Estrogen and skin
Skin cells — especially fibroblasts, keratinocytes, melanocytes — carry estrogen receptors. Estrogen pushes fibroblasts to produce collagen and hyaluronic acid. Skin thickness, moisture retention capacity, and elasticity change throughout life depending on estrogen. Estrogen fluctuations increase during perimenopause (5-10 years before menopause); after menopause, they rapidly and permanently decrease.
Clinical picture of menopausal skin
Four typical changes are observed in menopausal skin: (1) collagen loss (up to 30% in the first 5 years); (2) dryness — HA production decreases, TEWL increases; (3) loss of elasticity — especially the facial oval softens; (4) pigmentation changes — melasma-like spots may become more prominent.
Additionally, changes also occur in the mucous membranes during this period — vaginal atrophy, dry eyes. These are issues that non-dermatological branches also deal with.
HRT decision
HRT (hormone replacement therapy) was largely reduced after the publication of the WHI study in 2002. However, re-evaluation of the data in subsequent years revealed that especially early menopause (around age 50) and rapidly initiated HRT had a positive effect on cardiovascular risk and a very limited effect on cancer risk. Consensus reports from 2022-2024 partially rehabilitated HRT.
The HRT decision is made with a gynecologist or endocrinologist; an aesthetic physician cannot make this decision alone. However, in terms of complementary aesthetic care, a faster skin response is observed in patients using HRT. For patients not using HRT, topical estrogenic creams (containing phytoestrogens) are an alternative approach.
Clinical note:Retinoids and topical estrogen-like agents (genistein, resveratrol) started in perimenopause can significantly reduce postmenopausal skin loss. Skin booster applications started during this period are also particularly valuable.