cream into affected areas improves circulation and the appearance of the skin.”

“These are the building blocks of a healthy skin barrier, like the mortar that secures the ‘bricks’ of skin cells,” Hartman said.

Growth Factors

“They promote healthy, efficient production of key proteins in the skin,” Hartman said.

Hydroxy Acids

“Also called fruit acids, these are some of the most widely used and studied anti-aging skin care compounds,” Kirsch said. “When applied to the skin, they increase epidermal proliferation, thickness and hydration. Clinical trials have shown the effectiveness of these ingredients in reversing the effects of photo-aging and improving wrinkles, skin elasticity, tone and hydration. The two main classes to look for are alpha hydroxy acid, such as glycolic acid, and beta hydroxy acid, such as salicylic acid.”

“The highest level of medical evidence supports the use of retinoids such as retinol, tretinoin, adapalene and tazarotene,” Kirsch said. “They’re closely related to Vitamin A, and they’re well-recognized for their ability to stimulate collagen production and enhance the appearance of skin by effacing fine wrinkles, lightening age spots, firming skin and improving surface texture. They also imbue the skin with a flattering, rosy glow.”

“They can help slow the sagging process, especially in those who use them regularly for months to year,” Kourosh added.

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There’s been plenty of Tokyo 2020 headlines about Hend Zaza, the Syrian table tennis prodigy who, at 12 years old, is one of the youngest Olympians of all time.

But there’s some striking personal stories on the other side of the age spectrum, too.

Oksana Chusovitina, a 46-year-old gymnast from Uzbekistan, impressively competed in her eighth Olympic Games last week. Chusovitina, who competed in a sport dominated by teenage athletes, received a standing ovation after performing in what she said would be her last Olympics.

Then there’s Australian equestrian Mary Hanna, who at age 66 is the second-oldest female athlete in Olympic history and the oldest Olympian competing in Tokyo.

Through their efforts, Hanna and Chusovitina are changing the conversation around age and agility. They’re proof that you can compete or put yourself up to a physical challenge way past what is considered “your prime,” said Michael Stones, a professor emeritus at Lakehead University in Ontario, Canada, who researches healthy aging and physical performance.

“It’s terrific that this year’s Olympics includes so many younger and older athletes,” he told HuffPost. “They show that age alone is not an insurmountable barrier to excellence in physical activities.”

These Olympians also lend the games some experience and maturity, especially in team sports, said Sandra Hunter, a professor of exercise science and director of the Human and Athletic Performance Research Center at Marquette University in Milwaukee, Wisconsin.

“These older athletes can help mentor the younger ones, particularly with all the mental and psychological challenges that we’ve seen,” she said. “They bring a level of maturity to the teams and surrounding athletes that allow the younger athletes to learn.”

Below, we spotlight 10 older Olympians who are giving it their all at the Tokyo Summer Games.

If you’re talking about paper streamers to hang in the gym, then “crepe” is a perfectly good word. But when you’re talking about your eyes, face, neck, hands, arms and even (ugh) your knees, then it becomes something truly dispiriting.

Crepey skin, or, in medical terms, skin that has lost laxity, tends to show up more often in women than in men, and it usually becomes more noticeable with aging.

“I liken it to a warped and stretched-out rubber band that doesn’t retract back to normal, leaving the skin loose and wrinkled,” dermatologist Stacy Chimento told HuffPost. “In severe cases, the skin can appear as thin as tissue paper.”

“It’s the kind of skin you can ‘pinch and gather,’” plastic surgeon Tanuj Nakra told HuffPost.

The thinner the skin to begin with, the more vulnerable it is to the ol’ pinch and gather. And if there’s a spot you’ve always ignored, watch out. “I always tell younger women that I wish someone told me when I was their age that my arms would get wrinkles,” Joan Sutton, CEO and founder of 707 Flora, told HuffPost. “I’m over 50, and I’ve been diligent about staying out of the sun, using good skin care and getting facials regularly, so my face and decolletage look good — but I neglected my arms, and now I feel like I’m fighting to hold back the crepey skin in those areas.”

What in the world is going on here? Mostly, the passage of time. If you’ve hung around the planet for enough revolutions around the sun, you’re likely to notice skin like this somewhere on your lovely self.

“By the time people reach 50, or sometimes even at younger ages, the skin experiences degradation or loss of collagen and elastin/elastic fibers,” dermatologist Jeremy Brauer told HuffPost. “That results in compromised resiliency and increased fragility in the skin.”

For every time you forgot to put on sunscreen, there might be some new crepe creep happening. “Excessive sun damage is a key factor for accelerating the breakdown of elastin in the skin, which gives it that natural snapback,” Chimento said.

