TOPICAL OESTROGEN: FACT OR FICTION?

Dr Ginni Mansberg looks into the science, safety and results behind the latest menopause trend: oestrogen cream

Walk through any menopause corner of Instagram or TikTok and you’ll see influencers dabbing “oestrogen cream” onto cheeks as if it’s the missing chapter in the skincare bible. The most common version is not a purpose-made facial product at all, but prescription vaginal oestriol (or oestradiol) cream repurposed for the face. The logic is seductive, the before-and-afters are compelling, and the science is interesting, but far from bulletproof.

WHAT HAPPENS TO SKIN IN MENOPAUSE?

Skin contains oestrogen receptors¹ and is a hormonally responsive organ. When oestrogen levels fall during menopause, several changes tend to follow: reduced dermal collagen and elastin², thinning of skin, increased dryness, slower wound healing, and impaired barrier function. ³

Clinically, patients often report “crepey” texture, fine lines appearing seemingly overnight, increased sensitivity, and dullness.⁴ So, the hypothesis makes sense: replace oestrogen locally, improve skin quality locally.

WHAT TOPICAL OESTROGENS ARE PEOPLE USING?

Vaginal oestriol creams (off-label facial use) These products are designed for vulvovaginal atrophy/genitourinary syndrome of menopause, not facial skin. Menopause guidelines discuss vaginal oestrogen use for GSM, but not facial application. Compounded “bioidentical” facial oestrogen preparations Compounding can produce oestradiol/ oestriol creams intended for facial use. The key issue is that compounded products vary in dose, penetration, stability, and quality control. ⁵ Purpose-designed cosmeceutical analogues with “oestrogen-like” activity One example is methyl estradiolpropanoate, designed to have local cutaneous effects with minimal systemic hormonal effects.⁶ The studies of these are small, company-sponsored, and short. Phytoestrogens (e.g., genistein/isoflavones) These are not oestrogens, but plant-derived compounds that can interact with oestrogen receptors. ⁷ They sit in a different evidence and safety bucket to prescription hormones. Evidence is not robust enough to recommend these products at this stage. ⁷

WHAT DOES THE EVIDENCE TELL US?

The clinical evidence is suggestive, mixed, and mostly small-scale. ⁸

Histologic and biochemical studies show that oestrogen can stimulate collagen, but the “where” matters. A notable JAMA Dermatology study found that short-term topical oestradiol stimulated collagen production in sun-protected skin (hip) but not in chronically sun-exposed sites. ⁹

Some clinical trials report improvements in wrinkles, thickness and hydration. ⁸

However, protocols differ. Many used compounded hormones, and none compared oestrogen preparations to retinoids. ⁸ Studies were small, short, and included a mix of peri-, pre-and postmenopausal women, making conclusions difficult.

Many combine oestrogen preparations with other cosmeceuticals, so confounding is an issue. ⁸ While biologically plausible with some benefit, the evidence is insufficient. ⁸

ADVERSE EFFECTS AND SAFETY CONCERNS

Risks were addressed in a 2026 review published in the Journal of the American Academy of Dermatology, with authors warning that we do not have long-term safety data.⁸ The researchers pointed to the risk of endometrial proliferation with daily long-term use of topical oestrogen preparations. ⁸

Systemic absorption is expected with any transdermal product. Unopposed oestrogen raises the risk of endometrial cancer. ¹⁰

Another concern is pigmentation. Up to one-third of women taking oral contraceptive pills may develop melasma, and oestrogen exposure is known to trigger melasma. ¹ The JAAD authors raised pigmentation as a concern and noted that it is not routinely assessed as an endpoint in most studies, leaving the data patchy. ⁸

CONCLUSION

For routine cosmetic anti-ageing, it’s not yet suitable.⁸

Topical oestrogens may improve certain skin parameters in some postmenopausal women. However, clinical trials are small and short, results are mixed, and long-term safety data is limited.

Until better data arrives, the most defensible “skin in menopause” prescription remains gloriously unsexy but highly effective: daily sunscreen, a retinoid (as tolerated¹¹), pigment control where relevant¹¹, barrier repair, and lifestyle fundamentals that influence inflammation and glycation.¹¹ Influencers can keep their hacks; clinicians should keep their standards.

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DR GINNI MANSBERG

Dr Ginni Mansberg is a GP, TV presenter, podcaster, author and columnist. She is a physician specialising in women’s health, menopause and all things skin. She is also the co-founder and medical director of science-based cosmeceutical skincare brand, ESK.