By Corrie Pikul
We asked these top doctors to explain some of the less-than-awesome surprises of getting older.
Q. Argh, facial hair! Is there any way to get rid of it?
A. Many women are at some point plagued by errant hairs on their chin or upper lip, says Ranella Hirsch, MD, past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. The growth can be exacerbated by age-related hormonal fluctuations—but just because it's normal doesn't mean it isn't unsettling. Hirsch says that the most cost-efficient treatment is a surgical laser that targets the melanin (which is what makes the hair darker). Shaving is another option, and Hirsch says razoring off the offenders won't cause them to grow back coarser (despite what you may have heard). You can also use tweezers, but you risk causing an ingrown hair if you don't wait until the hairs are long enough, and that method can test the patience of the magnifying-glass obsessed. For those with a low pain tolerance, Hirsch suggests threading, in which a trained specialist pulls individual hairs out by the root. No matter which method you choose, the hair will eventually return. However, you can slow the regrowth with the prescription cream eflornithine (the brand name is Vaniqa), which interferes with an enzyme in the follicle.
Q. I'm thinking about Whoopi Goldberg all the time now....So, really, what are my options if I have that "little spritz" when I cough or do jumping jacks?
A. Pads may help you feel more comfortable, but stress incontinence is curable, says Melissa R. Kaufman, MD, PhD, a urologist, surgeon and an assistant professor of at Vanderbilt University in Tennessee. Docs like Kaufman often refer patients to a women's health physical therapist, who can give them exercises to strengthen pelvic floor muscles, a diet and exercise plan to lose the extra weight that may be putting pressure on the bladder and urethra, and advice like cutting back on caffeine and emptying the bladder more frequently. Surgery is a more invasive option. The sling procedure involves using strips of the body's tissue or a synthetic mesh material to create a supportive hammock around the bladder neck and urethra. Kaufman is also part of a clinical trial of a new procedure that involves taking cells from a patient's thigh and implanting them in the urethra to rejuvenate and strengthen the tissues. (For more information, or to see if you're eligible to participate, see researchsui.com.)
Q. I love the idea of sex with my husband, but the experience is...eh...somewhere on the comfort scale between a tooth cleaning and a leg wax. What's going on?
A. This is a near-universal question from menopausal women (and those going through perimenopause) who suddenly feel itching, burning or pain during sex, says Kaufman. If you've ruled out a urinary tract infection, these symptoms could be due to something called atrophic vaginitis. As the body loses estrogen with age, the lining of the vagina starts to thin, and the tissues become red and irritated. Although regular sex helps keep the vaginal tissues healthy, it can also have the opposite effect and make the pain worse. "I'll see an older male patient come into the urologist's office asking for Viagra, and his wife will be in the next room telling me about how painful sex has become," Kaufman says. Typical treatments include vaginal moisturizers, lubricants (silicone tends to last longer than water-based) and topical estrogen creams.
Q. Why do I suddenly need to know where my water bottle is every five seconds?
A. In the same way that roller-coasting hormone levels contribute to vaginal dryness, they can also lead to a decrease of salivary fluids in the mouth, explains Sally Cram, DDS, a periodontist in Washington, D.C. Antihistamines, decongestants, pain medications and antidepressants can make things worse. Cram says a lack of mineral-rich, teeth-strengthening saliva allows bacteria to proliferate, which causes halitosis, gum inflammation, periodontal disease and, in extreme cases, the loss of teeth. So keep flossing daily, brushing twice a day and getting a cleaning every year or so. Your dentist can also recommend oral moisturizers with artificial saliva.
Q. What happened to my face?
A. As we age, we can lose fat and tissue in our face, says Hirsch. "Patients will tell me that they think they look gaunt, even though they feel fine. But when we look at photos of them from when they were younger, we'll often notice a loss of volume in the temple," says Hirsch. She's lately been addressing the issue in-office with soft-tissue fillers. For a less-invasive solution, Hirsch suggests drugstore products that claim to "plump" the tissue around the eye area with hyaluronic acid.
Q. Why am I having trouble reaching my top shelves?
A. Starting around age 40, height declines by about half an inch per decade, says John Whyte, MD, chief medical expert at the Discovery Channel and the author of Is This Normal? The Essential Guide to Middle Age and Beyond. The disks get compressed with age, and the curve of the spine starts to bend. Whyte says that shrinkage is compounded by osteoporosis. Getting enough calcium, doing weight-bearing exercises, and even regular yoga have been shown to help forestall bone loss—and maybe help you keep a few inches.
Q. When did I become this delicate thing that bruises at the slightest touch?
A. Hirsch explains that age makes your blood vessels more fragile, and so does tissue damage due to sun exposure (as if we needed another reminder to wear sunscreen). Blood thinners like baby aspirin, which many doctors prescribe for older patients to take daily, can also make the vessels even more vulnerable. So you'll not only bruise more easily, but the spots may appear darker. The good news is that this type of discoloration is benign and may clear up over a few weeks or months. The bad news is that there's nothing you can really do to make it fade faster, and in some cases, it doesn't fade at all.
Q. Why do I suddenly feel like the Wicked Witch of the West?
A. This question is also known as "Wait—is that a wart on my neck?" It's likely not. Skin tags are small flesh-colored polyps, and while you may start noticing them in your thirties, 60 percent of people have some by the time they are 70, says Isaac M. Neuhaus, MD, assistant professor of dermatology at the University of California in San Francisco. Scientists don't know exactly what causes them, but they tend to appear in areas where there's a lot of friction, like the armpits, the neck, and underneath the breasts (they also run in families, and are associated with large gains in weight). Neuhaus reassures that they're benign, but if they bother you, a dermatologist can snip them off with surgical scissors or freeze or burn them off. The procedure is fast and mostly painless.
Q. Is there really nothing we can do to stop breasts from losing their oomph?
A. It's not a bad idea to wear a supportive bra while jogging, but there's no medically proven way to prevent the ligaments from stretching with age, says Ellen S. Marmur, MD, vice chair of cosmetic and dermatologic surgery at Mount Sinai Medical Center in New York. Even surgical augmentation is temporary; Marmur says that most women don't realize that implants usually need to be replaced after a decade. What's more, she says, "the skin on top of the implants can also sag, and I've had women come in with nipples pointing down." These patients often opt for a skin lift when they have their implants replaced.
As a reminder, always consult your doctor for medical advice and treatment before starting any program.