For women, lucky us, there also are hormonal issues at play. “The ovaries gradually decrease estrogen production starting in perimenopause, which typically begins around age 40,” Bryan Barron, content and research director at Paula’s Choice, told HuffPost. “The decline in estrogen leads to further loss of collagen, fragmentation of elastin fibers, reduced capacity for skin to hold on to water and thinning of skin’s surface layers, due to a slowdown of hyaluronic acid and ceramide synthesis.” And once these losses begin to occur, the skin needs more help than ever. “That decline in estrogen leaves unprotected, exposed skin even more vulnerable to environmental damage, increasing the need for daily UV protection with a broad spectrum sunscreen,” he said.

And if you’ve done your best to stay in shape, here’s some bad news: “I see many over-50 women who are thin and fit, but that can make the skin look much more aged and crepey,” dermatologist Sheila Farhang told HuffPost. Because a lower overall body fat percentage means a smaller overall “facial volume,” Farhang says that fitter or thinner people often will have less fat around areas like the temples, eyes, mid-cheek and lower face. “Fat pads usually hold everything up and together,” she said. “Less fat, especially in these areas, can contribute to crepey skin in mature women.”

The experts we spoke with had a number of suggestions for lifestyle changes you can make to help reduce crepey skin. The top one was wearing sunscreen year-round on any part of your body that’s exposed to the sun.

If you smoke, well, you know what we’re going to say: “Quit as soon as possible,” Barron said. “Smoking deprives skin of the nutrients it needs to repair itself. Also, moderate your intake of caffeine and alcohol, both of which dehydrate skin and exaggerate a crepey texture.” Dermatologist DiAnne Davis pointed to smoking and other air pollutants as contributing factors: “They produce free radicals that can damage plump, healthy skin cells, and that can lead to crepeiness,” she told HuffPost.

“It’s also important to maintain a healthy weight,” dermatologist Deanne Mraz Robinson told HuffPost. “Fluctuations of big gains and losses can cause the skin to stretch and retract, wearing down the elasticity.”

Take it easy when you clean up, too, dermatologist Seemal R. Desai told HuffPost: “It’s a good idea to avoid excessively hot showers.” Barron suggested using a gentle, moisturizing body wash. “You don’t want to use highly fragranced shower gel or worse, bar soap.” He recommended Dove Sensitive Skin Body Wash. “It produces a skin-smoothing, creamy lather that won’t leave skin depleted,” he said. You’ll also want to avoid harsh body scrubs that scratch and tear at already delicate skin. “Crepe-like texture can’t be scrubbed away,” he said.

And since what you put into your body tends to be reflected on the outside, many of the experts we spoke to urged increasing water intake and eating a balanced, healthy diet, both of which can contribute to overall skin wellness. You may want to consider supplements, too. “More studies are emerging supporting collagen supplements, and I usually recommend them for my over-50 patients,” Farhang said.

If you’d like to work with a dermatologist for in-office treatments, here are some of the most popular ways people address crepey skin:

Fractionated radiofrequency: “The No. 1 procedure in my office for crepey skin is fractionated radiofrequency with microneedling, such as Inmode Morpheus8, which stimulates collagen production,” Farhang said.

Ulthera: “This uses targeted ultrasound energy to heat the supporting tissues below your skin. This intense heat breaks down some of the cells and stimulates the growth of collagen to tighten your skin,” Robinson said.

Fraxel and Pico: “These laser therapies use heat to create columns of injury to the skin, which will stimulate the growth of new collagen. This helps support your skin and smooth out wrinkling from the inside out,” Robinson said.

Dermal fillers: “The Food and Drug Administration (FDA) has approved Restylane Lyft, a hyaluronic acid filler traditionally used in the face for use in the hands, which is a commonly affected area of the body for crepey skin,” Robinson said. “I use a hyper-diluted Radiesse dermal filler to the chest, arms and above the knees,” Farhang said.

Just in case you know a Zoomer who’s eager to hear your skin care advice, or if you plan to return to earth in another life and take much better care of your skin, keep these words from Chimento in mind: “It’s best to start treating the body as carefully as the face as early as your 20s.”

Finally, remember this: “It’s not so easy getting older, and as women, we tend to put a lot of pressure on ourselves for how we look,” Sutton summed up. “I’ve been concerned about aging since I was 30, which is a crazy thought to me now, at age 51. I’m still chasing youthful skin, but I’m also embracing the imperfections that come with age and that have taken me decades to create.”

