Q: I’ve seen several menopause-oriented brands selling anti-aging estrogen creams for the face. Is there any science behind them?
Hot flashes, night sweats and vaginal dryness are common symptoms of menopause. But the skin can undergo changes in midlife too, including sagging, thinning and becoming more dry.
Estrogen is key to maintaining skin integrity, said Dr. Susan Massick, a dermatologist at the Ohio State University Wexner Medical Center. When estrogen levels dip during menopause, your skin can become thinner with less collagen and elasticity, potentially causing more dryness or wrinkling.
Some skin care companies sell estrogen-infused face creams and serums — available over-the-counter or via prescription — that are supposed to prevent and reverse these changes. One doctor on Instagram even said that using prescription vaginal estrogen cream on your face can increase collagen production and minimize dryness.
While this use of estrogen cream “makes sense, in theory,” Dr. Massick said, we need more research showing that it is safe and effective. Here is what we know.
Can topical estrogen benefit your skin?
In one review published in 2019, researchers analyzed the results of about two dozen studies. They involved menopausal and postmenopausal women who used topical estrogen — including in gels, creams, ointments and patches — on their faces, abdomen, buttocks, forearms and thighs. The authors concluded that it was “plausible” that estrogen could minimize wrinkles and improve skin dryness, texture and elasticity. However, the studies they reviewed had various limitations, including that they looked at small groups of women. And some of the review’s authors were consultants for a skin care pharmaceutical company, presenting a conflict of interest.
Dr. Massick said that we need more rigorous research to understand how effective and safe topical estrogen products are, and what concentrations and forms are best.
Estradiol, the active ingredient in vaginal estrogen creams that are prescribed for menopause-related vaginal dryness and pain during sex, is a potent and therapeutic form of estrogen, said Dr. Mary Jane Minkin, an OB-GYN at Yale Medicine.
Some of her patients use it off label to treat dry and wrinkled skin on their faces, she said. But she doesn’t encourage this use — and the dermatologists we spoke with didn’t recommend it either, since it hasn’t been proven safe or effective.
Vaginal creams are not “designed or intended for facial use,” Dr. Massick said.
Estriol (a form of estrogen that is produced during pregnancy) and phytoestrogen (a plant compound that mimics estrogen in the body) are two ingredients often found in estrogen-based skin care products, Dr. Massick said. But the research on them is limited, too.
Is topical estrogen safe?
Applying estrogen to the skin could cause irritation, and trying any new topical product could lead to an allergic reaction, rash or redness, said Dr. Jacqueline Watchmaker, a dermatologist in Scottsdale, Ariz.
Estrogen could also worsen any dark patches and discoloration or make blood vessels more apparent, she added; or it could aggravate skin conditions like eczema and rosacea, said Dr. Debra Jaliman, a dermatologist in New York City.
The biggest question surrounding topical estrogen, however, is how much of the hormone gets absorbed into the bloodstream.
When used vaginally, Dr. Minkin said that only “minuscule” amounts of estrogen seem to be absorbed, so it stands to reason that the same rules would apply when using it on the face.
But until more research is done, Dr. Massick suggested that women who have or are at higher risk of developing “hormone-sensitive conditions” — like breast, uterine or ovarian cancers, or polycystic ovary syndrome — should avoid using estrogen-based skin care products.
Because of these potential safety concerns and the lack of evidence of benefit, Dr. Watchmaker and the other dermatologists recommended not using estrogen as skin care until more research is done.
What actually works?
There are many well-researched and effective options for addressing menopause- and age-related skin problems, Dr. Massick said.
Prescription topical retinoids (like tretinoin) and over-the-counter retinol can increase collagen and elastin, a protein that strengthens and plumps the skin. They can also boost cell turnover, which helps brighten skin and smooth fine lines, Dr. Watchmaker said.
Hyaluronic acid can help minimize dryness, she added. And antioxidants like vitamin C and niacinamide can reduce redness, improve discoloration and enhance skin texture, Dr. Jaliman said.
In-office treatments can also help, Dr. Jaliman added. These include laser resurfacing, which triggers collagen production and evens out skin tone; dermal fillers to add volume and smooth fine lines; and nonsurgical skin tightening procedures that stimulate collagen production.
Applying sunscreen with an SPF 30 or higher every day is also crucial. Ultraviolet damage accelerates skin aging, and sunscreen will keep problems like wrinkles and thinning from getting worse, Dr. Massick said.
If you’re not sure how to address your skin issues, she recommended seeing a dermatologist who can develop a tailored skin care routine for you. Also, check in with an OB-GYN for help addressing other menopausal symptoms.
