Ask Well
I've
seen several menopause-oriented brands selling anti-aging estrogen creams for
the face. Is there any science behind them?
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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.
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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.
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Some
companies sell estrogen-infused face creams and serums - over-the-counter or
via prescription - that are supposed to prevent and reverse these changes. One
doctor on Instagram said that using prescription vaginal estrogen cream on your
face can increase collagen production and minimize dryness.
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While
this use of estrogen cream "makes sense, in theory," Dr. Massick
said, we need more research showing that it is safe and effective.
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In
one review published in 2019, researchers analyzed the results of about two
dozen studies. They involved menopausal and post-menopausal 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.
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Dr.
Massick said that we need more rigorous research.
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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.
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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.
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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.
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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.
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Estrogen
could also worsen any dark patches and discoloration or make blood vessels more
apparent, she added; or it could aggravate conditions Iike eczema and rosacea,
said Dr. Debra Jaliman, a dermatologist in New York City.
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The
biggest question surrounding topical estrogen, however, is how much of the
hormone gets absorbed into the bloodstream.
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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.
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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.
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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.
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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.
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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. Jalirnart said.
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?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.
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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.
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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 ad-dressing other menopausal symptoms.
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Erica
Sweeney