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Arianna Sholes-Douglas remembers the moment her body was in the grips of perimenopause ― though she didn’t recognize it for what it was at the time, despite being an OB-GYN and integrative health physician focusing on women’s health. Sholes-Douglas was performing a C-section, a surgery she estimates she had done over a thousand times, and her brain just blanked.

“I had a total brain freeze. I couldn’t remember what to do,” she recalled. “It was very scary, and I didn’t know who to talk to or what to do.”

At first, she worried it was early-onset Alzheimer’s. But the big changes she’d been experiencing in cognitive function were hormonal. She was going through perimenopause, the transitional period before menopause when a woman’s body starts making less estrogen until eventually her ovaries stop releasing eggs.

And she’s not alone about being in the dark. Many Gen X women and cusp millennials — who are at the age range when perimenopause has begun or could soon start — have far too little support and information.

“We haven’t been educated. Patients haven’t been educated. Doctors haven’t been educated. There really hasn’t been a resource that’s been reliable for women, so they are caught off-guard,” said Sholes-Douglas, who went on to write the book “The Menopause Myth: What Your Mother, Doctor, and Friends Haven’t Told You About Life After 35.”

“Because in their minds, they’re thinking menopause is an old lady issue,” she added. “They think it’s only relevant when they stop having a period.”

But that’s not true. So here are three important things “Xennial” women should know about perimenopause:

There aren’t lines around when perimenopause begins, in part because it varies by individual and also because the types of symptoms are so broad. The term perimenopause really just means “around menopause.”

It’s also a stretch of time that can drag on for a while. Many women start to experience symptoms five or even 10 years before they stop having a period (though the average is about four years). And given that full menopause can happen when women are in their 40s or 50s, perimenopause can begin when they’re in their early 40s or even mid-30s.

“Since 5% to 7% of women are fully menopausal by age 45 (they’ve gone that magical full year without a period), they could be experiencing these symptoms at age 40, not thinking a thing about menopause — because these symptoms can be very vague and don’t come with a big sign ‘You are entering perimenopause,’” said Mary Jane Minkin, an OB-GYN with Yale University and founder of the informational website Madame Ovary.

If you’re a woman in your 30s or 40s who is planning to have children (and many women are) and you’re fretting that you might instead enter perimenopause, don’t freak out. It’s very much still possible for women to get pregnant during this phase, though it’s definitely worth bringing up with your doctor if you have concerns.

When most people think menopause, they think of hot flashes. And many (if not most) women getting closer to menopause will experience hot flashes, or brief feelings of being overheated, at some point — ranging from pretty mild to really severe.

But there are so many other symptoms that can come along with perimenopause, including missed periods or periods that are heavier or lighter than usual, mood swings, changes in cholesterol levels and bone density, urinary incontinence and cognitive fuzziness.

“Many [women] get disrupted sleep ― usually falling asleep quickly as they are exhausted, but are then up at 1 a.m., sometimes with a hot flash, sometimes without. They may have headaches, they may be achy, they may have some vaginal dryness or urinary leakage (although that usually comes later),” Minkin said.

Perimenopause can affect your sexual health and well-being, as well. “The sexual aspect part of perimenopause is something I deal with a lot,” Sholes-Douglas said. “Women are very much caught off-guard when they experience a decline in libido, vaginal pain, vaginal dryness — and they don’t know why.”

But while the possible symptoms associated with perimenopause are wide-ranging, they all really come back to the hormonal changes women go through in the run-up to menopause, as estrogen and progesterone levels fall — or rise and fall in uneven spikes.

Though there’s far more information available to women and health care providers now than had been the case a few decades ago, and many active support communities have flourished, perimenopause is still something women aren’t adequately educated about, according to experts.

Minkin said Gen X women are probably “slightly better prepared, but not dramatically so.” Sholes-Douglas was more emphatic: “Most women are just not prepared.”

There are a few reasons for this, one of which is that there simply isn’t a test doctors can perform to see if women have entered perimenopause.

“Hormone levels may not show much,” Minkin said. For example, a doctor might do an estradiol test to check your estrogen levels, but since normal levels during a menstrual cycle range wildly (from 45 to 350 picograms per milliliter), it’s hard to know where your level should be.

“Let’s say we draw a blood level of 50. Well, is that normal? It may be. But if your level should be 300, that’s low,” Minkin explained.

“It’s a tough diagnosis to make at the time,” she added. “When the patient goes that year without the period, you can then say, ‘Well, hey that was all perimenopausal!’”

