For many women, their 40s and 50s are the best time of their lives. However, perimenopause and menopause can bring about many frustrating changes, both aesthetically and physiologically. Topical estrogen can help improve a woman’s quality of life, but there’s a lot of fear and uncertainty surrounding it. And according to some doctors, there’s a lot of misinformation being circulated as well.
“When I spoke a year ago at The Menopause Society meeting about the topical care of patients in menopause, it sparked an outburst of interest,” says New York dermatologist Ellen Gendler, MD in her “Menopause Skincare” Instagram series. “I am shocked at the amount of misinformation there is about the safety and efficacy of this treatment. There are just endless numbers of publications on this.” Education is key when it comes to the use of topical estrogen cream, and there’s a lot left to be learned as clinical studies continue.
In the meantime, this is a growing trend that’s here to stay. “Estriol and estrogen creams are poised to become a significant trend in skin care in the coming years,” says San Carlos, CA dermatologist Marie Jhin, MD. “It’s driven by a convergence of factors within the beauty and wellness landscape [more on this below].”
Featured Experts
- Marie Jhin, MD, a board-certified dermatologist based in San Carlos, CA and chief medical officer at Musely
- Ellen Gendler, MD, a board-certified dermatologist based in New York
Signs of Estrogen-Depleted Skin
Estrogen plays a vital role in keeping a woman’s complexion vibrant and youthful, says San Carlos, CA dermatologist Marie Jhin, MD. “As we age, our estrogen levels naturally start to dip. This happens even more so during perimenopause and menopause. [The average age of menopause in the U.S. is 51.] This decline sets off a chain reaction that can noticeably affect our skin over time.”
As these hormonal changes begin setting in, skin may become drier and thinner with more lines and wrinkles, uneven pigmentation and loss of elasticity. “This is because estrogen helps keep our skin hydrated and regulates oil production,” says Dr. Jhin. “When those levels drop, our skin tends to dry out more easily, leaving it flaky and rough. But, it’s not just about moisture. Estrogen also teams up with collagen and elastin to keep our skin firm and resilient. When estrogen levels decrease, so does our skin’s supply of these vital proteins. This makes our skin appear thinner and more fragile, and speeds up the appearance of wrinkles.” If you’re noticing these changes in your skin, Dr. Jhin says it’s worth considering treatments that can help support your skin’s health. “Topical estrogen creams can be a game changer.”
What is topical estrogen?
These are creams containing bioidentical forms of estrogen that are meant to be applied to the skin. “There are varying forms and strengths of estrogen,” says Dr. Jhin. “For example, estriol is recognized as the gentlest form of estrogen among bioidentical hormones, making it safe for facial application,” she explains. “The gentle nature of estriol allows it to effectively rejuvenate the skin by stimulating collagen production and improving elasticity. It’s well-tolerated on sensitive facial skin. In contrast, estradiol is a stronger form of estrogen that is typically not recommended for direct application to the face due to its potential to cause irritation. Instead, estradiol is commonly used in other formulations or delivery methods. These include systemic patches, gels and creams that can be applied on the arms, legs or hands in order to address systemic menopausal symptoms.”
How does topical estrogen work?
“Topical estrogen creams work wonders by delivering estrogen directly to your skin, where it steps up to tackle several key aspects of skin health,” says Dr. Jhin. “Just like vaginal estrogen cream is used to promote vaginal skin health and help with dryness and skin integrity, so can estrogen for the face.” In fact, some dermatologists prescribe vaginal estrogen cream, such as Premarin, to be used on the face as well. Dr. Gendler recommends this approach. “I have been using Premarin cream on myself and prescribing it, or other vaginal estrogen cream, to my patients for 25 years to be used on selected areas of the face,” she says. “And, sometimes a little bit on the tops of the hands because those are the areas where women are affected most. I see it every day in my office.”
Dr. Jhin says estrogen helps regulate oil production, ensuring skin stays hydrated without pesky dry patches. “It’s also a champion at boosting collagen production, which means smoother, firmer skin that’s less prone to wrinkles and fine lines. This holy grail hormone even supports your skin’s natural barrier, making it thicker and more resilient against everyday stresses. Estrogen can also help even out skin tone by influencing melanin production. This gives skin a more radiant glow and reduces stubborn age spots. Plus, it’s been known to speed up the healing process for wounds, helping your skin recover faster and look healthier. Using topical estrogen creams is a smart move, especially if you’re navigating skin changes related to menopause or other hormonal shifts.”
