Menopause, skin and common dermatosis. Part 3: genital disorders.

Oestrogen plays a vital role in maintaining a normal vulvovaginal epithelium, vaginal lubrication, as well as a healthy microbiome to ensure an acidic pH. The decrease in oestrogen levels in women going through menopause results in both physiological and physical changes of the genitourinary system, and more specifically the vulva. We conducted a literature review on the effects of low oestrogen levels on the physiology and function of the vulva and the vulvovaginal epithelium. 'Genitourinary syndrome of menopause' (GSM) is the term used to describe the signs and symptoms of a low oestrogen state. The symptoms and signs of GSM can overlap or coexist with other vulval dermatoses. Expert opinion is needed to diagnose and manage vulval dermatoses in menopause. This article will discuss the signs and symptoms of GSM, as well as the different management options available. Other vulval dermatoses that can be affected by hypo-oestrogenism are also reviewed.

Menopause, skin and common dermatoses. Part 1: hair disorders.

Menopause, which usually occurs between the age of 45 and 55 years, is associated with falling oestrogen levels due to ovarian follicle depletion. The impact on the cardiovascular system and bone density are well documented; however, further research required to establish the impact on the skin and hair. In this first part of a four-part review, we examine the effect of menopause on the hair. We performed a literature review on dermatology and hair in menopause. Androgens and oestrogens are involved with regulation of the hair cycle, with a reduction in anagen hairs seen in postmenopausal women. Female pattern hair loss and frontal fibrosing alopecia have both been associated with the perimenopausal and postmenopausal states. It is clear that menopause and the change in hormone levels have an impact on the hair cycle and common hair conditions. However, further research is required, particularly to understand the therapeutic targets and role of hormonal therapy.

Menopause, skin and common dermatoses. Part 4: oral disorders.

The physiological impact of declining oestrogen levels during menopause has been well documented. We conducted a literature review to assess the impact of menopause on oral health. Falling oestrogen levels are associated with adverse effects on the gingival, oral and buccal epithelia. The symptoms prevalent in perimenopausal and postmenopausal women range from dry mouth to immune-mediated mucocutaneous disease and burning mouth syndrome. Our review has highlighted the need for further research into potential treatments for oral symptoms in menopause, particularly with regard to hormone replacement therapy.

Menopause, skin and common dermatoses. Part 2: skin disorders.

In this second part of a four-part review, we examine the effect of menopause on the skin. Menopause and the associated hypo-oestrogenic state have implications for the structure and function of the skin. We performed a literature review to investigate the impact of the menopause on common dermatoses. There is evidence that oestrogen is implicated in transepidermal water loss and reduction in dermal collagen. There are associations with menopause and multiple common dermatoses, including xerosis and pruritus, hidradenitis suppurativa and psoriasis. Menopause has a clear impact on the skin and common dermatological conditions. Further research to understand the mechanisms and explore therapeutic options is needed.

Food at checkouts in non-food stores: a cross-sectional study of a large indoor shopping mall.

OBJECTIVE: To investigate the display of food at non-food store checkouts; and to classify foods by type and nutrient content, presence of price promotions and whether food was at child height. DESIGN: Cross-sectional survey of checkout displays at non-food stores. Foods were classified as 'less healthy' or healthier using the UK Food Standards Agency's Nutrient Profile Model. Written price promotions were recorded. Child height was defined as the sight line of an 11-year-old approximated from UK growth charts. SETTING: A large indoor shopping mall, Gateshead, UK, February-March 2014. SUBJECTS: Two hundred and five out of 219 non-food stores in the shopping mall directory which were open for trading. RESULTS: Thirty-two (15·6%) of 205 non-food stores displayed food at the checkout. All displayed less healthy foods, and fourteen (43·8%) had healthier foods. Overall, 5911 checkout foods were identified. Of these, 4763 (80·6%) were 'less healthy'. No fruits, vegetables, nuts or seeds were found. Of 4763 less healthy foods displayed, 195 (4·1%) were subject to price promotions, compared with twelve of 1148 (1·0%) healthier foods (χ 2(df=1)=25·4, P<0·0001). There was no difference in the proportion of less healthy (95·1%) and healthier (96·2%) foods displayed at child height. CONCLUSIONS: Almost one-sixth of non-food stores displayed checkout food, the majority of which was 'less healthy' and displayed at child height. Less healthy food was more likely to be subject to a written price promotion than healthier food. Further research into the drivers and consequences of checkout food in non-food stores is needed. Public health regulation may be warranted.