On top of which there is a lack of consensus about how to treat symptoms of perimenopause even if it is clear that’s the issue. Hormone therapy, which involves taking supplemental hormones, is one option, but some past studies have indicated it can come with other health risks. Some doctors might recommend lifestyle changes to help manage symptoms; in other cases, women might take medications to more directly address such symptoms as vaginal dryness or mental health changes.

Unfortunately, a lot of this ends up falling on women. They end up needing to connect the dots in their own symptoms and find health care providers who have experience dealing with perimenopause. Which is why it is so important for Xennial women to be aware of what’s happening in their bodies now, or what lies just ahead.

“I’ve had countless patients tell me they went to the doctor and told them they suspected they were perimenopausal, and the doctor said: ‘Oh, you’re too young for that. You’re too young for that,’” Sholes-Douglas said.

“You should not assume that your doctor is going to know more about this than you do,” she added. “On some level, obviously they will. But don’t underestimate the power you have.”

A couple of years ago, while on a bike-packing trip through Armenia and Georgia, my friend Amy and I walked through the streets of Tbilisi. We were both 49 years old at the time, and I told her about how, over the last year, I felt as if I had become more emotional and more easily angered than I used to be and I didn’t know why.

“Ummm, perimenopause?” she said, laughing. The thought had never crossed my mind. I don’t know why perimenopause and menopause aren’t talked about more, why this huge transition in a woman’s life seems to be such a “secret” subject in polite society. Once I figured out that I was indeed in the midst of perimenopause (and I still am two years later), so many things began to make sense. I think I’ve experienced every possible symptom of perimenopause, including hot flashes, trouble sleeping, brain fog, forgetfulness, anxiety and heavier period bleeding than usual. And then there are the skin issues.

I’ve never in my life had any kind of acne, but over the past couple of years, a lone pimple would pop up every month or so. The skin on my elbows was drier than it ever used to be. And small hairs from my Eastern European heritage would show up more consistently on my chin.

I talked to some medical experts to understand some of what was going on.

Dr. Mary Jane Minkin, clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine and a board-certified obstetrician and gynecologist, first told me that I’d be all right. I’d make it through this transition, even if sometimes I felt as if I were going crazy. Then she explained that the cause of most of my issues was sporadic, fluctuating hormone levels.

“The way I describe it to my medical students,” Minkin said, “is that if you were to draw a picture of what hormone levels do during perimenopause, they would look like the Dow Jones industrial average in September of 2008: It went very far down but it wasn’t smooth; it was jaggedy.”

As Minkin outlined for me, during a normal Jane Doe menstrual cycle, estrogen and progesterone levels vary significantly, but usually in a regular, cyclical way. A ballpark baseline level for estrogen at the beginning of a woman’s period is 40 to 50 picograms (pg) per milliliter. A week or so before the start of the period, levels go up to a high of 300 or 350 pg per milliliter. During ovulation, the area the egg comes out of makes progesterone as well. Post-menopause, estrogen levels go below 20 pg per milliliter and stay that way while the ovaries cease making progesterone.

“And then,” Minkin said, “there’s perimenopause. That’s the tricky area, because what happens is things go really crazy.” What she meant by this is that estrogen and progesterone levels no longer go up and down in a regular way. They are sporadic, sometimes spiking, then dropping more quickly than during a normal cycle. And this causes all sorts of havoc in our bodies (and emotions).

As far as skin-related issues go, testosterone is predominantly to blame. Our ovaries, besides making estrogen and progesterone, also make testosterone. On average, the ovaries stop making estrogen at 51 years old, while testosterone production can go on until about the age of 60. “Your estrogen levels are declining, but you’re still chugging out a good amount of testosterone,” Minkin told me.

And the unwanted hair? Testosterone is to blame for that, too. “As your estrogen is reduced, testosterone becomes more prominent and may cause unwanted hair growth,” said Dr. Laura Carinci, clinical assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Health.

It’s androgens (a group of hormones responsible for “traditional” masculine traits and reproductivity) that cause unwanted hair. “Some people in general have hair follicles that are more sensitive to male hormones, which anti-androgen therapy can help with,” Carinci explained.

Estrogen, on the other hand, is responsible for helping to keep collagen in our skin. When estrogen levels go down, so does collagen production, which can exacerbate wrinkles or dry skin.

So what can we do to treat skin issues related to perimenopause? Minkin encouraged women to talk to their doctor about the possibility of estrogen therapy. “A lot of my patients take estrogen because of skin issues,” she said, “because they don’t like having skin dryness and loss of elasticity, and estrogen does help.”

“The biggest thing in terms of preventing and helping yourself with skin changes really is skin protection, wearing sunblock that blocks both UVA and UVB rays, such as products with zinc and titanium oxide,” Carinci said.