Women have long thought of estrogen as being a sign of youthfulness and energy, especially noting a decline in both when menopause hits. In fact, during the first few years of menopause, we lose around 30% of our collagen. To help combat vaginal symptoms of itch, dryness and atrophy, women have used topical estrogen cream for years. If you’ve used one, then you’ve noticed the improvement in vaginal skin hydration and firmness. Now the shift is from down there to up here, right on the face. Why? Well, the thought is if estrogen can rejuvenate vaginal skin, then why couldn’t it do the same for facial skin?
We have estrogen receptors in our facial skin, so it’s logical to think that topical estrogen might have a positive impact and possible anti-aging benefit. When you think of topical estrogens, there are three main types including estradiol, estrone and estriol. Estradiol is the most potent and used for prescription vaginal creams to alleviate gynecological symptoms like dryness and itch. Estrone is also used for prescription vaginal symptoms typically seen with menopause. Facial creams usually contain estriol which is less potent and allows for a more gradual absorption into the skin.
But what is the evidence that these estrogen creams might work? And more importantly, what are the potential risks? A systematic review recently published answers these questions by telling us what we know right now. Ten studies evaluated estradiol, with only one being the gold standard of a double-blind randomized controlled trial. The other studies were small, prospective studies with and without vehicle controls. Results showed increased skin thickness and collagen with estradiol use but the studies did not evaluate effects on vaginal tissue. This is concerning since that is one of the debates about potential harms from topical estrogen use and possible systemic absorption. Three studies using estriol demonstrated improvements in wrinkles, firmness and hydration, comparable to estradiol. Users reported hyperpigmentation as a side effect and in one study, breast tenderness and breast tension were noted. In all three studies, vaginal smears showed no estrogenic effects, which is reassuring. One double-blind, randomized controlled trial looked at estrone 1% and found it did not improve wrinkles or skin elasticity. In fact, researchers observed an increase in matrix metalloproteinase-1 expression (MMP-1), which promotes collagen break down—the exact opposite of the intended goal. No bueno!
What about plant-derived estrogens? Known as phytoestrogens, these molecules have similar chemical structures to estrogen and often are derived from plants like soybeans. Three small studies showed phytoestrogens increased skin thickness, collagen and hyaluronic acid but were consistently less effective as compared to estradiol controls. The good news is that vaginal cytology was stable for phytoestrogen users. And another player in the mix, methyl-estradiol-propanoate (MEP) was also included. MEP is a nonhormonal synthetic compound that activates estrogen receptors and initial studies have shown it can help improve various indicators of skin aging.
One important thing to note–None of the studies compared topical estrogen to a topical retinoid, like tretinoin. One study did compare estradiol to glycolic acid and concluded that estradiol was slightly less effective than glycolic acid. An interesting finding is that sun damaged skin may also pose a challenge to topical estrogen’s effectiveness. A study examining estrone 2 and another one evaluating estradiol, showed that skin exposed to ultraviolet (UV) light may respond less favorably than sun-protected areas. That spoils the fun since sun damaged skin is the usual targeted area to rebuild collagen.
It appears that the excitement surrounding the potential of estrogen cream is surpassing the actual data. Sort of like planning the wedding before meeting Mr. or Mrs. right. That’s not to say it’s total no-go, but it necessitates a conversation with your dermatologist on risks and benefits and skin concerns. For someone not using a topical retinoid but wanting an estrogen cream to build collagen, many of us derms would tell you the data supports a retinoid hands down and we just need more information on the benefit of topical estrogen, including the type, concentration and dosing as well as safety on gynecologic health.
Trotter’s Take: The data for topical estrogen creams is limited and more research is needed but if you are thinking about adding an estrogen cream into your skincare routine, check with your dermatologist. Want to hear what a dermatologist thinks about using estrogen cream? Then join me in a conversation with Dr. Brenda Dintima
