Menopause and Facial Skin: A Review of Studies on Topical Estrogen

The overlap of menopausal symptoms and the onset of skin aging suggests that a decline in estrogen levels may be a significant factor in women during the perimenopausal period.
Hormones are often considered important in intrinsic skin aging, but their role has not been clearly defined.
Therefore, this study examined whether topical skin treatment with estrogen might help reverse some of the changes in aging skin.

Important to know before anything: Topical estrogen for the skin is a prescription hormonal medication, not a cosmetic.

Topical estrogen preparations for the face (estradiol or estriol) are hormones available only by prescription.
Although applied to the skin, some of the hormone may be absorbed into the bloodstream and act systemically.
In women with a uterus, exposure to unopposed estrogen (estrogen without progesterone balance) is associated with an increased risk of endometrial hyperplasia and cancer.
Its use is contraindicated in women with hormone-sensitive cancers or a history of such cancers, such as breast, uterine, or ovarian cancer, as well as in other conditions that a physician must evaluate.
Additionally, most topical estrogen preparations for the face are compounded in a pharmacy and are not approved by the U.S. Food and Drug Administration (FDA) for this purpose.
Therefore, any such use requires diagnosis, prescription, and monitoring by a doctor or dermatologist, and is not suitable as a beauty solution for self-use.

Materials and Methods:
The effects of 0.01% estradiol compound in one group and 0.3% estriol in the second group were examined.
The study included 59 premenopausal women experiencing skin aging symptoms.
Monthly tests were performed for estrogen (E2), follicle-stimulating hormone (FSH), and prolactin (PRL).
Monthly clinical follow-up was accompanied by skin moisture measurements using a corneometer and profilometer.
In 10 subjects, skin samples were taken for immunohistochemical examination of collagen types I and III.

Results:
After 6 months of treatment, skin elasticity and firmness improved markedly, and wrinkle depth and pore size decreased by 61% to 100% in both groups.
It is important to note that this data comes from a single, small, uncontrolled study from 1996 (without a control group and with a limited number of participants), and therefore should be viewed with caution and not as definitive proof.
Furthermore, skin moisture increased, and skin profilometer measurement of wrinkles showed a significant, and even very high, decrease in wrinkle depth in the estradiol and estriol groups, respectively.
Immunohistochemical examination revealed a significant increase in type III collagen staining along with an increased number of collagen fibers at the end of the treatment period.
Regarding hormone levels, only prolactin levels increased significantly, and no systemic hormonal side effects were observed in this study.

Topical Estrogen:

Topical estrogen is applied directly to the skin in the form of a cream or gel.
This approach is intended to allow estrogen to act on the treated area, aiming to reduce some of the systemic exposure associated with oral hormone replacement therapy (HRT).
However, reduction is not elimination: systemic absorption is still possible, and therefore the hormonal risks do not disappear, and use remains under medical supervision.
Several studies, most of them small, have suggested that topical estrogen may improve skin dryness, wrinkles, and skin thickness, but the quality of the evidence is limited.
Additionally, topical estrogen use may cause local side effects, such as skin irritation, rash, and bleeding.

What a recent review of studies says:
A literature review published in 2019 (Rzepecki et al.) compiled studies examining topical estrogen treatment for aging skin.
The reviewers concluded that some studies indicate a possible improvement in skin parameters, but the evidence is still limited and inconsistent, and further, higher-quality research is needed before it can be recommended as an established treatment.

Isoflavones:

Isoflavones are plant compounds found mainly in foods like soy and soybeans.
Isoflavones are structurally similar to estrogen and can bind to the same receptors in the body.
Consequently, isoflavones may affect the skin in a manner similar to estrogen.
Studies on the effects of isoflavones on the skin have been less consistent.
Some studies have shown that isoflavones may improve skin dryness and wrinkles, while others have found no significant effect.

References:
https://pubmed.ncbi.nlm.nih.gov/8876303/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451761/