Estrogen Creams: The good, the bad and the not-so-ugly

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The use of estrogen in beauty products dates back to the 1940s, with companies like Helena Rubenstein and Elizabeth Arden touting its youthifying benefits. Marilyn Monroe was a fan, using a hormone cream formulated by her dermatologist, Dr. Erno Laszlo.

You’ve experienced hot flashes, brain fog and irritability. Then, you look in the mirror and you notice your skin is drier, saggier and there are more fine lines and wrinkles.  You could swear your pores have gotten bigger, too.  That’s the Change adding insult to injury.

Dr. Judith Hellman.

It turns out that menopause, with its depleting estrogen levels, plays a large part in facial aging.  That’s because this female sex hormone, produced in the ovaries, “has a very big function in making the skin thicker, increasing collagen production, maintaining the plumpness and hydration of the skin.  And of course, skin with more collagen and elasticity will have less sagging, fewer wrinkles and less pores,” says New York board-certified dermatologist, Dr. Judith Hellman.

Although gradual, the effects are noticeable.  Studies show that estrogen deficiency causes up to 30% of dermal collagen loss in the first five years of menopause, decreasing by another 2.1% every year thereafter.  But estrogen loss begins even earlier than that, starting to drop off during perimenopause, in a woman’s 40s.

Illustration: DF Archer, Gynecol Endocrinol 2012 Oct

So, how to tackle the issue?  “If we’re looking to address the effects of hormone depletion on the skin, then hormones are the logical place to start,” says UK hormone specialist, Dr. Fiona MacRae. While estrogen replacement can increase collagen levels, topical estrogen has also been linked to collagen synthesis.  Indeed, a number of studies including a 2013 University of Bradford analysis concluded that topical estrogen increases collagen in the area where it was directly applied.

Dr. Fiona MacRae.

Still, controversy clouds the topic due to reports like this one from the National Institutes of Health: “A long-term user of cosmetic cream containing estrogen developed breast cancer and endometrial hyperplasia [a precancerous condition].” In that case, the 93-year-old patient had used a compounded estrogen cream three times a day for 75 years.

“There’s so much misinformation and so much hysteria about this” says New York board-certified dermatologist, Dr. Ellen Gendler.  “Some people have used this example as a reason not to use topical estrogen, which is really preposterous.  That is such an extreme amount of estrogen, it would be like using pounds of estrogen a week.”

The fact of the matter is that the absorption of estrogen contained in facial creams (as opposed to systemic hormone therapy which comes in higher doses delivered via pills, gel or patches), is negligible, not even noticeable in blood levels, according to Dr. Hellman, thus rendering them safe even for those on hormone replacement therapy.

Dr. Ellen Gendler.

Are estrogen face creams safe for everyone?

There are some contraindications:  those who have had breast cancer or a family history of breast cancer, a clotting disorder, stroke or cardiac problems should proceed with caution.  Ditto for those with rosacea or hormone-dependent hyperpigmentation like melasma as topical estrogen can exacerbate both ailments, explains Dr. Hellman.  “In theory, this won’t increase the risk of all those conditions that would be a contraindication, but it doesn’t mean that the risks don’t exist, there is always a risk,” warns Dr. MacRae.  “It’s just not something that’s been documented because these face creams actually contain very low concentrations — definitely a lot lower than the vaginal creams prescribed by a gynecologist or HRT.”  As always, it’s best to check with your medical provider.  “I do believe that for the right patient, there is an advantage in using estrogen creams as there is definitely a good chance that these creams will improve the skin,” says Dr. Hellman.

What are the types of estrogen?

There are two main types of estrogen used in creams: estradiol and estriol.  These are bioidentical hormones manufactured in a laboratory from plants like wild yams and soy.  Estradiol is the more potent of the two while estriol is the weakest form of estrogen.  They work by binding to estrogen receptors.  “Estriol sits locally on the estrogen receptors in the face, so it doesn’t tend to cause any systemic effects,” explains Dr. MacRae.

Dr. Marion Gluck, who founded the Marion Gluck Clinic more than 10 years ago.

And it is estriol which is typically used in face creams like those supplied by prescription services such as M4, Musely and in the UK, the Marion Gluck Clinic, after an online or phone consultation with a doctor.  They are prepared at compounding pharmacies and mixed with other ingredients like Vitamin C, Vitamin E and hyaluronic acid.

There are also products that contain phytoestrogens, estrogen-like compounds found in plants.  Weaker than human or bioidentical estrogen, phytoestrogens “are the safest things to try if somebody wants to get into the estrogen cream territory and not take any real risk,” says Dr. Hellman.  These do not require a prescription.

A non-hormone alternative exists in the commercially available cream called Emepelle with its proprietary “MEP” technology.  Does it justify the hefty price tags ($175 for the serum and $195 for the night cream)?  “There is some degree of evidence that it may act in a similar way to topical estrogen,”’ says Dr. Gendler, “but the studies have been done on a small number of people.  I don’t think it would be as effective as a topical estradiol or estriol.  We need to see over the course of time.”

HRT therapy ad from the ’50s and ’60s.

How should these creams be used?

Providers like Musely and the Marion Gluck Clinic advocate daily usage all over the face.  Dr. Gendler, on the other hand, recommends a more limited application: only around the eyes and on the backs of the hands — where skin has thinned.  She herself has been using Premarin, a vaginal cream that contains a mixture of estrogen hormones, around the eyes for the past 20 years.  Dr. Gendler credits the lotion for thickening the skin, making it less crepey.

An ad for Estrogenic Hormone Cream from Helena Rubinstein, 1965.

“The tiniest little dab goes a long way,” declares the dermatologist going on to say that “there hasn’t been a study that has shown any systemic absorption of note when using topical estrogen in very limited areas such as around the eyes and on the hands.  And many studies have been done that show improvement in these areas when topical estrogen is applied.”

At what age should these creams be used?

While Dr. MacRae advocates their usage “as soon as you start noticing signs of aging — from the mid-30s onwards,” Drs Hellman and Gendler recommend perimenopause (early to mid-40s) as the starting point.  “During perimenopause, people will benefit from the fact that they still have estrogen on board,” explains Dr. Hellman.  “They can preventatively have fewer wrinkles and less sagging while maintaining better elasticity.”  That’s not to say that the window of opportunity closes after your 40s, however.  “There will still be benefits in your 50s and 60s, but they will be less visible.”

The final verdict?

The benefits are definitely noticeable, but not dramatic.  “For the right patient, there is an advantage in using creams that contain estrogen and estrogen derivatives. What people seem to notice is there’s a mild improvement in those parameters on the skin — the wrinkling, elasticity, the density, the firmness, but it’s not a game changer.  It’s not going to turn somebody who’s in their 40s to look like they’re in their 30s,” concludes Dr. Hellman.  For Dr. MacRae, “the biggest advantage to using these creams is the slowing down of the aging process and the prevention of further lines and saggy skin.”

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