Have you seen or heard recommendations to use vaginal estrogen cream on your face? Let’s talk about this trendy idea. To learn more basic information about skin changes with menopause, check out our article linked below.
First let’s review a little about estrogen. The most prominent and potent form of natural estrogen is estradiol, with estriol and estrone being less prominent. Estradiol levels peak at age 20-30 and reach consistently low steady levels starting around age 50. Studies show that estrogen declines by 2% per postmenopausal year. Yes, the clock starts ticking when menopause starts not necessarily chronological age.
Menopause is marked by 1 year of menstruation cessation, but hormonal changes begin as early as 2-8 years prior in a period known as perimenopause. The average age of menopause in America is 51, and women spend almost one third of their lives in this hormonal replete stage.
Menopausal skin symptoms follow symptoms of aging with skin thinning, lower collagen levels and elasticity, dryness, reduced bloodflow, reduced wound healing and a decrease in overall skin vitality both in appearance and function. One study showed that collagen decreased by 2% per year for the first 15 years of menopause.
So, should you start rubbing estrogen (estradiol) cream on your face?
The first question of any treatment we would consider is safety. The biggest concern with estrogen creams is cancer stimulation. Both breast and endometrial cancer can be stimulated by increased estrogen levels in the blood. Most studies looking at use of topical estradiol in limited areas have not shown any significant systemic absorption, but the studies were in patients using estradiol in only a small area. The other biggest risk with higher levels of estrogen in the blood stream is that it can increased risk of blood clots as is seen with those taking oral birth control pills.
Aesthetically, increased levels of estrogen in the blood stream can lead to melasma, over production of brown pigment in the skin. This is commonly known as the mask of pregnancy. Finally, the gold standard for anti-aging is tretinoin. I could not find any studies that compared topical estrogen to tretinoin. It’s hard for me to recommend using topical estrogen over tretinoin with the lack of safety and lack of proof of efficacy in large scale clinical trials.
Let’s review a few of the other options out there.
Estriol is the type of estrogen mainly made by the placenta during pregnancy. There are two Estriol 0.3% creams commercially available by Alloy and Musely, neither are FDA approved. Their efficacy claims contain a lot of the words “up to”, such as “up to 25% reduction in wrinkles”. That phrase “up to” always gives me pause. Their clinical studies are not in peer reviewed journals which is the scientific gold standard for publications.
Phytoestrogens are naturally occurring plant compounds that can act through the estrogen receptors in the skin. Every head to head study I read found their efficacy to be very limited compared to Estradiol. These can be used both topically and orally, but there are no regulated commercially available products.
MEP (1-2% cream) is a synthetic estrogen like compound that is available commercially under the name Emepelle made by a company called Biopelle. This was developed by a group of smart dermatologists, and showed modest but significant improvements in menopausal skinchanges.
At 52, I’m sticking to daily sunscreen and tretinoin as mainstays for my antiaging regimen. At this time, as a science girl, there’s not enough data out there to convince me to add a topical estrogen to my regimen. But if you’re still interested in exploring the options, I found a great article from the knower of all things, Oprah, which reviews many of the most popular commercial options.
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