Assessing topical estrogen for menopausal skin

Shoshana Marmon, MD, PhD

Some improvements seen in skin thickness and collagen, but study designs varied

Topical estrogen is emerging as a sought-after option for menopausal skin changes, but dermatologists caution that the evidence base remains limited and safety questions unresolved, according to a cover article in the Feb. 2026 issue of The Chronicle of Skin & Allergy. Patient interest in facial estrogen preparations has grown in parallel with menopause-focused marketing and social media campaigns in Canada.

Xerosis, thinning, and loss of elasticity are among the most visible cutaneous consequences of estrogen deficiency. The trend toward topical estrogen accelerated after vaginal estrogen was repurposed for facial use in several small studies, prompting a recent review in the Journal of the American Academy of Dermatology by Shoshana Marmon, MD, PhD. Across heterogeneous trials, Dr. Marmon and her colleagues from New York Medical College reported that topical estriol (E3) and estradiol were associated with improvements in skin thickness, collagen content, wrinkles, firmness, and hydration, though most studies were prospective and uncontrolled, with small samples and treatment durations of six months or less. Phytoestrogens appeared less effective, and conjugated equine estrogen, commonly used for atrophic vaginitis, showed efficacy on facial skin but also cytologic signs of systemic absorption. By contrast, 1% estrone not only failed to improve wrinkles or elasticity but significantly increased matrix metalloproteinase-1 expression, suggesting potential collagen degradation in photoaged facial skin.​

Canadian dermatologists report rising patient demand but emphasize the need for careful selection and counseling. “Many of my patients who identify as female are asking about the role of HRT and topical estrogen as part of a holistic positive aging plan,” said Dr. Sonya Abdulla, a dermatologist at Dermatology on Bloor in Toronto, noting that patients with nondermatologic menopausal symptoms should be referred for systemic hormone therapy evaluation.

Dr. Julia Carroll, co-founder of Compass Dermatology in Toronto, said it was “an exciting area, but one that calls for careful patient selection and clinical restraint,” and stressed that vehicle is critical, with emollient or serum-based estriol creams more likely to remain in the skin than gels or transdermal bases designed for systemic delivery.

Experts also underscore regulatory and safety gaps.

“These products are not approved for facial rejuvenation. Patients need to understand that results are modest at best and that standard anti-aging options like retinoids, antioxidants, and sun protection remain first-line,” said Dr. Geeta Yadav, founder and medical director of FACET Dermatology in Toronto. Dr. Yadav noted reports of breast tenderness, prolactin elevation, and vaginal cytology changes in short-term trials, and warned that combined use of facial and vaginal estrogen may compound exposure, particularly in women with an intact uterus who are not taking progesterone

With files from Correspondent Kate Kneisel

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