Who should use topical estrogen?
Dr. Gendler says topical estrogen cream is for a perimenopausal or menopausal women who is concerned about her skin. “One area where I’ve found particular benefit, especially on myself, is around the eyes,” she explains. “The reason is because the skin there is thin and similar to the thinness of vaginal epithelium, which we know is thickened by the use of topical estrogen. That’s why I started using it around my eyes 20 years ago. I don’t prescribe this [topical estrogen cream] to 30-year-olds. They are fully estrogenized. Those are not the people who are meant to use this.”
What are the side effects of topical estrogen cream?
These are some of the potential side effects of using topical estrogen cream, which Dr. Gendler says are limited to only a few case reports and aren’t backed by good evidence. If you develop a rash or swelling, or any other skin concern, contact your doctor.
It may aggravate melasma.
“Some dermatolgists talk about melasma being aggravated,” says Dr. Gendler. “All I could find were two case reports of melasma with topical estrogen. The biggest report came from Florida and involved a woman who used a very potent, compounded form of topical estrogen. She used it on a large area of her arm twice a day and developed melasma on her arm. This report came from Florida, and there’s no mention whatsoever of whether this woman ever used sunscreen. You can’t really count that as an accurate case report. However, as topical estrogen becomes more widespread in use, we may see more cases.” Therefore, if you’re someone who gets melasma, Dr. Gendler recommends proceeding with caution when using it on your face. Also, be sure to use a good broad-spectrum sunscreen.
It may cause breast cancer and endometrial hyperplasia.
“Another report came out with an even scarier side effect that was breast cancer and endometrial hyperplasia,” Dr. Gendler says. “This was a woman in her 90s who had been using a compounded topical estrogen of ginormous strength from who the heck knows what compounding pharmacy. She used it over her entire body for 75 years twice a day. Can you possibly say that this is what caused her breast cancer and endometrial hyperplasia? I don’t blame the topical estrogen for this. I advise my patients to use small doses conservatively; not to smear it all over their face twice a day and all over their body. In the way that I am advocating using topical estrogen, this is not a problem as far as I see.”
Does topical estrogen absorb systemically?
Topical estrogen creams are absorbed through the skin into the bloodstream in small amounts, but this is not known to cause harm. Dr. Gendler says there is no good evidence that topical estrogen in the doses we use is absorbed in any material amount systemically. “A study just came about that I think is pretty important,” she notes. “This study was done on 90 women over 12 weeks using topical estriol, topical estradiol and placebo. There was no statistically significant absorption of either when applied on the skin, and actually even in doses that are higher than what we generally use. This is great news and assures you of the safety of using topical estrogen in reasonable doses.”
Topical Estrogen Products to Try
First, let me stress the importance of speaking to your doctor and/or dermatologist before applying any estrogen product to your skin. Your doctor can prescribe you a product to use at home. Or, you can go the telemedicine route and meet with a doctor via a company such as Musely. You answer questions, upload photos, and then a board-certified derm will review your medical information and prescribe a product. “To get the most out of these creams, it’s best to consult with a healthcare provider who can tailor the treatment to your specific needs,” says Dr. Jhin. “They’ll consider things like the right formulation and concentration, ensuring you achieve the best results safely.”
Musely has two topical estrogen products. Its latest, The Estrogen Boost, just launched this month and combines both estriol and estradiol. “This cream is designed for the arms, legs or hands,” says Dr. Jhin. “Oral hormone replacement therapies (HRT), can have unwanted systemic side effects as they bypass through the liver, but this cream offers a stable and consistent delivery mechanism. It gradually absorbs through the skin into the bloodstream. This method mimics natural physiological hormone distribution patterns, providing consistent delivery and minimizing potential side effects associated with oral dosing. It addresses menopausal symptoms comprehensively, including hot flashes, night sweats, sleep disturbances and fatigue. It also aims to enhance skin, hair and nail quality.” Results take six to eight weeks.
The brand’s other product, The Aging Repair Cream, utilizes estriol only. “This cream is designed to be applied directly to the face,” says Dr. Jhin. “It works by enhancing collagen production, improving skin elasticity and promoting a more youthful appearance.”
