YOUR “LOW ESTROGEN FACE” AND HOW WE CAN HELP 

Sex hormones are not to be taken lightly. Some recent research measuring blood levels of estrogen in several hundred young women and then making facial “composite photos” showed that those with normal to high (but not too high) levels of estrogen were more physically (read “sexually”) appealing. Go overboard with estrogen and all sorts of medical complications occur, like blood clots, endometriosis, weight gain, PCOS and so forth. 

But then, come your late forties and you’re trodding into the foothills of menopause. The late Nora Ephron titled her book well, “I Feel Bad About My Neck and other Thoughts About Being a Woman.” Yes, look carefully (or even not so carefully) in the mirror and you’ll see changes in your skin that you might not like. These occur because your estrogen levels are dropping and you’ve been exposed to the great outdoors. If you smoke cigarettes, you’ve pressed the “Ultra Fast Forward” button on the whole skin aging process.

Estrogen deficient skin has a lengthy list of unique characteristics, all generally less than desired: dryness, wrinkling, itching, thinness. Your skin becomes more sensitive to itchy fabrics, soaps, beauty products. You may get more skin rashes or hives, you bruise easily, and because of less collagen production even minor cuts and bruises seem to take forever to heal.

And, of course, the other aspects of perimenopause/menopause I’ve written about many times: hot flashes, night sweats, mood changes, vaginal dryness, weight gain (especially mid section), brain fog, virtually all of which can be pretty dramatically helped by bioidentical hormone replacement therapy (BHRT).

So, a reasonable question: does BHRT, whether capsules, cream, or those twice weekly estradiol skin patches, actually help your aging skin as well? Yes, sometimes. 

Also, interestingly, I have had patients who used estradiol vaginal cream (for lubrication) twice weekly for years, saving a pea sized dollop to apply around their eyes. Seemed like a good idea and their eyes looked wrinkle free. You could do the same with Premarin Cream though I myself haven’t prescribed it in years. 

Basically, there are two ways you can get estrogen onto your face: 

The mild form of estrogen is called estriol (E3), a prescription cream, applied every morning. Since there is no systemic absorption of estrogen, you don’t concern yourself about the necessity of taking progesterone. If you want to know about the effectiveness of estriol skin cream, there are umpteen articles on Google. Here’s one from the Beauty Editor of the online magazine The Cut. She seems to like it but thought it was too early to pass judgment.

The stronger form of estrogen is called estradiol (E2). This is the same I prescribe as a cream, capsule or skin patch for menopausal symptoms. With estradiol, there can be systemic absorption so a small dose of oral progesterone should be used with it. The effect of your face will likely be more dramatic (in a positive way) and faster as well. 

For those of you using bioidenticals as a cream, you know how your dose is in “clicks” of the plastic dispenser (e.g., “apply four clicks to your thigh”). Well, change that. “Apply three to your thigh and one to your face.” 

If you’re new to bioidentical hormones altogether and want to start with estradiol, the compounding pharmacist will send you a low dose in a dispenser. Systemic hormones are contraindicated in women with a history of breast cancer or blood clots.

Schedule at any of the WholeHealth Chicago offices with your questions.

Be well,

David Edelberg, MD