Estrogen Cream: Your Qs, Answered

Is it safe? When should I start? Do I pair it with progesterone? Experts weigh in.

Welcome readers, old and new!

Let me first thank you for making Pass the Estrogen one of my most popular posts, second only to this Q&A with plastic surgeon Dr. Christian Subbio. As juicy and unfiltered as a New England IPA, the man is a click magnet. (I’ll be sharing more from Subbio very soon, so get excited!)

With the entirety of the Gen X sisterhood approaching or already ensconced in menopause, hormone content has become the new constant craving. I get it; I’m right there with you. Menopause specialists may soon outnumber aesthetic practitioners in my feeds. Many of the meno-advocates I follow appear in the PBS doc The M Factor. Have you seen it? I found it pretty fascinating—the brain stuff, especially.

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One trusted voice of the movement is Corinne Menn, DO, a board-certified OBGYN, menopause specialist, and medical advisor for Alloy Women's Health. She graciously agreed to help me tackle the smart questions you all raised in response to my last estrogen post.

I also tapped Jessica Wu, MD, a board-certified dermatologist in Beverly Hills and founder of the health-tech startup Residen. She commonly prescribes estradiol cream to help (peri)menopausal patients combat the hormonal skin changes many experience in their forties, fifties, and beyond.

Dr. Wu is among a growing group of dermatologists and plastic surgeons promoting the safety and efficacy of low-dose topical estrogen—both conventional vaginal creams and newer face formulas (from Alloy, Musely, and others)—for appropriate patients. As many of you know, New York City dermatologist Dr. Ellen Gendler was perhaps the first to widely tout the skin benefits of localized estrogen. On multiple occasions, she has shared with her vast social media following the science on topical estrogen and her personal history with Premarin Vaginal Cream.

Nevertheless, many women have only recently been introduced to the idea of smearing vaginal creams on their faces in the name of anti-aging. Understandably, they have some questions.

Let’s start with a quick recap: Estrogen receptors exist throughout the skin, affecting the function of both the keratin-rich cells composing our epidermis and the collagen-making cells in the deeper dermis. These receptors are actually found in a higher concentration in the face than in the breast or thigh, according to the OBGYNS who penned this piece. When estrogen dips during menopause, failing to sufficiently spark receptors, the skin’s normal operations slow and sputter. Eventually, the estrogen deficiency can manifest as dryness, thinning, fine lines, and laxity.

But studies show these changes can be reversed, to an extent, with local topical estrogen therapy, which works to enhance wound healing, decrease inflammation, and thicken the skin while encouraging it to retain and restore moisture. “Long-term studies have shown estrogen’s direct role in maintaining the building blocks of skin by signaling the production of collagen, hyaluronic acid, and elastin—all vital to keeping skin healthy, thick, and elastic,” says Dr. Menn. When applied to the vulvar and vaginal skin, she adds, estrogen helps with lubrication, painful sex, and bladder health, “improving urinary urgency and frequency and decreasing the risk of UTIs.”

Now, onto your questions!